V  Diagnosis

Alzheimer’s disease is only positively diagnosed by examining brain tissue under a microscope to see the hallmark plaques and tangles, and this is only possible after a patient dies. As a result, physicians rely on a series of other techniques to diagnose probable Alzheimer’s disease in living patients. Diagnosis begins by ruling out other problems that cause memory loss, such as stroke, depression, alcoholism, and the use of certain prescription drugs. The patient undergoes a thorough examination, including specialized brain scans, to eliminate other disorders. The patient may be given a detailed evaluation called a neuropsychological examination, which is designed to evaluate a patient’s ability to perform specific mental tasks. This helps the physician determine whether the patient is showing the characteristic symptoms of Alzheimer’s disease—progressively worsening memory problems, language difficulties, and trouble with spatial direction and time. The physician also asks about the patient’s family medical history to learn about any past serious illnesses, which may give a hint about the patient’s current symptoms.

VI  Treatment

There is no known cure for Alzheimer’s disease, and treatment focuses on lessening symptoms and attempting to slow the course of the disease. Drugs that increase or improve the function of brain acetylcholine, the neurotransmitter that affects memory, have been approved by the United States Food and Drug Administration (FDA) for the treatment of Alzheimer’s disease. Called acetylcholinesterase inhibitors, these drugs have had modest but clearly positive effects on the symptoms of the disease. These drugs can benefit patients at all stages of illness, but they are particularly effective in the middle stage. This finding corresponds with new evidence that low acetylcholine levels in patients with Alzheimer’s disease may not be present in the earliest stage of the illness.

Evidence shows that there is inflammation in the brains of Alzheimer’s patients, which may be associated with the production of amyloid precursor protein. Studies are underway to find drugs that prevent this inflammation, to possibly slow or even halt the progress of the disease. Other promising approaches center on mechanisms that manipulate amyloid precursor protein production or accumulation. Drugs are in development that may block the activity of the enzymes that cut the amyloid precursor protein, halting amyloid production. Other studies in mice suggest that vaccinating animals with amyloid precursor protein can produce a reaction that clears amyloid precursor protein from the brain. Physicians have started vaccination studies in humans to determine if the same potentially beneficial effects can be obtained. There is still much to be learned, but as scientists better understand the genetic components of Alzheimer’s, the roles of the amyloid precursor protein and the tau protein in the disease, and the mechanisms of nerve cell degeneration, the possibility that a treatment will be developed is more likely.

VII  Caring for the Alzheimer’s Patient

The responsibility for caring for Alzheimer’s patients generally falls on their spouses and children. Caregivers must constantly be on guard for the possibility of an Alzheimer’s patient wandering away or becoming agitated or confused in a manner that jeopardizes the patient or others. Coping with a loved one’s decline and inability to recognize familiar faces causes enormous pain.

The increased burden faced by families is intense, and the life of the Alzheimer’s caregiver is often called a 36-hour day. Not surprisingly, caregivers often develop health and psychological problems of their own as a result of this stress. The Alzheimer’s Association, a national organization with local chapters throughout the United States, was formed in 1980 in large measure to provide support for Alzheimer’s caregivers. Today, national and local chapters are a valuable source for information, referral, and advice.