Understanding Alzheimer's An Introduction for Patients and

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Published by Rowman & Littlefield Publishers, Inc.
A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc.
4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706
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10 Thornbury Road, Plymouth PL6 7PP, United Kingdom
Copyright © 2012 by Rowman & Littlefield Publishers, Inc.
All rights reserved. No part of this book may be reproduced in any form or by any electronic or
mechanical means, including information storage and retrieval systems, without written permission
from the publisher, except by a reviewer who may quote passages in a review.
British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data
Ali, Naheed, 1981-
Understanding Alzheimer’s : an introduction for patients and caregivers / Naheed Ali.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4422-1753-9 (cloth : alk. paper)—ISBN 978-1-4422-1755-3 (electronic)
I. Title.
[DNLM: 1. Alzheimer Disease. WT 155]
616.8'31—dc23 2012013305

™ The paper used in this publication meets the minimum requirements of American National
Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI/NISO
Z39.48-1992.
Printed in the United States of America
 Understanding Alzheimer’s is dedicated
to my students, to Alzheimer’s disease patients,
and to all who provided encouragement and
support throughout my research.
 Contents

Contents
Disclaimer
Preface
Part I: GROUNDWORK
Chapter 1: History of Alzheimer’s
Chapter 2: Anatomy, Pathology, and Physiology of Alzheimer’s
Part II: CLINICAL PICTURE
Chapter 3: Causes of Alzheimer’s
Chapter 4: Symptoms of Alzheimer’s
Chapter 5: Diagnosing Alzheimer’s
Part III: TREATMENT OPTIONS
Chapter 6: Pharmacological Treatment of Alzheimer’s
Chapter 7: Natural Treatment of Alzheimer’s
Part IV: SETTING THE STAGE
Chapter 8: Three-Stage Model of Alzheimer’s
Chapter 9: Six-Stage Model of Alzheimer’s
Chapter 1:0 Seven-Stage Model of Alzheimer’s
Part V: OTHER MANIFESTATIONS
Chapter 11: Mental Outcomes
Chapter 12: Diseases Associated with Alzheimer’s
Chapter 13: Pain and Alzheimer’s
Part VI: MONEY AND RESEARCH
Chapter 14: Economic Effects of Alzheimer’s
Chapter 15: Alzheimer’s Disease Research in the United States
TPart VII: HE PERSONAL QUEST
Chapter 16: Diet and Alzheimer’s
Chapter 17: Alzheimer’s and Exercise
Chapter 18: Finding Motivation to Cope with Alzheimer’s
Chapter 19: Alzheimer’s at Home
Chapter 20: Conclusion
Appendix A: Alzheimer’s Disease-Related Links
Appendix B: Research and Training
Appendix C: Alzheimer’s Disease Organizations
Appendix D: Nationally Recognized Alzheimer’s Clinics
Appendix E: Selected Studies
Notes
Glossary
Resources
Bibliography
About the Author
 Disclaimer

This book represents reference material only. It is not intended as a

medical manual, and the data presented here is meant to assist the reader in
making informed choices regarding wellness. This book is not a
replacement for treatment(s) that may have been suggested by the reader’s
personal physician. If the reader believes he or she is experiencing a
medical issue, professional medical help is recommended. Mention of
particular products, companies, or authorities in this book does not entail
endorsement by the publisher or author.
 Preface

