One-third of Americans die of Alzheimer's Disease (AD). During the past decade, early diagnosis has improved but can be problematic. A standard medical workup for Alzheimer's disease often includes structural imaging with magnetic resonance imaging (MRI) or computed tomography (CT). These tests are primarily used to rule out other conditions that may cause symptoms similar to Alzheimer's but require different treatments. There are no specific blood tests, nor imaging test that is diagnostic for AD
How is AD diagnosed? AD is often a rule-out illness, by eliminating other causes of dementia.
What causes dementia?
Common causes of dementia are:
Alzheimer's disease. This is the most common cause of dementia.
Vascular dementia. This may occur in people who have long-term high blood pressure, severe hardening of the arteries, or several small strokes. Strokes are the second most common cause of dementia.
Parkinson's disease. Dementia is common in people with this condition.
Dementia with Lewy bodies. It can cause short-term memory loss.
Frontotemporal dementia. This is a group of diseases that includes Pick's disease.
Severe head injury.
Less common causes of dementia include:
Huntington's disease.
Leukoencephalopathies. These are diseases that affect the deeper, white-matter brain tissue.
Creutzfeldt-Jakob disease. This is a rare and fatal condition that destroys brain tissue.
Some cases of multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS).
Multiple-system atrophy. This is a group of degenerative brain diseases that affect speech, movement, and autonomic function.
Infections such as late-stage syphilis. Antibiotics work well to treat syphilis at any stage, but they can't reverse the brain damage already done.
Inherited dementia
Some disorders that cause dementia can run in families. Doctors often suspect an inherited cause if someone younger than 50 has symptoms of dementia.
The classical pathologic signs are the neurofibrillary tangle and the senile plaque. The neurofibrillary tangle consists of abnormal accumulations of abnormally phosphorylated tau within the perikaryal cytoplasm of certain neurons. Tau is an abnormal protein that accumulates within the neurons.
Microtubules in neurons
Amyloid plaques are aggregates of misfolded proteins that form in the spaces between nerve cells. These abnormally configured proteins are thought to play a central role in Alzheimer's disease. The amyloid plaques first develop in the areas of the brain concerned with memory and other cognitive functions. Amyloid plaques form one of the two defining features of Alzheimer’s disease, the other being neurofibrillary tangles.
Amyloid Plaques
Neurofibrillary tau
The impact of AD is enormous in terms of caregiving, and support services. Many families cannot afford the full-time support necessary for a parent or loved one. Assisted living and/or memory support units are expensive, and most health insurance does not reimburse for those services.
Unlike heart disease where progress has been significant in diagnosis and treatment, AD presents other challenges, such as being difficult to diagnose and a lack of proven treatments.
Can Alzheimer's Disease Be Prevented? We know that control of blood pressure, lowering blood lipids, and regular exercise can reduce the risk of atherosclerotic heart disease.
The Alzheimer's Association has these suggestions for 10 Ways to Love your Brain
Which came first? The chicken or the egg? Are the tangles and amyloid the result of dementia, or do tangles and amyloid cause dementia?
Financial repercussions for the health system (Medicare/Medicaid)
In 2015, the costs to all payers for the care of people living with Alzheimer's disease and other dementias will total an estimated $226 billion, with Medicare and Medicaid paying 68 percent of the costs. Without a treatment, costs are projected to increase to more than $1.1 trillion in 2050.
A treatment introduced in 2025 that delays the onset of Alzheimer's would cut the number of people in 2050 who have the disease by 42 percent — from 13.5 million to 7.8 million. The Alzheimer's Association's report also shows the positive impact of adequate funding and the potential consequences of underfunding.
Reaching the 2025 goal would save payers $220 billion over the first five years and $367 billion in 2050 alone. Savings to Medicare and Medicaid would account for nearly 60 percent of the savings.
Notwithstanding the financial advantages, there is another and perhaps more important item, quality of life
The alternatives to alleviate suffering are
Death with dignity (A euphemism for death by suicide.)
Short of finding a successful treatment, advanced directives are proactive and allow for seniors to instruct their surviving children and relatives as to what you want. The Advanced Directive must be filed with your physician and/or hospital.
