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 The Encyclopedia of

Alzheimer’s disease
Second Edition
 The Encyclopedia of

Alzheimer’s Disease
Second Edition

Carol Turkington
and
Deborah Mitchell

Foreword by
James E. Galvin, M.D., M.P.H.
 Disclaimer: This book is intended to provide helpful information on the subject matter covered herein. It is sold with
the understanding that the authors and the publisher are not engaged in rendering professional medical, health, or any
other kind of personal professional services via this book. If the reader wants or needs personal advice or guidance, he
or she should seek an in-person consultation with a competent medical professional. Furthermore, the reader should
consult his or her medical, health, or other competent professional before adopting any of the suggestions in the book
or drawing inferences from information that is included herein. The authors and publisher specifically disclaim any
responsibility for any liability, loss, or risk, whether personal or otherwise, that someone may incur as a consequence
direct, or indirect, of the use and application of any contents of this book. In no way does reading this book replace
evaluation by a physician. Also, the full responsibility for any adverse effects that result from the use of information
in this book rests solely with the reader.

The Encyclopedia of Alzheimer’s Disease, Second Edition

Copyright © 2010, 2003 by the Estate of Carol Turkington

All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic
or mechanical, including photocopying, recording, or by any information storage or retrieval systems, without
permission in writing from the publisher. For information contact:

Facts On File, Inc.

An imprint of Infobase Publishing, Inc.
132 West 31st Street
New York NY 10001

Library of Congress Cataloging-in-Publication Data

Turkington, Carol.
The encyclopedia of Alzheimer’s disease / Carol Turkington with Deborah Mitchell ; foreword by
James E. Galvin.—2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN-13: 978-0-8160-7766-3 (hardcover : alk. paper)
ISBN-10: 0-8160-7766-5 (hardcover : alk. paper) ISBN: 978-1-4381-2858-0 (e-book) 1. Alzheimer’s disease—
Encyclopedias. I. Mitchell, Deborah R. II. Title.
[DNLM: 1. Alzheimer Disease—Encyclopedias—English. WT 13 T939e 2009]
RC523.T87 2009
616.8'31003—dc22 2009006661

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Text and cover design by Cathy Rincon

Composition by Hermitage Publishing Services
Cover printed by Sheridan Books, Ann Arbor, MI
Book printed and bound by Sheridan Books, Ann Arbor, MI
Date printed: March 2010

Printed in the United States of America

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LHL-Alzheimer-FNL.indd 4 4/2/10 10:52:39 AM

To my wife, Doris, and my sons, Chris, Jake, and Conor.
They are my source of inspiration and strength.
—J. E. G.

h
 CONTENTS
Foreword ix
Acknowledgments xiii
Introduction xv
Entries A–Z 1
Appendixes
Appendix I: Alzheimer’s Disease Resources 222
Appendix II: Alzheimer’s Disease Centers 232
Appendix III: Area Agencies on Aging 236
Appendix IV: International Alzheimer’s Disease
 Associations 241
Appendix V: Legal/Financial Issues 248
Appendix VI: Read More about It 254
Appendix VII: Alzheimer’s Disease Clinical Trials 256
Glossary 261
Bibliography 264
Index 285
 Foreword
F ew words evoke more fear or uncertainty than
dementia. Dementia comes from the Latin de-
“apart, away” and mens, “mind,” but for millions
dementing disorder, increases with age for every
decade after 65. It is currently estimated that there
are more than 5 million Americans with AD, up to
of people the word indicates a thief that has stolen half of whom may be undiagnosed.
away a loved one’s personality, memory, language, About one in 10 individuals over the age of
and knowledge. The transformation typically is 65 and half of everyone over age 85 will develop
gradual, a slow decline in abilities that eventually dementia. In addition to AD, other common
leaves behind a victim who is uncommunicative, causes of dementia are cerebrovascular disease and
uncomprehending, and unresponsive. I use the Parkinson’s disease. The annual direct and indirect
term victim deliberately, because anyone who has costs of Alzheimer’s and other dementias to Medi-
seen a loved one changed by the progression of care, Medicaid, and businesses amount to more
these relentless disorders knows this image is apt. than $148 billion. Dementia is clearly a challenge
I say disorders because dementia is not a single that affects many sectors of society.
disease but, rather, a symptom of many conditions Overt clinical dementia is not the only cogni-
that cause brain dysfunction. Dementia is associ- tive/memory deficit that affects so many older
ated with a wide range of symptoms, modes of individuals. Terms such as mild cognitive impairment
onset, clinical courses, and therapeutic responses. and age-associated memory impairment have been
Perhaps the one positive thing that can be said proposed to characterize people who have some
about this condition is that the diverse background memory challenges but who have relative preser-
of clinical symptoms provides researchers with vation of other cognitive abilities and functions of
fertile grounds for developing theories and insights daily life. It has been difficult to reach consensus,
into the basic inner workings of the brain and of however, on how and when these entities should
the mind. be diagnosed. Moreover, because the prevalence of
Over the years, I have often looked upon my dementia increases with age, and because there is
patients with sorrow because I am all too aware of wide variation in test performance among normal
the changes that will occur in their lives. I am in older adults, the boundaries between age-related
awe of the inner strength and resolve of so many cognitive decline and very early dementia are
caregivers who strive to provide their loved ones sometimes uncertain, both to the patients and to
with the care they deserve. I watch as they look the physicians who treat them.
for answers and for hope. In the early part of the 20th century, Dr. Alois
Dementia is a common problem. There is a good Alzheimer described his first patient (Auguste D)
chance that everyone who opens this book will with the disorder that would come to bear his
know someone who has dementia. The prevalence name. A psychiatrist, Dr. Alzheimer examined
of Alzheimer’s disease (AD), the most common Auguste D in an institutionalized setting after she