People suffering from a particular disease will have abnormal or deviated

characteristics, but anyone can study the abnormalities and explore their
possible cure. People want to stay in touch with friends and want to lead a
happy and joyful life, and since a healthy body makes a healthy mind and
keeps it sharp, it is important to learn about diseases such as Alzheimer’s if
one wants to keep up with life and maintain its spark.
As a person gets older, he or she faces memory and cognitive problems.
It is a simple fact of nature. Forgetfulness becomes a noticeable part of
everyday life with every passing minute, hour, and day. This is why it can
be very difficult to recognize the early stages of Alzheimer’s disease.
Studying Alzheimer’s disease is, in this sense, of utmost importance for
aging individuals and the people who look after them. Understanding the
disease in its entirety also makes it easier for patients to cope with their
specific problems. Alzheimer’s disease is currently the most rapidly
growing neurodegenerative disease.1 People above sixty-five years of age
have a high tendency of being affected by this disease,2 and additional
statistics3 show that almost thirty million of the world’s population is
suffering from Alzheimer’s. Learning about other diseases is also very
important because doing so provides an individual with adequate
knowledge of what tests should be conducted before and after a successful
diagnosis. On the other hand, one might be suffering from not Alzheimer’s
but rather another form of mild dementia. It is important to rule out all the
possibilities of any serious illness.
It can be difficult to recognize the symptoms of Alzheimer’s disease.
However, it is important to recognize the early symptoms which emerge
before any signs of memory loss or brain damage is actively recorded. As
the complete cure for this disease is yet to be unearthed, researchers try to
focus on people with a probable risk of being affected and reduce any kind
of fear or other psychological factor. Alzheimer’s research uses volunteers
who are already affected by the disease, under the supervision of the latest
technology, to determine the root cause—and possible cure—of the
problem.
Elderly people want to lead a healthy and peaceful life just as much as
everyone else. However, remembering the important events and tasks, such
as a grandson’s birthday, the last day to submit an important assignment, or
the time and date of an appointment with a doctor, can be difficult with
Alzheimer’s disease. No one really wants to forget the important activities
and tasks of life. Alzheimer’s is a fatal disease that, in most severe cases,
can take away one’s cognitive ability to think and to remember basic events.
The problem can even separate two loved ones.4
Alzheimer’s can be categorized by three different staging systems, each
explained comprehensively in part IV. The initial phase (of each of the
staging systems) is usually the most difficult one to spot. It is very
important for individuals who wish to provide care to their family members
or to their loved ones to understand the stages of this disease. Medical
studies confirm that the early phases of the disease, no matter the staging
model used, can be very deceptive.5 Physicians and scientists are trying to
find a solution for detecting the first phase of the disease. They believe that,
if the early phase is detected, patients can be treated easily by
psychologists. The memory impairments associated with Alzheimer’s can
be treated but not cured, while other symptoms of the disease can be easily
avoided.
The Harvard School of Public Health conducted a recent survey that
focused on awareness and concern about Alzheimer’s disease among
participants in Europe and the United States.6 The results of this survey
were mind-boggling and showed that more than 86 percent of the
participants in Europe and America are afraid of the disease and say they
would be relieved to discover early on that they suffer from it, rather than
finding out after the disease reaches terminal levels. The results also
suggested that Alzheimer’s is the second-most feared medical problem, with
cancer being the first. Most of the surveyed people, especially adults, were
able to identify the symptoms of the disease in themselves. They reported
experiencing common symptoms such as forgetting important tasks and
losing a sense of direction while on their way to college or home.
Approximately thirty respondents in European countries were confident that
a cure exists.7 They believed the progression of the disease can be slowed
down and that a permanent form of treatment exists.
Before moving on deeper within this book, the reader should know that
the journey to treating Alzheimer’s disease can be difficult because of its
relation to other brain disorders. If not detected early, Alzheimer’s can lead
to other fatal ailments such as Parkinson’s disease.8 It would then be
extremely difficult to cope with both diseases, and in most cases, the patient
would have little chance of escaping death unnaturally. The root cause of
brain-related illness should, therefore, be dealt with quickly to prevent any
serious injury to the brain or to other vital organs. Ways of overcoming the
illness should be learned as soon as possible, rather than having the patient
go through otherwise avoidable challenges.
