Alzheimer Auguste D And The Defining Of A Disease
. Reprinted from The Lancet, 349, Maurer et al., Auguste D and Alzheimer’s disease, 1546-9, 1997, with permission from Elsevier.
Alzheimer presented the clinical and pathological findings from Auguste D.s case at the meeting of Southwest German Psychiatrists held in Tübingen, in 1906 and his lecture was published under the title A Characteristic Disease of the Cerebral Cortex the following year. He described and beautifully recorded characteristic changes in the neurofibrils revealed by the Bielschowsky silver stain at autopsy. Thick fibrils accumulated in apparently normal-appearing cells until eventually, the nucleus and cytoplasm disappeared, and only a tangled bundle of fibrils indicated the site where once the neuron had been located. Severe neuronal loss was observed and over the entire cortex, and in large numbers especially in the upper layers, miliary foci could be found which represented the sites of deposition of a peculiar substance. Many years later, hyperphosphorylated tau was found to be the key component of the tangles and amyloid- the peculiar substance that formed the core of the plaques. Psychoanalytic studies presented at the meeting received more attention than Alzheimers paper and were the ones to get reported in the local press. However, in 1910 Kraepelin coined the term Alzheimers disease in the eighth edition of his Handbook of Psychiatry, declaring it to be a specific clinical-pathological disease entity.
Mortality Due To Any Cause
All-cause mortality rates increase with age. In 20132014, for Canadians with dementia, the rate was 75.5 deaths per 1,000 population in the 6569;years age group, and it reached 207.2 deaths per 1,000 population in the 85;years and older age group. However, as the overall mortality among Canadians with and without dementia increases later in life, mortality rates between the two groups tend to converge. In other words, the all-cause mortality rate ratios decrease with age. In 20132014, the rate ratio was 7.6 in the 6569;years age group, and it decreased to 2.9 in the 85;years and older age group.
Since 20032004, all-cause mortality rates have decreased among all Canadians. Among Canadians with dementia however, rates decreased at a slower pace. This is illustrated by the increasing rate ratios between 20032004 and 20132014. In 20132014, the age-standardized all-cause mortality rate was about four times higher among seniors with dementia compared to those without .
Figure;2: Age-standardized all-cause mortality rates and rate ratios among Canadians aged 65;years and older with and without diagnosed dementia, including Alzheimer’s disease, Canada, 20032004 to 20132014
Text description: Figure;2Figure;2: Age-standardized all-cause mortality rates and rate ratios among Canadians aged 65;years and older with and without diagnosed dementia, including Alzheimer’s disease, Canada, 20032004 to 20132014
| Fiscal year | |
|---|---|
| 25.3 | 4.3 |
Diagnosis Of Dementia Due To Alzheimer’s Disease
- Obtaining a medical and family history from the individual, including psychiatric history and history of cognitive and behavioral changes.
- Asking a family member to provide input about changes in thinking skills and behavior.
- Conducting problem-solving, memory and other cognitive tests, as well as physical and neurologic examinations.
- Having the individual undergo blood tests and brain imaging to rule out other potential causes of dementia symptoms, such as a tumor or certain vitamin deficiencies.
- In some circumstances, using PET imaging of the brain to find out if the individual has high levels of beta-amyloid, a hallmark of Alzheimer’s; normal levels would suggest Alzheimer’s is not the cause of dementia.
- In some circumstances, using lumbar puncture to determine the levels of beta-amyloid and certain types of tau in CSF; normal levels would suggest Alzheimer’s is not the cause of dementia.
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Specific Information In This Report
Alzheimer’s Disease Facts and Figures
- Brain changes that occur with Alzheimer’s disease.
- Risk factors for Alzheimer’s dementia.
- Number of Americans with Alzheimer’s dementia nationally and for each state.
- Lifetime risk for developing Alzheimer’s dementia.
- Proportion of women and men with Alzheimer’s and other dementias.
- Number of deaths due to Alzheimer’s disease nationally and for each state, and death rates by age.
- Number of family caregivers, hours of care provided, and economic value of unpaid care nationally and for each state.
- The impact of caregiving on caregivers.
- National cost of care for individuals with Alzheimer’s or other dementias, including costs paid by Medicare and Medicaid and costs paid out of pocket.
- Medicare payments for people with dementia compared with people without dementia.
- Number of geriatricians needed by state in 2050.
The Appendices detail sources and methods used to derive statistics in this report.
