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"Alzheimer's disease" is the term used to describe a dementing disorder marked by certain brain changes, regardless of the age of onset. Alzheimer's disease is not a normal part of aging--it is not something that inevitably happens in later life. Rather, it is one of the dementing disorders, a group of brain diseases that lead to the loss of mental and physical functions. The disorder, whose cause is unknown, affects a small but significant percentage of older Americans. A very small minority of Alzheimer's patients are under 50 years of age. Most are over 65.

Alzheimer's disease is the exception, rather than the rule, in old age. Only 5 to 6 percent of older people are afflicted by Alzheimer's disease or a related dementia--but this means approximately 3 to 4 million Americans have one of these debilitating disorders. Research indicates that 1 percent of the population aged 65-74 has severe dementia, increasing to 7 percent of those aged 75-84 and to 25 percent of those 85 or older. At least half the people in U.S. nursing homes have Alzheimer's disease or a related disorder; in 1985, the annual cost of caring for individuals with Alzheimer's disease and related dementias in institutional and community settings was estimated between $24 billion and $48 billion for direct costs alone and is probably higher today. As our population ages and the number of Alzheimer's patients increases, costs of care will rise as well.

Although Alzheimer's disease is  reversible, there are ways to alleviate symptoms and suffering and to assist families. Not every person with this illness must necessarily move to a nursing home. Many thousands of patients--especially those in the early stages of the disease--are cared for by their families in the community. Indeed, one of the most important aspects of medical management is family education and family support services. When, or whether, to transfer a patient to a nursing home is a decision to be carefully considered by the family.

Who Gets Alzheimer's Disease?

The main risk factor for Alzheimer's disease is increased age. The rates of the disease increase markedly with advancing age, with 25 percent of people over 85 suffering from Alzheimer's or other severe dementia.

At the same time, data indicate that the likelihood that a close relative (sibling, child, or parent) of an afflicted individual will develop Alzheimer's disease is low. In most cases, such an individual's risk is only slightly higher than that of someone in the general population, where the lifetime risk is below 1 percent. And, of course, many disorders have a genetic potential that is never expressed--that is, despite being at risk for a certain illness, one might go through life without ever developing any symptom of the disease.

What To Expect When Someone Has Alzheimer's Disease

-- The person will lose memory, forget to do what they are supposed to do. Such as buying grocery, paying bills and doing the day to day things.

Some people get agitated, delirious, develop paranoid symptoms and are restless. There is a personality change!

They need help with eating, going to the bathroom and dressing.

The onset of Alzheimer's disease is usually very slow and gradual, seldom occurring before age 65. Over time, however, it follows a progressively more serious course. Among the symptoms that typically develop, none is unique to Alzheimer's disease at its various stages. It is therefore essential for suspicious changes to be thoroughly evaluated before they become inappropriately or negligently labeled Alzheimer's disease.

Problems of memory, particularly recent or short-term memory, are common early in the course of the disease. For example, the individual may, on repeated occasions, forget to turn off the iron or may not recall which of the morning's medicines were taken. Mild personality changes, such as less spontaneity or a sense of apathy and a tendency to withdraw from social interactions, may occur early in the illness. As the disease progresses, problems in abstract thinking or in intellectual functioning develop. The individual may begin to have trouble with figures when working on bills, with understanding what is being read, or with organizing the day's work. Further disturbances in behavior and appearance may also be seen at this point, such as agitation, irritability, quarrelsomeness, and diminishing ability to dress appropriately.

Later in the course of the disorder, the affected individuals may become confused or disoriented about what month or year it is and be unable to describe accurately where they live or to name correctly a place being visited. Eventually they may wander, be unable to engage in conversation, seem inattentive and erratic in mood, appear uncooperative, lose bladder and bowel control, and, in extreme cases, become totally incapable of caring for themselves if the final stage is reached. Death then follows, perhaps from pneumonia or some other problem that occurs in severely deteriorated states of health. The average course of the disease from the time it is recognized to death is about 6 to 8 years, but it may range from under 2 to over 20 years. Those who develop the disorder later in life may die from other illnesses (such as heart disease) before Alzheimer's disease reaches its final and most serious stage.

Though the changes just described represent the general range of symptoms for Alzheimer's disease, the specific problems, along with the rate and severity of decline, can vary considerably with different individuals. Indeed, most persons with Alzheimer's disease can function at a reasonable level and remain at home far into the course of the disorder. Moreover, throughout much of the course of the illness individuals maintain the capacity for giving and receiving love, for sharing warm interpersonal relationships, and for participating in a variety of meaningful activities with family and friends.

A person with Alzheimer's disease may no longer be able to do math, but still be able to read a magazine with pleasure for months or years to come. Playing the piano might become too stressful in the face of increasing mistakes, but singing along with others may still be satisfying. The chess board may have to be put away, but one may still be able to play tennis. Thus, despite the many exasperating moments in the lives of Alzheimer patients and their families, many opportunities remain for positive interactions. Challenge, frustration, closeness, anger, warmth, sadness, and satisfaction may all be experienced by those who work to help the person with Alzheimer's disease cope as well as possible with the disease.

The reaction of an individual to the illness--his or her capacity to cope with it--also varies and may depend on such factors as lifelong personality patterns and the nature and severity of stress in the immediate environment. Depression, severe uneasiness, and paranoia or delusions may accompany or result from the disease, but they can often be alleviated by appropriate treatments. Although there is no cure for Alzheimer's disease, treatments are available to alleviate many of the symptoms that cause suffering.

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