Simply put, understanding the internal (physical) and external (effects on
life) characteristics of Alzheimer’s disease is of utmost importance in
today’s society. This disease is separated into different phases or stages.
These phases should be examined thoroughly in order to understand the
foremost question of why this disease should be studied. Since Alzheimer’s
is the most rapidly growing neurodegenerative disease of the elderly
population,9 the reader should understand its progression before getting
introduced to other in-depth discussions on the subject.
Patients lead normal and productive lives at the initial phases of
Alzheimer’s disease. The symptoms of the disease start to become apparent
when it is not addressed in time. After that, there comes a point when it
cannot be controlled. If the disease is not discovered in a timely manner,
there is little or no chance that a patient’s mental health will be restored to
normal. The periodic length of any stage or phase is indeterminable. Once
out of the picture, the other stages slowly continue to diminish the patient’s
mental health and badly affect the mental capacity to think and remember.
Stage 1 of the disease, based on the seven-stage model covered in chapter
10, does not involve any cognitive impairment as the symptoms are mild
and are very difficult to spot. Individuals in the first phase do not
experience any problems with remembering names and daily chores. They
face no difficulty while communicating with other individuals, and they can
easily recall their way home. They do not encounter any problems with
carrying out their daily life activities and appear to be ordinary individuals.
 Stage 2 involves a slow decline in an individual’s cognitive abilities.
Affected individuals will experience memory losses, forgetting the names
of their loved ones, and will also have difficulty speaking to others.
Furthermore, patients suffer from decision-making problems. Logical
decisions will be even more difficult to execute. The patient’s sleep cycle
also gradually declines, causing fatigue and laziness. In addition to the said
sleep issues, patients will require constant supervision since they may
develop a habit of sleepwalking.10
An increase in the severity of the above symptoms occurs as the disease
progresses. In the third or fourth stages, patients start to confuse the past
with the present. Gradually, patients may find themselves confined to their
beds and at the mercy of their caregivers. Such patients will slowly lose
their speaking or language skills because of the disease. The last few stages
of Alzheimer’s disease can be fatal because sufferers cannot manage the
disease alone.
Research done by Dalhousie University’s Department of Medicine
involving seven thousand Canadian nationals evaluated the health and aging
effects on people sixty-five years of age or older.11 At the end of the ten-year
study period, more than 40 percent of the study subjects had died. The
subjects developed a form of dementia and other cognitive disabilities. Of
the remaining percentage, almost 20 percent of the people had developed
cognitive disabilities. The investigator leading the study said that minor
health problems might have had a cumulative effect on the brain, which
would have caused Alzheimer’s in the patients.
A healthy body makes a healthy mind and keeps it sharp. The
investigators’ hypothesis suggests that minor health problems are the cause
of Alzheimer’s because these minor issues have a cumulative effect on the
brain. Experts believe that what is best for the body is best for the brain as
well.12 Minor problems in the central nervous system, if not addressed
promptly, may develop into Alzheimer’s disease. When the patient passes
away, he or she may not be included in the statistics when measuring the
magnitude of the disease because it may have gone unreported.13
The reader may already have a broad understanding of what Alzheimer’s
disease is, but some information about the disease such as the hormonal
causes discussed in chapter 3, as well as unconventional treatments, are
easily overlooked these days. For instance, field studies suggests that some
daily activities such as drinking coffee in minor amounts might also help
relieve symptoms of Alzheimer’s.14 A study on the effects of caffeine was
conducted at the University of Coimbra and the University of Lisbon.15 One
experiment within the same study proved that caffeine can have a positive
effect on the brain as well as on the body. Another experiment, part of the
same study, proposed that moderate coffee drinkers have a probable chance
of developing Alzheimer’s disease.
Another reason to learn more about Alzheimer’s is its sheer magnitude,
both demographically and symptomatically. Clinical reports suggest that
forty million people are suffering from dementia, known as a stand-alone
medical condition as well as the primary symptom of Alzheimer’s disease.16
These reports also indicate major possible causes of Alzheimer’s, including
diabetes mellitus, hypertension, smoking, depression, obesity, physical
inactivity, and low education levels. While researchers are putting forth
their best efforts to find a single cause and an all-in-one solution to the
disease, I encourage all to learn about this growing problem to identify
people who are affected so these sufferers can be examined and treated in
time.
 I