When possible, specific information about Alzheimer’s disease is provided; in other cases, the reference may be a more general one of âAlzheimer’s or other dementias.â
Racial And Ethnic Differences In The Prevalence Of Alzheimer’s And Other Dementias
Although there are more non-Hispanic whites living with Alzheimer’s and other dementias than any other racial or ethnic group in the United States , older black/African Americans and Hispanics/Latinos are disproportionately more likely than older whites to have Alzheimer’s or other dementias., , – Most studies indicate that older black/African Americans are about twice as likely to have Alzheimer’s or other dementias as older whites., , Some studies indicate older Hispanics/Latinos are about one and one-half times as likely to have Alzheimer’s or other dementias as older whites.,, , However, Hispanics/Latinos comprise a very diverse group in terms of cultural history, genetic ancestry and health profiles, and there is evidence that prevalence may differ from one specific Hispanic/Latino ethnic group to another .,
There is evidence that missed diagnoses of Alzheimer’s and other dementias are more common among older black/African Americans and Hispanics/Latinos than among older whites., Based on data for Medicare beneficiaries age 65 and older, it has been estimated that Alzheimer’s or another dementia had been diagnosed in 10.3% of whites, 12.2% of Hispanics/Latinos and 13.8% of black/African Americans. Although rates of diagnosis were higher among black/African Americans than among whites, according to prevalence studies that detect all people who have dementia irrespective of their use of the health care system, the rates should be even higher for black/African Americans.
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Alzheimer’s Disease Is A Condition That Affects The Brain
Alzheimer’s is a progressive disease, meaning symptoms will gradually change and become more severe. Caregivers find them particularly useful in support groups, as well as in conversations with doctors, family and care professionals. What is alzheimer’s disease, what causes it, what are the symptoms, and how is it treated? Alzheimer’s disease does run in some families, particularly in early onset cases in which someone gets the disease well before the age of 65. When alzheimer’s begins in middle age, misdiagnosis may be more likely. Alzheimer’s disease is currently defined based on the presence of toxic protein aggregations in the brain known as amyloid plaques and tau tangles, accompanied by cognitive decline and dementia. One of the proteins involved is called amyloid, deposits of which form plaques around brain cells. Teenagers can show early development of alzheimer’s, when their spinal fluid is tested, about 20 years before they exhibit symptoms. Frequently asked questions regarding alzheimer’s disease presentd by the alzheimer’s disease program at the texas department of state health services. How to handle difficult behavior with alzheimer’s disease patients. In many cases, doctors do not know why younger people develop this condition. When did alois alzheimer die? Although alzheimer’s disease strikes both sexes, it is a disease that particularly affects women.
Social And Economic Impact
Dementia has significant social and economic implications in terms of direct medical and social care costs, and the costs of informal care. In 2015, the total global societal cost of dementia was estimated to be US$ 818 billion, equivalent to 1.1% of global gross domestic product . The total cost as a proportion of GDP varied from 0.2% in low- and middle-income countries to 1.4% in high-income countries.
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Causes And Risk Factors
The cause depends on the type, but the exact causes of many forms of dementia are currently unclear.
Dementia is not an inevitable part of aging, but age is one of the main risk factors. In fact, up to 50% of people aged 85 years and older may have a type of dementia.
Also, in the United States, around 11.3% of people aged over 65 years currently have Alzheimers disease, according to the Alzheimers Association. This number rises to 34.6% in those aged 85 years and older. Symptoms tend to worsen with age.
It is possible to develop dementia at a younger age, but the condition is more common among older adults.
How Many Canadians Live With Dementia Including Alzheimer’s Disease And How Many Are Newly Diagnosed Each Year
According to the most recent data available , more than 402,000 seniors are living with dementia in Canada . This represents a prevalence of 7.1%. About two-thirds of Canadian seniors living with dementia are women. Annually, there are approximately 76,000 new cases of dementia diagnosed in Canada. This represents an incidence of 14.3 new cases per 1,000 in the senior population . The incidence is higher among women than men. The prevalence and the incidence increase with age, as does the differential in prevalence and incidence estimates between men and women .
Table;1:
| Age | |
|---|---|
| 15.8 | 14.3 |
Notes: Data do not include Saskatchewan’s data. The 95% confidence interval shows an estimated range of values which is likely to include the true value 19 times out of 20.
Data source: Public Health Agency of Canada, using Canadian Chronic Disease Surveillance System data files contributed by provinces and territories, April 2017.
Over a ten-year period , the age-standardized prevalence of dementia increased by 21.2%. During the same period, fluctuations in incidence have been observed. Drug data, one of the criteria used for case identification , became available in Alberta and Prince Edward Island in 20092010, which contributed to the temporary peak in incidence that year. Since then, incidence data suggest a decline .
| Sex | |
|---|---|
| 6.1 | 14.3 |
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Treatment Of Alzheimer’s Dementia
2.5.1 Pharmacologic treatment
None of the pharmacologic treatments available today for Alzheimer’s dementia slow or stop the damage and destruction of neurons that cause Alzheimer’s symptoms and make the disease fatal. The U.S. Food and Drug Administration has approved five drugs for the treatment of Alzheimer’s â rivastigmine, galantamine, donepezil, memantine, and memantine combined with donepezil. With the exception of memantine, these drugs temporarily improve cognitive symptoms by increasing the amount of chemicals called neurotransmitters in the brain. Memantine blocks certain receptors in the brain from excess stimulation that can damage nerve cells. The effectiveness of these drugs varies from person to person and is limited in duration.