ix
 The Encyclopedia of Alzheimer’s Disease

was admitted for delusions of extreme jealousy 1992. In 1996 donepezil (Aricept) was approved.
and spousal infidelity. She lived only four and Donepezil was followed by rivastigmine (Exelon)
a half years after she was admitted to the sani- in 2000 and galantamine (formerly Reminyl; now
tarium. Dr. Alzheimer performed an autopsy and Razadyne) in 2001. All four of these drugs are in
described the classic senile degenerative changes the category of cholinesterase inhibitors. Then in
that have come to be synonymous with AD. For 2003, the Food and Drug Administration (FDA)
three-quarters of a century after that, the diag- approved memantine (Namenda), the (so far) sole
nosis of AD was largely relegated to individuals drug in the glutamate receptor–blocking agent
confined to nursing homes and psychiatric insti- classification. Currently there are more than 100
tutions, bedridden and incontinent, unaware of new compounds undergoing clinical trials for the
their surroundings. People living at home who treatment of dementia.
had memory problems were often told they were The high level of research activity offers hope
just getting old or a little senile. Memory problems for a brighter future of the care of dementia
were misdiagnosed as “hardening of the arteries” patients. With the advent of advances in molecu-
or “part of the normal aging process.” In general, lar biology, genetics, pharmacology, and biochem-
there was little effort to search for either the cause istry, we have learned so much about the disease
of the disease or for treatments. process that mechanistic approaches to both diag-
Two factors dramatically changed these per- nosis and treatment now seem within reach. The
ceptions. The first was the creation in 1974 of search for biomarkers of the disease has greatly
the National Institute on Aging (NIA) within the advanced. Very soon it will be possible to take a
National Institutes of Health (NIH). From this point blood test to make a diagnosis of AD. We are also
onward, significant focus was placed on the public on the brink of being able to image the pathology
policy implications of the aging American popula- of AD in a living person’s brain, enabling clinicians
tion, as it was becoming increasingly apparent that to accurately diagnose an individual at the earliest
a marked proportion were experiencing some form possible stage of dementia.
of memory impairment. One of the first actions of Treatment options will also greatly expand. In
the NIA was to create centers of excellence for addition to the symptomatic treatment from the
clinical and basic science research investigating cholinesterase inhibitors and the newest drug addi-
AD and other forms of dementia. Twenty-nine tion, memantine, mechanism-based approaches
such centers now operate in the United States, will enable clinicians to prevent the production of
and other branches of NIH have also established amyloid proteins and enhance its removal from
centers to investigate other diseases of the elderly the brain.
such as cancer and Parkinson’s disease. There is still so much more to do, however. It
The second important factor was the chemical is estimated that within one generation (the year
analysis of the proteins found in the brain lesions 2050), there will be as many as 16 million Ameri-
of AD: amyloid beta protein in the senile plaques cans with dementia. People with AD currently
and tau protein in the neurofibrillary tangles. With make up half of all nursing home populations,
targets of scientific inquiry and funding available and AD is the sixth leading cause of death in the
for scientists to pursue these new avenues of United States. Part of the problem still lies in the
research, the chase was on. Neuroscience research underrecognition of the disorder. Fewer than half
is now one of the largest areas of scientific growth, of the individuals with dementia are correctly
along with cancer and cardiovascular disease. diagnosed, and more important, even in the face
Once the federal government and academia of diagnosis, less than half of all persons with
displayed interest in dementia, the pharmaceutical dementia are treated with the only medications
industry leapt into action. With advances in the currently approved to treat the disease. This is not
molecular understanding of AD, the first medica- the case with other diseases of the elderly, such
tion for the treatment of AD (tacrine, Cognex; as hypertension, diabetes, or heart disease. If the
no longer actively marketed) was approved in field is to advance further, families and clinicians
 Foreword xi

must be more aware of the problems so that as read it. In today’s world most medical information
new treatments become available, eligible patients is readily available on the Internet or at university
are prescribed them. Knowledge is power! libraries. The information is also available from
I first became interested in dementia observ- most family physicians.
ing my grandfather’s battle with Parkinson’s dis- I have dedicated my professional career to help-
ease and dementia. He was diagnosed during ing individuals with dementia and their families,
my junior year in high school. Over the next 15 and I provide a substantial amount of (what I con-
years I watched a vital, strong-willed individual sider) useful information to each family from the
decline both physically and mentally until he was time of the first office visit through the terminal
essentially immobile, mute, and unaware of his portion of the patient’s life. Should I really take
surroundings. Ultimately, the only response my the time to put all of this information down in
grandfather was able to consistently make was to one place so that it is readily available to someone
his visual hallucinations, causing him eventually searching for answers?
to fall and fracture his hip. Although the surgeon Of course, that is when I came to understand
succeeded in repairing his fracture, my grandfather the true value of this project. The real question
never recovered, passing away in his sleep at the is not should I help put together this volume, and
rehabilitation hospital. This experience combined now this updated version, but rather why I had not
with my interest in science led to the pursuit done it sooner.
of a career in neurology, focusing on geriatric Volumes such as the Facts On File series pro-
disorders. vide families and patients with Alzheimer’s disease
Sadly, back then I was not able to provide my and other forms of dementia the information and
grandmother with information that might have resources they need and provide it in an easy-to-
prevented grandfather’s death or at the very least understand and easy-to-read format.
made both their lives a little bit easier. I hope we
have succeeded in providing such useful informa- —James E. Galvin, M.D., M.P.H.
tion with this updated volume. Associate Professor, Neurology,
When I was first approached to assist in this Psychiatry and Neurobiology
project, I questioned the value of producing an Director, Memory Diagnostic Center
encyclopedia about Alzheimer’s disease. I won- Director, Education and Community Outreach
dered about the individuals who would read it Alzheimer’s Disease Research Center
and, more important, why they would want to Washington University School of Medicine
 Acknowledgments
I would like to acknowledge the sources of my
research support, including the National Insti-
tute on Aging, the National Institutes of Health,
generous support of Alan A. and Edith L. Wolff.
Most of all, I wish to thank all my patients, their
families and caregivers, who have taught me so
the American Federation for Aging Research, the much but constantly show me that I have so much
Missouri Alzheimer Disease and Related Disorders yet to learn.
Program, the Longer Life Foundation, and the —James E. Galvin, M.D., M.P.H.

xiii
 Introduction
S ince the 2003 edition of this volume, research-
ers and investigators dedicated to unraveling
the mysteries of Alzheimer’s disease have been
beta amyloid, the hallmark of Alzheimer’s, and
dimebon, a drug that targets the mitochondria, the
source of energy for all cells. As of this writing, bap-
working diligently and making great strides in ineuzumab and dimebon were both in Phase III tri-
increasing our understanding of and our ability als while two other drugs, Flurizan and Alzhemed,
to prevent and treat Alzheimer’s disease. To help failed Phase III trials and were withdrawn.
bring you up to date with the many new develop- In genetics, one of several findings was the
ments and exciting prospects surrounding this dev- gene SORL1, which has been implicated in late-
astating disease, one that is affecting an increasing onset Alzheimer’s disease. This gene appears to be
number of adults in our aging population, we have involved in a cellular sorting process that eventu-
put together this revised edition. ally leads to the formation of amyloid plaques.
Among the many new developments, for exam- So far, the only way to definitively diagnose
ple, are a novel drug that may slow the progression Alzheimer’s disease is an autopsy, and the need
of moderately severe to severe Alzheimer’s disease for reliable methods to identify the disease in the
and another that may soon enter the marketplace; living brain would be invaluable for early diagno-
exciting discoveries in genetics that may allow doc- sis and for monitoring the impact of treatment. A
tors to determine who is at greater risk for devel- study published in March 2007 in the Archives of
oping Alzheimer’s and how to better treat their Neurology stated that a positron emission tomog-
patients; innovative diagnostic tools that may help raphy (PET) done after injection of Pittsburgh
identify Alzheimer’s in the living brain and one compound B (PIB), a radioactive dye, showed the
day permit clinicians to diagnose the disease early distribution of amyloid at autopsy matched the
on; and improved ways to safeguard the emotional overall distribution seen on the PET-PIB scan. If
and physical health of Alzheimer’s caregivers. Take the accuracy of this test can be replicated in large
a look at each of these areas. trials, it may become one way to make a definitive
In 2003, the Food and Drug Administration diagnosis of Alzheimer’s disease in a living brain.
(FDA) approved memantine, the first and only Some new discoveries about the impact on
drug in its class (it blocks glutamate) that can treat Alzheimer’s disease caregivers have also come to
moderate to severe Alzheimer’s disease. During light. For example, researchers found that people
the same time frame, the manufacturer of tacrine, who care for Alzheimer’s patients have shorter
which had been approved in 1993 for treatment of telomeres than non-caregivers. Telomeres are bits
mild Alzheimer’s, stopped actively marketing the of genetic material found at the end of chromo-
drug, as it is associated with liver damage. Among somes. Although shortening of telomeres is part
the possible new drugs that may someday hit the of the natural aging process, caregivers have telo-
market are bapineuzumab, a drug that clears away meres that are significantly shorter than those of

