Aging Begins at 30

A Disease in Search of a Nobel Prize

"A 51-year-old woman, suspicious of her husband, with a rapidly increasing mental impairment and could no longer orient herself in her own dwelling, dragged objects here and there and hid them, with the stamp of utter bewilderment." So wrote Alois Alzheimer in 1907. His paper detailed the autopsy and the microscopic features still used to characterize the illness now called Alzheimer's disease.

There are about 4 million demented people in the USA, 60% with Alzheimer's disease. They account for $10 billion of the nation's $21 billion nursing home bill and use half the beds. Other costs amount to $26 billion. One hundred thousand people die of the disease each year. Dementia means without a brain. Delirium is literally out of the furrow and implies that this confusion can be corrected. In dementia, there is enough loss of intellectual ability to interfere with social and occupational activities.

Loss of memory for recent events is associated with difficulties like asking the visitor, "Why haven't you seen me for so long", when the visit was only two days ago. Sometimes there are purposeless movements and speech problems. Alzheimer's is rare under 50 years except in people born with Down's syndrome, who almost always develop Alzheimer's disease by age 40. Alzheimer's disease occurs in 9% of those over 65 and 22 to 40% older than 80. Surveys differ. A few rare families have multiple cases of Alzhiemer's disease. There is no known cause or cure for this dreaded disease.

A history and examination is very important to rule out correctable dementias such as an underactive thyroid or deficiency of vitamins B12 or folic acid. Brain syphilis must also be ruled out. Winston Churchill's father died of this, demented in middle age, otherwise he would have been Prime Minister of Britain. Another infectious dementia is called Creutzfeldt-Jakob disease and is caused by a virus. The symptoms vary and alert the physician to look for it. A mimicker of dementia is severe depression. Both diseases can occur together but depression can be successfully treated. Chronically prescribed or over-the-counter drugs can cause a pseudo dementia. Repeated small strokes diminish the functions of the brain and dementia develops.

Spinal fluid accumulation in the head can make a child grow a huge cranium. In the elderly the head cannot enlarge and the fluid pressure leads to dementia. This can be stopped by surgery. A deep-seated slowly enlarging bruise or subdural hematoma, can cause dementia and can be cured by surgery. These last few causes of dementia can be seen on a CAT scan. A complete work-up will cost about $2,500, but in the 8% of dementia that are treatable, it will save thousands and untold family misery.

To make a preliminary diagnosis, we use a series of 11 questions with a score of 30 about orientation to the world; 25 or less indicates a need for a careful evaluation by a neuropsychologist. The patient's ability to draw a clock putting in the numbers and adding the hands to indicate 4:30 can be rated on a ten point scale.

"How long will this last?" "Two to twenty years", without much ability to refine that number. The family enters the funeral that never ends. Involved caregivers are the hidden victims of this disease and must be warned that nursing home care may be needed.

Guidance for home care is available. I like "The 36 Hour Day", available in paperback. "Let's stimulate or wake grandma up." "No." A much better solution is a totally boring existance without radio, telephone, or television but with caring supervision. Support groups such as the Alzheimer's Disease Association are very helpful. Education is critical to develop appropriate expectations of the patient.

Alzheimer's disease is a medical failure. One hopes and prays that some inspired scientist or group of scientists will win the Nobel prize for discovering its cause and treatment. It is not normal aging. It is a pernicious and tragic disease.

Section Top | Title Page

See related Patient Topics Alzheimer's Disease, Brain and Nervous System, Mental Health and Behavior, Seniors' Health or Seniors' Health--General.

See related Provider Topics Alzheimer's Disease, Brain and Nervous System, Mental Health and Behavior, Seniors' Health or Seniors' Health--General.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

http://www.vh.org/adult/patient/internalmedicine/aba30/1993/alzhei.html