Alzheimer's disease (pronounced Alz'-hi-merz) is a progressive, degenerative disease that affects the brain and results in impaired memory, thinking and behavior. It was first described by Dr. Alois Alzheimer in 1906 and has been diagnosed in millions of people to this day (1). This disease results, ultimately, in the destruction of the brain and brings new meaning and insights into just how much brain may equal behavior.
Alzheimers is a degenerative disease that usually begins gradually, causing a person to have memory lapses in both basic knowledge and simple tasks (7). Alzheimers disease causes the formation of abnormal structures in the brain called plaques and tangles (particularly causatory are NFTs- neurofibrillary tangles) (5). As they accumulate in affected individuals, nerve cell connections are reduced. Some initial symptoms are loss of job skills, difficulty with familiar tasks, language problems, unawareness of time and place, lack of good judgment, problems with abstract thinking, misplacing things, and dramatic changes in personality (1). The speed with which the disease progresses can vary, but ultimately, as it destroys brain cells, causes confusion, personality and behavior changes and impaired judgment so severe that the patient may not seem to be the same person. Communication becomes difficult for the patient as they struggle to find words, finish thoughts or follow directions. Some experts classify the disease by stage (early, middle and late). But specific behaviors and how long they last vary greatly, even within each stage of the disease. Eventually, most people with Alzheimers become unable to care for themselves (1). The symptomology here is very different from and more complicated then the acute memory loss sometimes associated with aging.
Researchers are still not certain as to the exact roots of Alzheimer's and are still struggling to accurately diagnose it. Age and family history, as with many other illnesses, have been identified as potential risk factors. One sight boasted that most families, however, do not have several immediate members who wind up with the disease unless it is the type of early onset Alzheimer's (ten percent of cases). However, another stated that there is a clear familial link (6). Most Alzheimer's patients develop the symptoms late in life (after the age of sixty-five) (1) (6). Various studies have improved our understanding of plaques and tangles in the brains of individuals with Alzheimers disease. A previously unknown lesion characteristic of Alzheimers disease may provide clues as to its origin. This lesion, called an AMY plaque, may play a role in the onset and progression of Alzheimers disease. Other areas of research include looking into the genetic factors related to the onset of the disease (4), the Ab protein and senile plaques (4), tau protein and neurofibrillary tangles (3), the role of estrogen in the brain, neurotransmitter deficiencies and dysfunction in brain cell communication, inflammation and its effect on brain cell activity, and oxidative stress and its effect on brain cell processes. Further research has proven fruitful and progress is being made continually which is helping to generate more accurate diagnostic tools and better treatment options for affected individuals (1).
It is not a simple nor a single-stepped task diagnosing Alzheimer's disease. Medical specialists often rule out other conditions through a process of elimination. A physical examination, blood work, radiology (CTs and/or MRIs), and neuropsychological testing are usually conducted and a thorough medical history taken of the patient (4). A tentative diagnosis of Alzheimer's disease can be obtained through evaluation with approximately 90% accuracy. The only way to confirm a diagnosis of Alzheimer's disease, however, is through autopsy (1). Medical and psychological support should be sought by both the patient and the potential caregivers and family members (2). As more is learned about the disease, new assessment scales are being developed to help physicians track, diagnose and treat symptoms of Alzheimers (3).
There is no known medical treatment available to cure or stop the progression of Alzheimers disease. Cognitive as well as behavioral improvements are the desired effects of treatments used with Alzheimer's. Two drugs that have been approved by the Food and Drug Administration to treat cognitive symptoms are tacrine (Cognex®), available by prescription since 1993, and donepezil (Aricept®), available since 1996. The two cognitive medications mentioned, as well as antidepressants, anti-anxiety drugs, and neuroleptics are sometimes helpful in fighting specific behavioral symptoms in some patients (1) (6). Non-drug therapies (usually recommended first), such as family education and counseling, environment modification, and planning activities, music therapy and other non-traditional methods are also available to reduce some of the behavioral symptoms associated with Alzheimers, such as depression, sleeplessness and agitation (4). Recent research shows that we soon may be able to delay the onset of the disease through existing treatments, such as anti-inflammatories, anti-oxidants, or hormone replacement therapy. Some of these drugs currently being studied (which can last up to ten years) for their effects on the symptoms of Alzheimer's are melatonin, estrogen, and neo trofin (4).
A very general and obvious observation is that the brain does, in fact, in many ways (if not all) equal behavior. Alzheimer's disease, which affects much of the brain, affects so much of who the patient is (or was): what they were capable of doing, thinking, feeling. When this disease strikes the memory is lost, "reality" is lost, and the afflicted are left with whatever the brain decides to do, not do, or what it decides to let be known to the self.
Memory is such a precious thing to most of us. To have one's brain swiped clean of any recollections is probably inconceivable to most. Memory is obviously dependent on the fine connections in the brain between all of the various parts that store our memory for speech, image recognition, sound recognition etc. It is interesting that patients fade in and out of memory lapses- that these lapses are only temporary suggests some sort of ebb and flow of neural function and/or connections. It is interesting to speculate just how selective and fragile memory is. How much of our day do we actually remember the next? Probably not much at all- at least consciously. Some patients with Alheimer's who engage in repeated activities do not remember learning them before, yet they show improvement each time (1). This observation may entangle memory with one's sense of self. How much of memory is conscious or unconscious? How could one trust their own memory? Is it not true that the brain does a great deal of "making things up" (i.e. blind spot in vision)? It seems quite possible that the brain could very well take fragments of our actual memories and make more up, or delete, at random according to various connections and signals.
A person afflicted with Alzheimer's disease also experiences having an altered personality. In this way the brain is a part of almost every aspect of the person's usual behaviors- the signiture emotions, movements, and language- by which others identified them. The person is no longer "there", yet their body can be seen plainly.
So who are we? Flesh? Brain? Something else that our brain and flesh create together? Probably. Those afflicted with Alzheimer's experience the ultimate brain shutdown. Their brains are destroyed by a currently unstoppable disease; connections are lost. And in the process of losing their minds, they lose themselves.
3)Alzheimer's Disease Review
4)Alzheimer Research Forum
5)Alzheimer starting point?
7)The Health Connection
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This paper reflects the research and thoughts of a student at the time the paper was written for a course at Bryn Mawr College. Like other materials on Serendip, it is not intended to be "authoritative" but rather to help others further develop their own explorations. Web links were active as of the time the paper was posted but are not updated.