liferation of support groups and respite programs,
the caregiver problem remained acute.
In 1991, Dr. Jack Kevorkian, the controversial
guru of physician-assisted suicide and euthanasia, at-
tracted national attention by assisting in the suicide
of a woman in the early stages of Alzheimer’s disease.
Most commentators felt this act fell far outside what
society ought to condone: The woman was still in
good physical health and probably had several years
before complete mental debility set in. On the other
hand, the physical deterioration and mental incom-
petence this woman sought to avoid would have pre-
cluded assisted suicide at a later date. Those who
condemn such acts out of hand, or automatically la-
bel them as insane, discount a desire to spare loved
ones the emotional and financial burdens of
caregiving as a valid motivation.
A related debate concerns the extent to which
modern medicine should be used to prolong the
lives of people with dementia. Much of the explo-
sion in Alzheimer’s incidence can be traced to medi-
cal innovations unavailable before World War II.
Should a person be denied a procedure, such as
open-heart surgery, which has become routine,
based on his or her dementia? The answer in the
1990’s was no, with efforts focusing on ensuring
equal access.
Diagnosis and Treatment At the beginning of the
decade, medical researchers had high hopes that
early diagnosis combined with new therapies would
provide a cure or at least slow the progress of this
devastating disease. In the search for a cause, they
looked for predisposing environmental factors.
They found little aside from the genetic pattern.
One study, involving a cohort of nuns, suggested
that subtle mental impairment was present decades
before the onset of clinical disease. This explains
why people who pursue continuing education in
their sixties almost never develop Alzheimer’s, a
finding used in the 1990’s to sell education to retir-
ees. Rather than being protective, an active intellec-
tual life in late middle age indicates a healthy brain.
Aluminum toxicity is implicated in some cases of de-
mentia, but no link to Alzheimer’s has been found.
If there is an actual pathogen involved, it remains
elusive. Prions—abnormal infectious proteins—
cause other spongiform encephelopathies, but in
humans at least these are rare diseases with a clear
chain of transmission. The common pathogenic
bacteriumChlamydia trachomatissometimes occurs
in brain tissue and arteriosclerotic plaques; this may
be a secondary infection.
In 1990, the Food and Drug Administration ap-
proved tacrine and donepezil for treating Alzhei-
mer’s patients. Neither slows organic brain degener-
ation, and severe side effects offset temporary
improved functioning. Behavioral approaches can
improve the quality of life for a time, but acquired
routines are forgotten as the brain deteriorates.
Impact In general, the 1990’s saw increasing inci-
dence and increasing public awareness of Alzhei-
mer’s disease but very little progress in treatment at
the individual level or in grappling with the disease
as a societal problem.
Further Reading
Cutler, Neil R., and John J.Sramek.Understanding
Alzheimer’s Disease. Jackson: University Press of
Mississippi, 1996. Explains research in layman’s
terms.
Post, Stephen G., and Peter J. Whitehouse.Genetic
Testing for Alzheimer Disease. Baltimore: The Johns
Hopkins University Press, 1998. Explains the ge-
netics and the ethical issues involved.
Whitehouse, Peter J., Konrad Maurer, and Jesse F.
Bellenger, eds.Concepts of Alzheimer Disease: Biologi-
cal, Clinical and Cultural Perspectives. Baltimore:
The Johns Hopkins University Press, 2000. A
good overview of the history and developments
in the 1990’s.
Martha SherwoodSee also Elder abuse; Genetics research; Health
care; Medicine; Physician-assisted suicide. Amazon.com
Identification American-based online business
Date Founded in 1994
The first online bookstore, Amazon.com grew to have one of
the world’s largest selection of books. After launching, the
company soon emerged as a leading Internet commerce site
for the purchase of books and eventually other products.
Amazon.com was the brainchild of Jeff Bezos, who in
1994 was the youngest senior executive at invest-
ment firm D. E. Shaw. He had been avidly watching
developments in the Internet, the giant network ofThe Nineties in America Amazon.com 33