GROUNDWORK
 • 1•

History of Alzheimer’s

Well into the twenty-first century, societies have had the urge to learn
more about various disorders and their origins. Experts have even gone as
far as finding out how each disorder affects the behavior, socialization, and
growth of a person. It is crucial to also understand the origins of a disease
so that progress can be made in finding a cure. It is important to keep track
of a disease’s origin, such as that of Alzheimer’s, because people will, with
time, change the perception of the disease. This altered perception will also
affect the diagnosis and course of action pertaining to treatment.1
Mental disorders and brain-related diseases such as Alzheimer’s have
existed even during the time of ancient civilizations. Societies of those eras
had a way of realizing that some mental behaviors were not normal. All
cultures have their code of conduct, which can in turn render some
behaviors boisterous or misplaced. Societies were subjected to different
cultures, as some behaviors considered normal in one would be considered
irregular in another.2 Mental disorders are widespread, and globally, one in
three people will, during their lifetime, display traits that can qualify as
mental disorder symptoms.3

PREVALENCE THROUGHOUT HISTORY

Mental disorders were widespread in ancient civilizations, but even then,

there was a criterion in place for telling the difference between sound mind
and “mental patient.” For example, ancient Egyptian and Mesopotamian
cultures had a document that is now referred to as the Ebers Papyrus.4 This
document makes references to hysteria and melancholy as forms of mental
disorders. The document also considered heart disease and uterine problems
to be mental disorders.5 These are not currently the phases of being in a
state of mental destruction or loss of focus, but back then, it was common
practice to refer to these as spells or spiritual attacks. That is why a number
of treatments included the recital of magical spells even as bodily fluids
were applied onto the patient.6 Religious gatherings were hotspots for
people who needed spells removed.7
Due to their large prevalence, mental health disorders such as
Alzheimer’s are not completely alienated ideas.8 A study found that 20
percent of all Americans suffer from a mental disorder.9 Some of these traits
include schizophrenia, “shell shock,” hysteria, and anxiety. Mental
disorders simply lurk in the shadows and strike people unexpectedly.
Because mental disorders were highly unpredictable, it was important that
all who suffered had some means of getting help.10 By the turn of the
Industrial Revolution, there was a widespread creation of laws in the
Western world that pushed authorities to form care programs for those
suffering mental and neurological disorders. Still, very little was achieved
because the people who were minding those suffering from mental
disorders were merely nurses and administrative staff hired to tend to—but
not clinically treat—the patients.11