xv
xvi The Encyclopedia of Alzheimer’s Disease

a control group. Caregivers also have signs of a President Bill Clinton on July 16, 2000. Among its
weaker immune system and more inflammation- goals was an acceleration of research on new ways
promoting proteins. With this and similar informa- to prevent and treat the disease, with specific focus
tion, experts can take steps to protect the health of on the development of an Alzheimer’s vaccine. To
Alzheimer’s caregivers. these ends, the NIH set aside $50 million through
Also since 2003, two international conferences 2005. Again, some results of this initiative can be
were held. The Alzheimer’s Association Interna- found in these pages.
tional Conference on Prevention of Dementia Today scientists in both public and private sec-
attracted more than 1,000 scientists, physicians, and tors are working together to understand more
policymakers who shared information and goals. At about this devastating disease. Some of the major
the second conference in June 2007, the Centers for supporters of Alzheimer’s research are part of the
Disease Control and Prevention and the Alzheimer’s NIH Alzheimer’s Disease Working Group, which
Association released the first National Public Health includes the National Institute on Aging, the
Road Map to Maintaining Cognitive Health. This National Institute of Neurological Disorders and
road map, which can be viewed at www.cdc.gov/, Stroke, the National Institute of Mental Health,
offers strategies for evaluating public perceptions and the National Institute of Nursing Research.
about cognitive health, recommends specific actions They are joined by dozens of nonprofit organiza-
that can be taken to support cognitive health, and tions that provide monies for research and much-
calls for more research into the risk factors for cog- needed support for Alzheimer’s patients and their
nitive decline and interventions to prevent it. caregivers and families.
At the time the previous volume was published, This book has been designed as a guide and ref-
the National Institutes of Health (NIH) had launched erence to a wide range of subjects relevant to the
several initiatives, and now in this revised version understanding of Alzheimer’s disease. It includes a
we can share some of the fruits of their labors. wide variety of contact information for organiza-
One initiative was called the NIH Alzheimer’s Dis- tions and governmental agencies affiliated with
ease Prevention Initiative, which was designed to the condition, including current Web site addresses
accelerate the progress of experts who are engaged and contact information. However, the book is not
in findings ways to delay or prevent the onset of meant to be a substitute for prompt assessment
Alzheimer’s disease as well as working on getting and treatment by experts trained in the diagnosis
potential new treatments to market. One of the and support of Alzheimer’s disease.
initiative’s projects was a clinical trial that focused In this encyclopedia we have tried to present the
on preventing or delaying the onset of clinically latest information in the field, based on the most
diagnosed Alzheimer’s disease in people at risk, up-to-date research and current FDA approvals of
which was launched in March 1999. The three-year new treatments. Readers will find comprehensive
study (sponsored by the Alzheimer’s Disease Coop- entries on the suspected causes (and controver-
erative Study Group) investigated the effectiveness sies), risks, diagnoses, prevention, and treatment
of donepezil (a drug prescribed for mild to moder- of the disease.
ate Alzheimer’s) and vitamin E in delaying or pre- Although information in this book comes from
venting the onset of Alzheimer’s disease in people the most recent medical journals and research
who had mild cognitive impairment. The results sources, readers should keep in mind that changes
of the study were published in the June 9, 2005, occur very quickly in neurology. A bibliography
issue of the New England Journal of Medicine and are has been included for those who seek additional
explained in detail elsewhere in this volume. sources of information.
A second initiative, called the President’s Initia- —Deborah Mitchell
tive on Alzheimer’s Disease, was announced by Tucson, Arizona
Entries A–Z
 A
abstract language See language areas of the supersedes doctor-patient confidentiality issues;
brain. failure to report the problem can make doctors
liable.
See also elder abuse.
abuse Abuse of a patient with Alzheimer’s disease
may be physical, psychological, financial, material,
or any combination of these. Because patients with acetylcholine A chemical messenger that brain
Alzheimer’s are demented, they are vulnerable to cells use to communicate with each other, espe-
a wide range of abuse by others—either caregivers, cially in parts of the brain important for thought,
family, friends, or strangers. In an institution, a memory and judgment. Acetylcholine is a critical
patient may be abused not only by a staff member, neurotransmitter in the process of forming memo-
but by another patient, an intruder, or a visitor. ries, and it is the neurotransmitter commonly used
Physical abuse is usually easy to spot, but other by nerve cells in the hippocampus and cerebral
types of abuse may be more insidious. Emotional cortex—regions devastated by Alzheimer’s disease.
abuse includes verbal assaults, threats of abuse, Normally, acetylcholine is produced by these brain
harassment, and intimidation. Neglect is usually cells, released to carry signals, and then broken
the responsibility of a caregiver who fails to pro- down for reuse by enzymes. When brain cells are
vide food, clothing, shelter, or medical care. Finan- damaged by Alzheimer’s disease, they produce less
cial abuse involves misusing or withholding the acetylcholine, which disrupts communication in
patient’s money. the brain.
Sometimes, sexual abuse may be a problem; Since low acetylcholine levels were first dis-
this could involve anything from inappropriate covered in patients with Alzheimer’s disease, the
touching or fondling to any sexual activity when chemical has been the subject of hundreds of stud-
the patient is unable to understand, unwilling to ies. Scientists have found that acetylcholine levels
consent, or physically forced to participate. can be as much as 90 percent lower in people with
Family members who don’t live with the patient Alzheimer’s. They have also discovered that low
can guard against abuse by routinely asking ques- levels are linked to memory problems.
tions directly related to abuse or neglect. If the Acetylcholinesterase is an enzyme that breaks
patient confirms abuse, family members should down acetylcholine. Medications that disrupt the
examine the patient thoroughly and document transmission of acetylcholine in the brain are
findings, including the person’s statements, behav- known as anticholinergic drugs. They work by
ior, and appearance. Family members should blocking cholinergic receptors, preventing acetyl-
maintain well-documented medical records and choline release or completely depleting neurons
photographs that can provide concrete evidence that use acetylcholine.
and may be crucial in any legal case. A recent study (2008) found that the use of anti-
Many states require physicians to report sus- cholinergic drugs is associated with a more rapid
pected elder abuse and neglect to a designated state decline in cognitive abilities and performance in
agency. A doctor’s duty to report suspected abuse older individuals. The study, which was presented


