Alzheimer’s disease
Identification A progressive deterioration of the
brain, usually in elderly people, resulting in
dementia and death
Public attention in the 1990’s focused on a rapid increase
in the number of Americans either suffering from Alzhei-
mer’s disease or caring for an affected family member. Poten-
tially useful genetic findings raised thorny moral dilem-
mas. A decade of intensive research produced no cure or
effective treatment of symptoms.
Alzheimer’s disease is a spongiform encephalop-
athy—that is, a disease causing brain tissue to degen-
erate, becoming riddled with holes. Over a period of
years, mental functioning declines, culminating in a
vegetative state and death. Alois Alzheimer, who for-
mally described it in 1907, considered it to be a rare
disorder affecting middle-aged people. Around 1960,
the medical community started recognizing that a
common form of senile dementia affecting people
in their seventies and eighties was the same thing. Se-
nile dementia has been recognized since antiquity
but was regarded as a normal consequence of aging.
The number of Alzheimer’s patients in America
rose steeply between 1950 and 2000. By the mid-
1990’s, they represented one-third of all patients re-
quiring long-term nursing care, and it was estimated
that one in five Americans would eventually suc-
cumb. Despite these alarming statistics, this is not an
epidemic in the usual sense. The age-specific inci-
dence of new cases remains fairly constant. More
people are hospitalized with Alzheimer’s now be-
cause of an increase in overall life span and because
antibiotics and other therapies keep elderly senile
patients alive longer. Improvements in cardiac ther-
apy contribute disproportionately. A gene predis-
posing a person to late-onset Alzheimer’s also pre-
disposes him or her to arteriosclerosis (hardening of
the arteries). The person who avoids an early grave
with triple bypass surgery is at high risk for Alzhei-
mer’s disease.
Genetics The years 1989-1995 witnessed great
strides in understanding the biochemistry of and ge-
netic basis of Alzheimer’s. Geneticists identified
four genes, all involved in fat metabolism, as predis-
posing factors. Three of these are rare and are
strongly associated with inherited early-onset Alzhei-
mer’s. The fourth, a variant of the gene for apolipo-
protein E, is present in 30 percent of Americans and
is also associated with cardiovascular disease. An-
other variant of this gene appears to confer immu-
nity.
This discovery sparked considerable controversy,
because in the absence of any effective treatment for
Alzheimer’s, a person carrying the risk factor would
be subjected to worry and possible discrimination
without receiving any benefit. Should carriers of the
gene being treated for the cardiovascular risks also
be told of the potential for Alzheimer’s? The con-
sensus among medical professionals is that this gene
should be used as a diagnostic tool only to help con-
firm a suspected case of active disease. More defini-
tive diagnostic tests have since become available.
Human Costs The 1990’s saw a focus on caregivers
and the burdens imposed on them. A surviving
spouse or adult child endures years of caring for a
person who consumes increasing amounts of time
and money while becoming progressively less re-
sponsive, while dealing with a medical system and
a bureaucracy insensitive to the psychological well-
being of family members. Changing the rules for
Medicare reimbursement of nursing home ex-
penses addressed monetary issues. Despite the pro-32 Alzheimer’s disease The Nineties in America
Alzheimer’s brain Normal brainAlzheimer’s disease causes the volume of the brain to shrink sub-
stantially. (Hans & Cassidy, Inc.)