Alzheimer’s disease, which lead to the death of former President Reagan on Saturday, is one of the most common, and perhaps the most dreaded, consequences of growing old.
Reagan described Alzheimer’s disease as a journey that would take him “into the sunset of my life.”
Just last month — 10 years after the diagnosis — his wife, Nancy said that journey “has finally taken him to a distant place where I can no longer reach him.”
There is no cure and little can be done for now to control its insidious destruction of victims’ personalities, memories and skills.
Cases rising
An estimated 4 million Americans have Alzheimer’s, and the numbers will increase as better medical care helps people escape other major killers, such as heart disease. The Alzheimer’s Association estimates the total will be 14 million by the middle of this century unless a cure or prevention is found.
Alzheimer's is the most common form of dementia, gradually robbing sufferers of their memories and ability to care for themselves by destroying brain cells.
Eventually, it kills, although patients can linger anywhere from three to 20 years after diagnosis.
It is named for a German doctor who in 1906 discovered what now considered are the disease’s hallmarks — mysterious clumps of plaque and fibrous tangles in the brain tissue of a woman who died with memory-loss symptoms.
In recent years, Nancy Reagan has been among those leading the effort to fund research into embryonic stem cells as a possible treatment for Alzheimer’s and other diseases. Last month she spoke at a celebrity-studded fund-raiser for it.
No one knows exactly what causes Alzheimer’s, although aging is the biggest known risk factor. The number of people with the disease doubles every five years after age 65. Beyond 85, nearly half have it.
It is an especially democratic illness that has taken prominent people from all walks of life, including former British Prime Minister Harold Wilson, singer Perry Como, actress Rita Hayworth and former Secretary of State Cyrus Vance.
The disease begins in parts of the brain that regulate memory and thinking skills, but eventually it spreads to other areas. This attack on the brain can be fatal, although victims often die first of other things. The disease typically lasts for eight to 10 years, although some die much sooner or live as long as 20 years.
The eventual loss of cells in the brain leads to the failure of other essential systems in the body. But the actual cause of death for someone with Alzheimer’s may be no single factor because many patients have other illnesses.
Treatments uncertain
Under a microscope, the hallmark of Alzheimer’s disease is abnormal lumps of proteins in the brain. Clumps of what is called amyloid plaque accumulate outside of brain cells, while tangles of misplaced proteins build up inside.
Scientists are working on treatments intended to prevent these proteins from gathering. Even if this is possible, though, it is unclear whether the strategy will help, since researchers are still unsure whether the proteins truly cause Alzheimer’s or are simply a byproduct of some still unknown process.
Inherited factors almost certainly play a role. Those whose parents or siblings have the disease are at increased risk, although the precise genes involved are not known.
Typically, Alzheimer’s begins slowly with memory lapses, such as groping for common words or misplacing keys and glasses. Over time, symptoms become more obvious. People may seem withdrawn in groups and lose the ability to balance a checkbook or do other routine things, such as cook or play cards.
Eventually, those with Alzheimer’s cannot take care of themselves. They may become anxious and agitated and see things that do not exist.
Drugs used to treat Alzheimer’s are called cholinesterase inhibitors. They work by preventing the breakdown of a chemical messenger in the brain. These drugs do not slow the progression of the disease, but they may help reduce symptoms for some, delaying the need for nursing home care.
Research is under way to develop ways of revealing Alzheimer’s on brain scans. This should make it easier to diagnose the disease, which now relies largely on assessing patients’ outward symptoms and mental abilities.
Also in progress are several studies intended to see if drugs can delay or prevent it. These include cholesterol pills, folate and anti-inflammatory painkillers.