 acetylcholinesterase

at the American Academy of Neurology 60th without. The participants without Alzheimer’s dis-
Annual Meeting, suggested that physicians should ease had been more active between the ages of 40
seriously consider this complication when prescrib- and 60 than were those with Alzheimer’s, no mat-
ing anticholinergic medications to older patients. ter the age, gender, economic status, or education
Other neurotransmitters have also been impli- of the subjects.
cated in Alzheimer’s disease. For example, sero- While earlier research had linked Alzheimer’s
tonin, somatostatin, and noradrenaline levels are disease to less active individuals with low educa-
reduced by at least 50 percent in some Alzheimer’s tional and occupational status, the more recent
patients, which may contribute to sensory distur- findings show that it is activity alone, not job and
bances, aggressive behavior, and brain cell death. educational factors, that affects the risk of getting
Most neurotransmitter research, however, contin- the disease.
ues to focus on acetylcholine because of its steep
decline in Alzheimer’s disease and its close ties to
memory formation and reasoning. activities Patients with Alzheimer’s disease ben-
However, scientists aren’t sure if the drop in ace- efit from activities that boost their sense of involve-
tylcholine and other neurotransmitters is the cause ment, accomplishment, and well-being. As long as
of the disease, or whether the low levels occur as the activities are not too confusing or overstimulat-
a result of the disease process. Scientists do know ing, it is usually helpful for patients with Alzheim-
that drugs that boost acetylcholine levels in the er’s to maintain their sense of self-esteem in the
brain can improve memory. These drugs include face of constant deterioration. Anything from
donepezil, rivastigmine, galantamine, and others. going to a restaurant to taking a trip to a museum
may be suitable, depending on the patient’s level
of function and the stage of the disease. However,
acetylcholinesterase See acetylcholine. while many patients who are more active seem to
maintain better physical and mental function, oth-
ers can’t tolerate anything other than a very simple
acetylcholinesterase inhibitors See drug activity. Elaborate trips—such as a visit to a theme
treatments. park—even for a mildly demented patient may
cause serious confusion with devastating results.
This is why a patient’s tolerance to activity must
active lifestyle People who are physically and be determined on an individual basis. Regular activ-
mentally active in midlife may have a better ities in familiar locations should be encouraged,
chance of avoiding Alzheimer’s disease later in life. but trips that require staying overnight in a strange
According to experts, recreational activities such environment should be considered carefully.
as physical exercise, playing a musical instrument, The types of activities that a patient may benefit
or using board games play a key role in prevent- from will almost certainly change as the disease
ing Alzheimer’s. In fact, people who are involved progresses. In general, patients with Alzheimer’s
in only minimal physical activity are at least tend to have problems concentrating and following
three times more likely to suffer from Alzheimer’s directions, which can turn even the simplest activi-
disease. ties into a challenge. Many patients may simply sit
One recent study investigated how much activity or stand in one place, or pace the room for long
Alzheimer’s disease patients participate in five years periods of time; unless directed, it is quite common
before symptoms appeared. Subjects answered for patients not to initiate an activity on their own;
questions about mental activity (such as reading even when they do, they may have trouble carry-
and painting), physical activity such as sports and ing out the activity.
gardening, and passive activity like social interac- A daily routine can help patients feel good about
tion and going to church. The study was composed themselves as they maintain more of their normal
of 193 people with Alzheimer’s disease and 358 day-to-day life.
 activities 

When planning an activity schedule for patients, While it’s important for patients to stay busy,
caregivers should consider how to adapt the person’s they don’t need to be involved in a 24-hour whirl-
past interests and hobbies to the current situation. It wind of activities. A mixture of rest and brief,
may be possible to adapt a hobby, such as ham radio simple activities is a good way to take advantage of
or model trains, in ways that would still be manage- the patient’s limited ability to concentrate. Patients
able by someone with even significant limits. would probably not be able to spend five hours
Structure and schedules will give most patients a helping to reorganize the kitchen cabinets, but 20
sense of security, so caregivers should think about minutes of helping to wipe down shelves would
providing the same activities in the same way at be helpful.
the same time each day. Caregivers should expect Most patients benefit from activities that tie in
to offer constant guidance and supervision, helping with former jobs and responsibilities, because they
the patient through the activity with simple, step- are reassuring and familiar. For example, a patient
by-step directions. who used to work in a business office might enjoy
Daily activities as basic as dusting or running putting stamps or address labels on envelopes,
the vacuum may please a patient with Alzheimer’s. or putting papers in a file. A former florist might
If someone used to love to read the paper while enjoy puttering in the yard, setting out tomato
having a cup of morning coffee, this may still be plants, or planting seeds.
enjoyable even if the person can no longer make While patients may not be able to perform
sense of the daily news. The fact that it is a familiar complicated procedures, self-expression is still
activity will often make it enjoyable. important. Many patients still enjoy drawing and
It is also important that caregivers be able to painting, working in clay, dancing and singing,
understand the implications of the disease. If a or playing a musical instrument. People with
patient suddenly insists she doesn’t want to do Alzheimer’s respond very well to familiar songs
something, it may be that the person can’t do it or and music from their past, so playing, singing, or
is afraid. performing songs and hymns can be important.
Just because a patient “always” was a fabulous Exercise is also important for patients, who
cook in the past does not mean she can still func- may enjoy playing Ping-Pong, taking regular walks
tion at the same level—but she may still enjoy part around a mall (during quiet times, not peak shop-
of the process of baking a cake, for example. If the ping hours), playing catch with a soft ball, or play-
person has lost the ability to follow a complicated ing badminton in the backyard.
recipe, caregivers can help by separating the tasks Even as the disease continues, patients may
involved in baking a cake, taking over the steps enjoy looking at magazines, photo albums, or
that are too much for the patient. Caregivers might books. Many patients enjoy being read to from the
count the eggs and break them into a bowl, and newspaper or a magazine, or listening to poetry or
then hand the bowl to the patient to stir. favorite stories.
Involving patients in activities that are impor- Tasks involving separating and organizing may
tant in keeping the household running is a good interest patients, who may be able to sort nuts and
way to help the person maintain self-esteem. This bolts, buttons, or coins. Other patients may enjoy
might include activities such as sweeping, garden- working with cloth, folding laundry, or sewing
ing, taking out the trash, or raking leaves. Working together different types of material, such as denim
alongside the patient setting the table, drying the and corduroy.
dishes, or emptying the wastebaskets, can boost Many patients benefit from getting in touch
the person’s feeling of being useful and sociable. with past experiences and memories, so old TV
Patients may also enjoy helping prepare for family shows or movies from earlier decades are often a
picnics or birthdays, although caregivers should be good choice. Some patients may enjoy going to a
careful to prevent the patient from feeling over- sports event, such as a tennis match or golf tourna-
whelmed. Activities before and during the event ment, riding in the car, or taking a trip to the zoo
should be simple and well organized. or an art museum.
 activities of daily living

