Losing It

The genetic connection may be pointing a way toward new treatments that effectively reduce the number of Alzheimer's cases. Studies using sophisticated brain imaging techniques have shown that people who are genetically at risk for Alzheimer's but not yet manifesting symptoms tend to have reduced glucose metabolism in much the same way that Alzheimer's victims do. This would seem to indicate that the disease starts attacking the brain a long time--maybe even decades--before any symptoms are apparent. Because those symptoms become noticeable relatively late in life, it follows that any means of delaying their onset would reduce the eventual number of Alzheimer's cases. According to one Duke University researcher, a five-year delay in the onset of symptoms would reduce the number of Alzheimer's patients by half.

For that reason, part of the $310 million in federal funding devoted to Alzheimer's research now goes toward developing drugs and treatments to retard the progress of the disease. There is currently one drug on the market, Cognex, designed to prevent the breakdown of the acetylcholine chemical, but it appears to be effective in only about 20 percent of Alzheimer's cases, most of them early-stage.

In addition to a number of new drugs currently being tested, there may be some over-the-counter preventative measures available. For reasons no researcher fully understands, anti-inflammatory drugs have been effective in reducing Alzheimer's symptoms; the incidence of the disease is very low in people with arthritis who take a large amount of painkillers such as ibuprofen. And Frey notes that Vitamin E may help protect the health of the brain's receptor cells. Meanwhile the demand for improved Alzheimer's drugs and treatments is obviously huge. An estimated 4 million people in this country now have the disease, and the steady aging of the population has that number climbing rapidly.

Because Alzheimer's involves such complex, diffuse brain processes, it is a disease of infinite variation. "Alzheimer's is like a different disease in each person," says Nina Grafenstein, the Alzheimer's program director at the Lake Ridge Health Care Center in Roseville. "Each one is as individual as a snowflake."

urray Tate was diagnosed with Alzheimer's shortly before Christmas in 1993. His symptoms came on so gradually they were easy to overlook. There were little incidents, sure--like the time in 1989 when Lois started canning tomatoes while Murray set up the home entertainment system they had just bought. About four hours later, her work finished, she found her husband sitting cross-legged on the floor and staring helplessly at the pieces. Another time Murray, who had always liked working on cars, poured windshield wiper fluid in with the crankcase oil.

Then one day he got hopelessly lost buying gas, just a mile or so up the street. "I spent about two hours trying to come home," he says ruefully. "The streets seemed to be going a certain way and I was going along and I knew I was right but I was wrong. I knew I was right but then I knew I was wrong, everything else said I was wrong." He chuckles. "I had a hell of a time. I knew the house was what I was looking for. I finally stopped in at a service station and got directions and I still got lost. He told me to just go down this road and take a right. And I went down the road and I knew I was right. But I was wrong again."

He and Lois went to see Dr. Richard Nadler, a geriatrician and internist who had been their physician for about three years. He asked Tate some basic questions: What is the year, date, day of the week? Nadler offered three words--Cadillac, rose, ball--and asked Tate to repeat them, first immediately and then after three minutes. Nadler then told him to focus on the number 100 and subtract by sevens: "an exercise where you have to remember the instructions and then remember how to carry them out," Nadler explains. Overall, the doctor saw that "there were some important things that drifted by Murray."

"When the doctor asked him what year it was," Lois confides, "Murray would say 1934."

Some tests were run to rule out other possible causes for the memory lapses, like low thyroid production or a minor stroke. Two heart attacks had forced Tate to retire from the railroad 15 years earlier, and while Alzheimer's is the diagnosed cause of more than 60 percent of the dementia symptoms experienced by people over 65, the second-most prevalent diagnosis, encompassing nearly 20 percent, is a mini-stroke, or "multi-infarct dementia," common to people with heart problems. There was also a period in his life when Murray Tate drank heavily, which could have had an impact on his brain activity. Another possibility was that he had a relatively rare brain disorder called Lewy Body Disease, which is characterized by hallucinations and delusions even at a fairly early stage.

"Even when you do a brain biopsy," says Nadler, "the diagnosis is not 100 percent. It might be possible [that Murray has Lewy Body], or he might have Alzheimer's. There are a number of problems that can give you dementia of the sort he has. Unfortunately there are very few that you can do anything about."

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