[Ed. note: Michael Jorrin, who we like to call “Doc Gumshoe,” is not a doctor, he is a longtime medical writer who contributes pieces for us that we hope give a good background or perspective on medical issues (and marketing) for those of us who are as overwhelmed with “live to 150” promises as we are with “get rich” promises. His comments, thoughts and opinions are his own. You can see all of his commentaries here. This time, he’s writing about a disease that touches almost every American at some point — and that is the focus of thousands of researchers (and investors) who are searching for cures and treatments.]
Most likely, you all know the bad news, which I will put right up front so the rest of this piece can be at least moderately upbeat.
- 5.2 million persons in the US are currently diagnosed with Alzheimer’s disease (AD). That’s diagnosed with AD; an equal number are thought to have undiagnosed AD, perhaps in the early stages.
- This includes 200,000 persons under 65 years of age.
- AD is the 6th leading cause of death in the US.
- The prevalence of AD increased by 68% between 2000 and 2010.
- The cost of AD in the US in 2013 was $203 billion, of which $107 billion was borne by Medicare and $35 billion by Medicaid. (Those figures are billions with a b!)
- These costs don’t figure in the huge economic impact of AD on caregivers, often the immediate family members of the person with AD.
- At present, there is no cure, and the most effective treatments do nothing to stop the progress of the disease, but only slow it.
However, the health-care community is by no means throwing in the towel. Currently there are 1,286 clinical trials under way in Alzheimer’s disease. This includes trials that are now only recruiting subjects all the way to trials that have been completed, but have yet to report the results. About two thirds of these (based on my quick survey of the National Institutes of Health Clinical Trials Registry) have to do directly with treatment, and the rest have to do with procedures that may impact the management of AD in some way.
Alzheimer’s Disease and Alzheimer’s Dementia
The popular assumption is that this is a distinction without a difference – the growth of those notorious plaques in the brain interferes with vital brain function, and people slowly lose memory, fail to recognize their most immediate family members, lose the ability to perform even the simplest tasks, stop breathing and digesting food, and die. This assumption is entirely reasonable, but in fact there are important distinctions between the disease and the dementia, and these differences can, and we hope, will, have a crucial impact on the future management of this disease.
A Bit of History
Although some old folks remain, as the pleasing expression goes, “sharp as a tack” until they are very old indeed, it has been commonly accepted since just about the dawn of time that some elderly people lose some of their mental acuity. This was commonly attributed to “hardening of the arteries in the brain.” However, Alzheimer’s disease has been recognized as a separate disease entity for over a century. A German physician named Alois Alzheimer had a female patient named Auguste Deter, who became severely demented starting at about age 50, an unusually early onset for senile dementia. Dr Alzheimer carefully followed Auguste for about 5 years, from 1901 to her death in 1906, and then he obtained permission to examine her brain, which he found had been invaded by a dense, whitish substance. Alzheimer recognized that the substance was a form of amyloid, which had been identified and named in the 19th century by the eminent scientist Rudolph Virchow. Virchow, by the way, mistakenly thought that this substance was related to starch, and named it “amyloid” after the Latin for starch, amylum. However, amyloid is not starch, but a protein, composed of chains of amino acids.
For most of the 20th century, the diagnosis of Alzheimer’s disease was applied only to persons who developed the symptoms of dementia prior to old age. Persons who developed those symptoms in old age were described as being affected by “senile dementia.” While there are many possible causes of the loss of mental capacity, old age by itself is not one of them. For about the past 30 years has it been recognized that AD is a principal cause of dementia regardless of age at onset.
Not all forgetfulness or absent-mindedness is dementia or related to Alzheimer’s disease. Being unable to summon up the name of a person you met at a party, or not remembering the precise word you want, or misplacing your cell phone, are not signs that you’re succumbing to AD. People with early AD who have memory lapses frequently forget that they had memory lapses in the first place. As time goes on, they may become confused, angry, sometimes apathetic, frightened, and paranoid. They wander, easily get lost, and may fail to recognize a spouse or a child. Ultimately, larg