activities of daily living The collective term for nal fluid or urine can’t by itself indicate or rule out
personal care activities necessary for everyday liv- Alzheimer’s disease.
ing, such as eating, bathing, grooming, dressing, For this reason, many experts (including the
and toileting. People with Alzheimer’s disease may Alzheimer’s Association) are uncertain about the
not be able to perform these functions without usefulness of this test for diagnosing or ruling out
help. Geriatric professionals often assess a person’s Alzheimer’s disease, and more studies of its efficacy
activities of daily living as a way of determining are needed. A 2007 blinded multicentered study
what type of care is needed. Secondary-level activi- that evaluated 168 patients found that the nonin-
ties important to daily living, such as cooking, writ- vasive NTP test results were potentially helpful as
ing, and driving, are called instrumental activities part of the workup of dementia for nonspecialists
of daily living. when trying to decide whether to make a refer-
ral and/or whether more detailed evaluation is
advisable.
acupuncture New research with Alzheimer’s
disease suggests that acupuncture may increase
a patient’s verbal and motor skills and improve ADAPT (Alzheimer’s Disease Anti-inflammatory
mood and cognitive function, according to two Prevention Trial) This was a randomized, double-
separate studies, one at the Wellesley College blind, multicenter clinical research study that
Center for Research on Women and the other at tested a possible link between two different anti-
the University of Hong Kong. The studies sug- ­inflammatory drugs and the prevention of Alzheim-
gest that acupuncture may significantly reduce er’s disease. The study was initiated because
depression and anxiety in patients with dementia. researchers had noted that people who regularly
Experts hope that acupuncture might improve took anti-inflammatory medicines seemed less
the life of Alzheimer’s patients by altering their likely to develop Alzheimer’s disease.
mood, behavioral symptoms, and overall sense of The study began on January 30, 2001, and
well-being. included six memory clinics in the United States.
Acupuncture is most often practiced by inserting Sponsored by the National Institute on Aging,
needles into specified points in the patient’s body, ADAPT followed 2,117 of 2,528 healthy men and
which is believed to unblock the flow of energy women aged 70 years and older who had a family
through the body. Acupuncture is also believed history of Alzheimer’s disease. The original protocol
to increase blood flow to the brain and lessen was to follow the participants for up to seven years.
inflammation, which is a problem associated with Participants were given naproxen sodium (Aleve;
Alzheimer’s. 220 mg twice daily), a nonprescription nonsteroi-
Acupuncture has been recognized as a potentially dal anti-inflammatory drug (NSAID); celecoxib
effective therapy by the World Health Organization (Celebrex; 200 mg twice daily), a prescription
and by the National Institutes of Health’s Center for NSAID; or a placebo. All participants underwent
Complementary and Alternative Medicine. tests of their physical and cognitive abilities three
times in the first year of the study and twice a year
after that, as well as a telephone interview twice
AD7C test A controversial test that measures lev- a year.
els of neural thread protein (NTP) found in spinal Administration of the study drugs was sus-
fluid or urine. High levels of NTP have been found pended in December 2004 after results of another
in people with Alzheimer’s disease, as well as in study found that celecoxib may be associated with
those who suffer from brain tumors, strokes, and an increased risk of heart problems. However, the
other neurological disorders. Because patients with researchers continued to monitor the participants
other neurological problems besides Alzheimer’s since they had been taking naproxen, celecoxib,
disease can test positive on this assessment, a result or a placebo for up to three years. The research-
showing higher-than-average levels of NTP in spi- ers found that use of either drug did not improve
 advance directive 

cognitive function. In fact, there was weak evi- Adult Day Services Association (NADSA, formerly
dence that naproxen may increase the incidence of the National Institute on Adult Daycare) of the
Alzheimer’s disease. National Council on Aging provide important
guidelines for states that have chosen to regulate
adult day services. Funding sources also define the
adult day services Programs that provide clients range of services for which they will pay while
with opportunities to interact with others in a com- an eligible participant is at an adult day center.
munity-based center or facility. Adult day services Besides the voluntary NADSA standards, there are
are designed to meet the needs of patients with no uniform national standards governing either the
Alzheimer’s disease through an individual plan of operation of centers or the qualifications of staff
care. These structured, comprehensive programs members.
provide a variety of health, social, and other related NADSA offers a certification process for program
support services in a protective setting during any assistants and is developing the same for adminis-
part of a day. Typically, an adult day center oper- trators and directors.
ates programs during normal business hours five Daily fees for adult day services vary depending
days a week. Some programs offer services in the on location and the type of available services, and
evenings and on weekends. there is quite a variable range. Funding for adult
The typical adult day center offers a wide range day services comes from participant fees as well as
of services which may include transportation, social public and charitable sources. The average cost of a
services, meals, nursing and personal care, counsel- day at an adult day center is often much less than
ing, therapeutic activities, and rehabilitation. a visit from a home health nurse and about half the
Adult day centers are designed to serve adults cost of skilled nursing facility care.
with physical problems or mental confusion, and A high-quality adult day center will:
who may require supervision, more social oppor-
tunities, and help with personal care or other • assess a client’s needs
daily living activities. The average age of a client • provide an active day program that meets the
is 76; two-thirds of all participants are women. client’s social, recreational, and rehabilitation
One survey found that about half of all clients needs
of these centers had some cognitive impairment,
• develop an individualized treatment plan for
and a third required nursing services at least
each client and regularly monitor each person’s
weekly.
progress
In the 1940s, adult day care began in psychiatric
day hospitals such as the Yale Psychiatric Clinic, • provide referrals to other needed services in the
primarily to assist patients following release from community
mental institutions. During the 1960s, the day care • develop clear criteria for service and guidelines
concept shifted from a single psychiatric focus to for termination of service, based upon the func-
other health maintenance. Centers began in Ari- tional status of each client
zona, Pennsylvania, and Minnesota. In 1978, the • provide a full range of in-house services
government published a directory of nearly 300
• provide a safe, secure environment
adult day care centers. Today, there are more than
4,000 adult day centers operating in every state of • hire qualified and well-trained staff and
the United States, most of which are nonprofit or volunteers
public. Many are affiliated with larger organiza- • follow existing state and national standards and
tions such as skilled nursing facilities, medical cen- guidelines
ters, or multipurpose senior organizations.
Regulations regarding adult day service differ
from state to state. The Standards and Guidelines advance directive A written document, com-
for Adult Day Care developed by the National pleted and signed when a person is legally compe-
 Advil