INTRODUCTION TO HIPPOCRATES

In 400 BC, a Greek scholar named Hippocrates devised studies about

mental disorders and examined a number of patients. The scholar came
close to discovering that mental disorders, such as that which is known
today as Alzheimer’s, were caused, in a great part, from having levels of
body “humors” that exceeded the normal levels. Body humors are fluids
present in the body that have to be in balance for a person to be healthy. An
excess or lack of them meant otherwise. In Hippocrates’s time, sanguine,
melancholic, choleric, and phlegmatic were the four humors examined
when determining a person’s psychological dispensation. In a contemporary
setting, “melancholy” applies to mental or emotional states of depression.
Historically, however, “melancholia” was viewed as a physical as well as
mental state, and melancholic conditions were evaluated by their roots
rather than how they manifest.12 In a similar vein, melancholia was
previously a reference to mental disorders that can today be diagnosed as
schizophrenias or some bipolar disorders.
 Hippocrates soon suggested that mental disorders came directly from the
lack or excess of body humors. Back then, body humors were considered
fluids that directly correlated and metaphysically expressed environmental
influences in the form of pain or other physical qualities of the body. This is
basically an earlier version of the contemporary view that mental instability
arises from disturbances in the body’s neurotransmitters.13 Neurotransmitters
are chemicals that conduct electrical signals in the nervous and
musculoskeletal systems, allowing for movement and other functions.
Hippocrates held the view that cases such as schizophrenia and anxiety
stem from what goes on around a person. Hippocrates refuted the idea that
spells, demons, or godly beings are the causes or remedies of a disease. He
believed that all matter is made up of physical elements. These elements
include air, water, earth, and fire. In that sense, he believed tangible things
such as man’s behavior and the seasons could be blamed for disease and
could bring healing. Whenever the four humors were unbalanced,
treatments were taken to restore stability. Common remedies included
laxatives and bleeding. Primary care at the time, including for mental
disorders such as memory or cognitive issues, would require rest, proper air
circulation, good diet, and water. Furthermore, herbal extracts such as
willow bark were used for relieving pain while a disease ran its course.14
Hippocrates offered a paradigm shift to traditional medicine, traversing
from spiritual inclination to logic. He believed that physicians should delve
into each mental symptom in a patient-to-patient basis, rather than finding
conclusions and cures related to each disorder. To fulfill this, he came up
with the idea of performing clinical observations. His means of observing a
patient involved four stages of action. These stages of assessing a patient
for what is now termed Alzheimer’s included proper diagnosis, prognosis,
close observation, and finally, good treatment. Hippocrates also concluded
that the prevailing doctrine of the four humors would determine a person’s
overall health or sickness.15

ALZHEIMER’S DISEASE COMING TO LIGHT: ALOIS ALZHEIMER

Alois Alzheimer was a renowned scientist from Marktbreit, a municipality

in southern Germany. Born in 1864, he did well in sciences at school and
therefore studied medicine and did research in Germany throughout his
career. He went to Tubingen and Wurzburg schools where he graduated
with a medical degree in 1887. He commenced work in a country asylum in
Frankfurt. It was there that he became interested in doing advanced research
on the human brain. His work focused primarily on the brain cortex, and he
furthered his education in subjects such as psychiatry and neuropathology.
Alzheimer committed most of his years to histological and
histopathological research related to the cerebral cortex, a part of the brain
discussed in more detail in chapter 2. Alzheimer believed nerve cells have a
lot to do with the overall pathology of a human being’s nervous system. His
work on the cortex was published in 1907.16 He earned accolades afterward
and was appointed the director of the asylum where he used to do his
research. Motivated, he continued to investigate manic depression along
with schizophrenia and other psychiatric disorders.
Alzheimer was the first to recognize Alzheimer’s disease as a distinct
mental disorder. It all began in 1901, when he was carefully following the
case of a fifty-six-year-old woman named Auguste Deter,17 who would pass
away six years later.18 It was around that time that similar cases were
noticed. Emil Kraepelin later chose to include Alzheimer’s disease as a
separate type of dementia in his 1910 textbook of psychiatry since it could
not be said to have a similar cause to the other cases of dementia.19
Looking for a post where clinical practice is possible while academic
research was done, Alzheimer decided to be an apprentice of Emil
Kraepelin who also worked at a medical school in Munich, Germany, in
1903. In Munich, Alzheimer created a research program that was intended
only for cerebral research. He had by this time mastered theories and
practices regarding the nature of the brain. By 1906, his research and
discoveries had brought him to the limelight. His name grew exponentially.
Alzheimer then noticed a little-known disease that affected the human
brain, especially during his observation of the elderly woman mentioned
earlier. This “disease” was found to be responsible for a lot of her memory
loss, overall disorientation, and sporadic hallucinations. She died at the age
of fifty-five.
Alzheimer joined a team of Italians who also were interested in learning
the staining techniques that help identify amyloid plaques. The same
research also pointed toward irregular structures in the brain known as
neurofibrillary tangles. In 1906, Alzheimer convened a speech that was the