tent, that explains what the person would or would age and Alzheimer’s disease The single greatest
not want if unable to make decisions about medical risk factor for Alzheimer’s disease is age. While the
care. Common advance directives include: disease can occasionally occur in people as young
as 30 or 40, the risk increases considerably after age
• Health care proxy (or health care power of 65. Experts estimate that half of those over age 80
attorney) that gives another person the author- will be diagnosed with Alzheimer’s.
ity to make health care decisions for the patient As people age, the brain undergoes a number
when the patient is unable to do so of changes. Some brain cells in some brain regions
• Living will, which directs a doctor on what is degenerate, although most neurons important to
to be done for a patient about specific health learning remain healthy. Slowly, cells begin to
care decisions, such as whether or not to start shrink and stop functioning, especially in areas
or continue life-sustaining treatment for a dying important to learning, memory, planning, and other
and incapacitated patient; see Appendix V for a complex mental activities. Neurofibrillary tangles
sample of a living will. develop in brain cells and senile plaques appear in
surrounding areas in certain brain regions, such as
• Non-hospital do not resuscitate order (DNR) the hippocampus.
that directs emergency staff not to resuscitate a In healthy older people, the impact of these
person when not in a hospital or other health changes may just mean that it gets a little harder
care facility to remember day-to-day details. In people who
• Do not resuscitate order (DNR), which legally develop Alzheimer’s, on the other hand, some of
directs a doctor and/or hospital staff not to try to these changes are much more severe and have
help a patient whose heart has stopped beating; devastating consequences.
DNR orders are accepted by doctors in hospitals During normal metabolism, the body produces
in all states. molecules called free radicals that help cells by
fighting infection. However, free radicals are very
Advance directives are an important part of reactive, and when the body produces too many,
the management of the affairs for a patient with they can damage and kill cells—a major cause of
Alzheimer’s disease, because an advance directive the aging process. With age, the brain gets less
allows someone else to make treatment decisions able to cope with and eliminate free radicals. Brain
on a patient’s behalf when the person is no longer cells are particularly vulnerable to attack by free
capable of making those decisions. In particular, radicals because they have a high metabolism and
patients with early Alzheimer’s disease should ask are low in natural antioxidants, the substances that
themselves what they would want to happen if destroy free radicals. Free radicals also attack DNA
they stopped eating because of their disease. and RNA, brain lipids, and proteins. This is why
Patients should prepare and sign advance direc- researchers are studying whether treatment with
tives that comply with state law, and give copies to antioxidants can slow age-related cognitive decline
family, friends, and doctors. The document should or development of Alzheimer’s.
reflect the patient’s wishes and appoint someone Because Alzheimer’s often develops in older
to make decisions who is willing to carry out those people who may already have other health prob-
wishes. lems such as heart disease or high blood pres-
sure, scientists suspect that these conditions may
play a role in the development of Alzheimer’s. For
Advil See nonsteroidal anti-inflammatory example, Lewy bodies are the second most com-
drugs. mon cause of dementia; there is some evidence
that there may be a link between Alzheimer’s and
strokes. High cholesterol levels that occur in old
African Americans See race and Alzheimer’s age may increase the rate of plaque formation.
disease. There are also similarities between Alzheimer’s
 aging 

and other progressive neurodegenerative disor- Alzheimer’s disease, often when a caregiver tries to
ders that cause dementia, such as prion diseases, help with daily activities. It is important to control
Parkinson’s, and Huntington’s disease. All of these such behavior because aggressive patients can hurt
conditions involve deposits of abnormal proteins in themselves or others. Newer atypical antipsychot-
the brain, and new research is showing that these ics, including risperidone (Risperdal), olanzap-
diseases have a number of important overlapping ine (Zyprexa), and quetiapine (Seroquel), appear
characteristics. to significantly decrease symptoms of aggression
while posing a very low risk for severe side effects.
Carbamazepine, an antiseizure drug, may also be
age-associated memory impairment (AAMI) A effective for agitation and dementia.
controversial idea that normal decline in memory
due to aging leads to “memory lapses,” such as
forgetting the location of an everyday object, while aging Aging does not necessarily cause an irrevers-
retaining perfectly clear memories of personal infor- ible loss of cells in the cerebral cortex; major cell loss
mation, such as the names of family members. appears to be in the basal forebrain, in the hippocam-
Some experts may diagnose a patient over age pus, and amygdala (the sites of learning and mem-
50 with AAMI if all other obvious causes of mem- ory). The loss of these cells, in turn, causes a drop in
ory decline have been ruled out and the person: the production of the neurotransmitter acetylcho-
line, a chemical that is vital to memory and learning.
• has noticed a decline in memory performance Not surprisingly, Alzheimer’s disease patients have
• performs below “normal” levels on a standard markedly low levels of this vital neurotransmitter.
test of memory Unfortunately, the hippocampus (probably one
of the most important brain structures involved
A more severe memory problem may be clas- in memory and learning) is highly vulnerable to
sified as mild cognitive impairment (MCI), which aging, and up to 5 percent of the nerve cells in the
may be an indication of the early stages of Alzheim- hippocampus break down with each decade past
er’s disease. The memory loss associated with MCI middle age. This could add up to a loss of up to
is more severe and involves continuing problems in 20 percent of total hippocampal nerve cells by the
delayed recall of information. time a person enters the eighth decade of life.
Abnormal memory loss associated with Alzheim- Damage to this area of the brain may be caused
er’s is characterized by even more severe prob- by stress hormones such as cortisol. Rat studies
lems, such as disorientation and general confusion. have found that stress-induced increases in cortisol
Research suggests that people with MCI appear to prematurely age the hippocampus. In addition,
be at a higher risk of developing Alzheimer’s dis- excessive amounts of free radicals (a toxic form
ease when they get older. As many as 15 percent of oxygen) can also build up as a person ages, dam-
of people over the age of 65 with MCI eventu- aging the hippocampus.
ally develop Alzheimer’s per year, whereas only However, the aging brain can also be negatively
1 percent of healthy people over age 65 develop affected by a whole host of other factors, such as
Alzheimer’s per year. Some experts believe that malnutrition, alcohol, depression, and medica-
all individuals with MCI will develop Alzheimer’s tions (especially the benzodiazepines used to treat
disease if followed long enough. anxiety). In addition, there are a range of organic
problems that can occur in the brain itself. Func-
tional brain problems may also be caused by dying
Agency on Aging See Area Agencies on Aging. neurons or decreased production of neurotransmit-
ters (chemicals like acetylcholine that allow brain
cells to communicate with each other).
aggression Hitting, pushing, or threaten- In addition, there are physical changes in the
ing behaviors may be exhibited by people with aging brain; tissue actually shrinks and the cells
 agitation

become less efficient. In addition, hereditary prob- tal drills, preventing intellectual breakdown and
lems, environmental toxins, or poor lifestyle choices reversing a decline.
such as smoking or substance abuse, can speed up Evidence from both animal and human research
the decline in brain function. indicates that brain stimulation stops cells from
About half the elderly men and women with shrinking and can also strengthen brain cell func-
severe intellectual impairment have Alzheimer’s tion. For example, studies show that rats living
disease, but another fourth suffer from vascular in an enriched environment have larger outer
disorders such as strokes. The rest have a variety brain layers with healthier neurons and more
of problems, including brain tumors, abnormal cells responsible for providing food for the neu-
thyroid function, infections, pernicious anemia, rons. Rats kept in a barren cage had smaller brains
adverse drug reactions, and abnormalities in the than did rats with a lot of toys. Studies in people
cerebrospinal fluid. who have Alzheimer’s disease or other forms of
The chief problem among healthy older people is dementia show that those who play games have
a decline in their ability to perform several tasks at better speech and brain function. The Alzheim-
once, or to switch back and forth rapidly between er’s Association promotes its own Maintain Your
them. While general vocabulary and knowledge Brain program and recommends that people play
about the world often stays sharp through the with puzzles, read, and write as therapy because
seventh decade of life, the ability to recognize faces research shows that these activities improve mem-
and find one’s car has begun to wane by the time ory, problem solving, and attention while staving
a person enters the 20s. Memory for names begins off mental decline and, perhaps, reduce the risk of
to decline as early as the mid-30s. While long-term Alzheimer’s disease.
memory does not usually decline as a person ages,
short-term and episodic memory do deteriorate
with age. agitation A term used to describe many typical
Researchers believe that after age 30, most behaviors in patients with Alzheimer’s disease,
people reach an intellectual plateau which is usu- such as screaming, shouting, complaining, moan-
ally maintained until about age 60; after that, there ing, cursing, pacing, fidgeting, or wandering. As
are small declines, depending on initial ability and the disease progresses, many people experience agi-
gender. tation in addition to memory loss and other think-
Overall brain function, however, remains strong ing problems. Abnormal behavior is considered to
in most people through the 70s. In fact, many peo- be agitation only if it poses risk or discomfort to a
ple in their 60s and 70s score significantly better in caregiver or the individual with Alzheimer’s. Agita-
verbal skills than young people. For many people, tion can be a nonspecific symptom of a physical or
it is not until the 80s that any sort of serious mental psychological problem such as headache, pain, or
slowdown occurs. depression.
Brain deterioration with age is not inevitable. Agitation may be caused by a medical problem,
Studies of nursing home populations showed that a drug interaction, or anything that interferes with
patients were able to make significant improve- a patient’s ability to think clearly. A wide variety of
ments in cognitive ability when given rewards situations can trigger agitation, especially changes
and challenges. Furthermore, physical exercise in routine such as moving to a new home or nurs-
and mental stimulation can even improve mental ing home, a different caregiver, or even altered
function in some people as they age. A stimulating daily routines. In addition, a patient’s fuzzy think-
environment strengthens the brain, while a dull ing may lead to perceived threats, or may cause
environment weakens it. fear and exhaustion as the result of trying to make
Indeed, the brain often becomes less effective sense of a confusing world. Agitation can inter-
as a person ages because of disuse rather than dis- fere with a patient’s ability to handle activities of
ease. However, it is possible to challenge the brain daily living, and it can also frighten and exhaust
to become more efficient by practicing daily men- caregivers.
 agitation 

Symptoms and Diagnostic Path Antipsychotic medications are the most common
A patient who experiences agitation should be drugs used to treat agitation, in addition to halluci-
thoroughly examined, especially if the problem has nations, delusions, aggression, hostility, and unco-
appeared abruptly. Agitation often may be caused operativeness. These include olanzapine (Zyprexa),
by an underlying physical illness (such as infection) quetiapine (Seroquel), or risperidone (Risperdal).
or medication, so a good history and physical exam Both risperidone and olanzapine have been shown
are important. Proper treatment can often stabilize to be effective in easing hallucinations and treating
or even reduce symptoms. agitation. These atypical antipsychotic drugs can
also make patients drowsy, which increases the
Treatment Options and Outlook risk of falls and resulting broken bones and might
Agitation is usually treated first with behavioral increase the risk of stroke. In 2008, a University of
methods; if these fail, medication can be added. Pennsylvania study found aripiprazole (Abilify®),
Experts believe it is important to understand the a drug used to treat schizophrenia, to be effective
cause of the behavior and change the environment in relieving agitation, anxiety, and depression in
or routine, which is why it is important to correctly people with Alzheimer’s disease.
identify what triggered agitated behavior in the However, it is important to note that anti-
first place. psychotic medications are not indicated for the
Agitation may be eased by changing caregivers, treatment of behavioral problems in patients with
living arrangements, or the environment. Both pet dementia. The Food and Drug Administration
and music therapy have been shown to calm agi- (FDA) has issued a black box warning that the
tated patients. It is important when trying to ease use of antipsychotic medications in patients with
agitation to avoid arguing, disagreeing, cornering, Alzheimer’s disease may cause a 1.7 times increased
risk of death (usually due to pneumonia, cardiac
criticizing, or confronting the patient. Instead, care-
disease, or stroke). While these medications may
givers can:
be effective in reducing behavioral symptoms, they
should only be used after a thorough discussion of
• redirect the patient’s attention
the risks and benefits.
• simplify routines Antidepressants may be used to treat low mood,
• limit stimulation depression, or irritability. Typically, a doctor will
• reassure prescribe one of the newer selective serotonin
reuptake inhibitors (SSRIs): citalopram (Celexa),
• focus on pleasant events
fluoxetine (Prozac), paroxetine (Paxil), or sertra-
• provide the patient with rest line (Zoloft).
• use labels as a reminder Antianxiety drugs (anxiolytics) can treat anxi-
• back off and ask permission ety, restlessness, verbally disruptive behavior, and
resistance. Common drugs used for these symp-
• turn up the lights at night toms include Buspar or oxazepam (Serax), which
• use calm, positive statements reduce anxiety.
Some doctors may prescribe an anticonvulsant/
Medications can help manage some symptoms of mood stabilizer such as carbamazepine (Tegretol) or
agitation, but they must be used carefully and are divalproex (Depakote) for hostility or aggression.
most effective when combined with behavioral Sedatives should only be used with caution
and environmental changes. Medications should because of the risk of side effects, such as incon-
target specific symptoms so that improvement can tinence, instability, or falls; they may worsen
be monitored. If medication is needed to target agitation.
specific symptoms, most doctors prefer to start with Although the drugs haloperidol or trazodone are
one drug at a low dose and carefully monitor the commonly used to treat agitation in Alzheimer’s
patient’s response. patients, the first large controlled study of behav-
10 agnosia

ior and drug treatments found that they are only it appeared that drinking wine might help protect
marginally effective at best. The Alzheimer’s Dis- patients from dementia.
ease Cooperative Study (ADCS) reports that across In that study, researchers analyzed data gath-
all groups, only 34 percent of patients improved; ered from 15,807 patients over 65 who had taken
patients getting trazodone showed the greatest part in a study of adverse drug reactions in hospi-
improvement. Agitation worsened in 46 percent of talized patients. Among these patients, wine was
patients, however, and did not change in 20 per- the alcoholic beverage of choice. Study authors
cent. Interestingly, 31 percent of patients receiving found signs of cognitive problems in 19 percent
placebo showed improvement. This suggested that of the participants who reported regular alcohol
meeting regularly with a well-trained and support- consumption, and in 29 percent of those who
ive clinician may help reduce agitation. abstained from alcohol. Statistical methods ruled
out other contributing factors such as age, gender,
Risk Factors and Preventive Measures education, disease, or medication, but scientists did
It is better to try to prevent agitation than to have find that how much a person drank each day was
to treat it once it appears. To head off episodes of an important factor.
agitated behavior, caregivers should try to create The risk of cognitive impairment was lower
a calm, quiet, stress-free environment. Security among women whose daily alcohol consumption
objects, rest, and privacy may help. Caffeine should was less than 40 grams and among men who drank
be limited, and caregivers should try to offer exer- less than 80 grams, compared to people who did
cise, and soothing rituals. To some extent, agitation not drink at all. On the other hand, subjects who
may be avoided by cutting down on noise, glare, drank more than this were at increased risk of
and too much background distraction, such as TV. cognitive impairment when compared with both
abstainers and moderate drinkers.
This study showed that among older people,
agnosia Loss of the ability to recognize what an moderate drinking protects against the development
object is and what it is used for, despite undam- of cognitive impairment. However, alcohol abuse—
aged senses of sight, smell, touch, hearing, and so more than one bottle of wine a day for a man, or
on. Agnosia is one of the symptoms that may be more than a half bottle for a woman—is associated
required for a diagnosis of Alzheimer’s disease. with an increased risk of cognitive dysfunction.
A person with agnosia might try to use a knife These findings add to a body of hard scientific infor-
instead of a spoon, a brush instead of a glass, mation developed in the last decade which suggests
or a ruler instead of a pen. Others with agnosia that alcohol confers clear health benefits on those
might not be able to recognize another person not who consume it in moderation. However, research-
because of poor memory but because the brain ers caution against “prescribing” alcohol for the
can’t match the person’s identity with information elderly, despite its emerging health benefits, because
supplied by the eyes. the risk of alcohol abuse is higher among older
adults and because so many take medications that
may interact with alcohol. However, people who
alcohol In a 2008 meta-analysis of 23 studies enjoy one or two drinks a day should understand
published in Age and Ageing, researchers noted that this practice is consistent with a healthy lifestyle.
small amounts of alcohol may be protective against Scientists aren’t sure exactly why moderate
Alzheimer’s disease and dementia but not vascular drinking appears to protect patients from devel-
dementia or cognitive decline. They further indi- oping dementia in old age, but suggest that per-
cated that limited alcohol intake in earlier adult life haps moderate alcohol consumption might protect
appeared to provide the protective element. against heart attacks and stroke, which are linked
Various other studies have identified alcohol to dementia. In addition, the antioxidant compo-
consumption as either a risk factor for dementia or nents of wine might account for the specific protec-
as a protection, but in a recent large Italian study, tion against Alzheimer’s disease.
 aluminum 11

Aleve See nonsteroidal anti-inflammatory drugs. If A2M interfered with this system, or if a variant
of apoE blocked the usual breakdown process, beta
amyloid plaques could form and clog the synapses,
alpha-2-macroglobulin (A2M) A gene on chro- slowing nerve signals and preventing the release of
mosome 12 that, when defective, may make people growth factors that keep cells healthy.
who inherit it more susceptible to Alzheimer’s See also heredity and Alzheimer’s disease;
disease. The gene was discovered by researchers at chromosome 1; chromosome 10; chromosome 14;
Massachusetts General Hospital and the Harvard chromosome 19; chromosome 21.
School of Public Health, who found that patients
with late onset Alzheimer’s were more likely to
have a mutation in this gene than were siblings alpha-tocopherol See vitamins.
who had not developed the disease. Although the
defective gene doesn’t always cause Alzheimer’s,
its presence increases the risk of developing the aluminum One of the most abundant elements
disease. found in the environment, which has been from
The Alzheimer gene mutation on chromosome time to time suspected as one potential cause
12 is especially important because the protein it of Alzheimer’s disease. Aluminum is one of 90
codes for interacts with proteins coded for by two naturally occurring chemicals and is the third most
previously identified Alzheimer genes—apolipo- common element found in the Earth’s crust. Sci-
protein E (apoE) and amyloid precursor protein entists are still studying ways to clarify how alumi-
(APP). However, the exact nature of these relation- num affects the body and whether it is a factor in
ships is still unclear. Alzheimer’s disease.
The risk of developing Alzheimer’s disease con- Early studies in the 1960s suggested that alu-
ferred by the A2M mutation seems to be the same minum triggered changes in an animal’s brain
as the risk conferred by the gene variant (identified that seemed to be similar to those in the brain of
above) apoE-4. However, people who carry both a person with Alzheimer’s. However, closer analy-
variants don’t seem to be at higher risk. Although sis proved that the changes in the animals’ brains
apoE-4 appears to affect the age at which symp- were very different from the structural changes of
toms appear, A2M doesn’t affect age of onset. Alzheimer’s.
The A2M gene controls the activity of enzymes Human studies searching for a link between
that break down other proteins, and helps remove Alzheimer’s and aluminum have been inconclu-
potentially toxic proteins out of the synapse (the sive and contradictory. While some researchers
space between neurons). Since one of the proteins have found increased levels of aluminum, mer-
A2M removes is beta amyloid, a hallmark compo- cury, or other metals in the brains of patients with
nent of the plaques and tangles that characterize Alzheimer’s, other scientists have not. Although
Alzheimer’s disease, a defective alpha-2-macroglob- some investigators still suspect that aluminum
ulin might allow beta amyloid to build up to toxic buildup may play a role in the onset of Alzheimer’s
levels. Scientists believe that Alzheimer’s may be disease, most believe aluminum is a result of the
caused by a failure in the process of the breakdown disorder, not its cause. Research continues in an
and removal of beta amyloid, so a flawed A2M gene effort to better understand this phenomenon and
may fail to help brain synapses function properly. to determine whether the aluminum deposits are a
Scientists believe that the key event trigger- cause or a result of the disease.
ing Alzheimer’s is the buildup of amyloid plaques Because it is found everywhere in the earth, it’s
made up of toxic deposits of insoluble beta amyloid almost impossible to avoid contact with aluminum.
protein fragments inside the brain. It could be that Most people don’t ingest very much because alu-
the A2M and apoE are involved in a sensitive, bal- minum doesn’t dissolve well in many of its natu-
anced system that breaks down beta amyloid and rally occurring forms. In fact, less than 1 percent of
removes it from brain cells. the aluminum a person eats or drinks is absorbed
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