Many factors contribute to the difficulty of developing effective treatments for Alzheimer’s. These factors include the slow pace of recruiting sufficient numbers of participants and sufficiently diverse participants to clinical studies, gaps in knowledge about the precise molecular changes and biological processes in the brain that cause Alzheimer’s disease, and the relatively long time needed to observe whether an investigational treatment affects disease progression.
2.5.2 Non-pharmacologic therapy
Brain Changes Associated With Alzheimer’s Disease
A healthy adult brain has about 100 billion neurons, each with long, branching extensions. These extensions enable individual neurons to form connections with other neurons. At such connections, called synapses, information flows in tiny bursts of chemicals that are released by one neuron and detected by another neuron. The brain contains about 100 trillion synapses. They allow signals to travel rapidly through the brain’s neuronal circuits, creating the cellular basis of memories, thoughts, sensations, emotions, movements and skills.
The accumulation of the protein fragment beta-amyloid outside neurons and the accumulation of an abnormal form of the protein tau inside neurons are two of several brain changes associated with Alzheimer’s.
Plaques and smaller accumulations of beta-amyloid called oligomers may contribute to the damage and death of neurons by interfering with neuron-to-neuron communication at synapses. Tau tangles block the transport of nutrients and other essential molecules inside neurons. Although the complete sequence of events is unclear, beta-amyloid may begin accumulating before abnormal tau, and increasing beta-amyloid accumulation is associated with subsequent increases in tau.,
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Common Forms Of Dementia
There are many different forms of dementia. Alzheimer’s disease is the most common form and may contribute to 6070% of cases. Other major forms include vascular dementia, dementia with Lewy bodies , and a group of diseases that contribute to frontotemporal dementia . The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
What To Do If You Suspect Alzheimers Disease
Getting checked by your healthcare provider can help determine if the symptoms you are experiencing are related to Alzheimers disease, or a more treatable conditions such as a vitamin deficiency or a side effect from medication. Early and accurate diagnosis also provides opportunities for you and your family to consider financial planning, develop advance directives, enroll in clinical trials, and anticipate care needs.
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Estimates Of The Number Of People With Alzheimer’s Dementia By State
Table lists the estimated number of people age 65 and older with Alzheimer’s dementia by state for 2020, the projected number for 2025, and the projected percentage change in the number of people with Alzheimer’s between 2020 and 2025.,
| Projected Number with Alzheimer’s | Percentage Increase |
|---|---|
| 30.0 |
- Created from data provided to the Alzheimer’s Association by Weuve et al.,
As shown in Figure , between 2020 and 2025 every state across the country is expected to experience an increase of at least 6.7% in the number of people with Alzheimer’s. These projected increases in the number of people with Alzheimer’s are due solely to projected increases in the population age 65 and older in these states. Because risk factors for dementia such as midlife obesity and diabetes can vary dramatically by region and state, the regional patterns of future burden may be different than reported here. Based on these projections, the West and Southeast are expected to experience the largest percentage increases in people with Alzheimer’s dementia between 2020 and 2025. These increases will have a marked impact on statesâ health care systems, as well as the Medicaid program, which covers the costs of long-term care and support for many older residents with dementia, including more than a quarter of Medicare beneficiaries with Alzheimer’s or other dementias.
FIGURE 3
On World Alzheimers Day The Black Doctor Who Helped Decode The Disease
As the worlds population ages, the number of people suffering from dementia 50 million in 2020 is expected to nearly double every 20 years.
Alzheimers, the most prevalent form of dementia, understandably commands the most attention, as does the doctor, Alois Alzheimer, for whom it is named.
The history of Alzheimers, however, has one curiously neglected figure: Solomon Carter Fuller, a neurologist, the first U.S. psychiatrist of African descent and the person who, in the early stages of Alzheimers research, arguably did the most to reveal the true nature of the disease.
Fuller was born in 1872 in the Liberian capital of Monrovia. His paternal grandfather had been enslaved in the United States and immigrated to Liberia after purchasing his freedom; his maternal grandparents were medical missionaries who served in Liberia.
In 1889, Fuller moved to the United States and enrolled at Livingstone College in Salisbury, N.C. He pursued his medical studies at the Long Island College Hospital in Brooklyn and then at Boston University, where he received his MD in 1897. Following an internship at the Westborough Insane Hospital in Massachusetts, he began working as a pathologist there in 1899, the same year he joined the faculty of the Boston University School of Medicine as an instructor of pathology.
On Jan. 16, 1953, Fuller died at 80 of complications related to diabetes and gastrointestinal cancer.
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Trends In The Prevalence And Incidence Of Alzheimer’s Dementia Over Time
A growing number of studies indicate that the prevalence, – and incidence, , – of Alzheimer’s and other dementias in the United States and other higher-income Western countries may have declined in the past 25 years,, , – though results are mixed., , , These declines have been attributed to increasing levels of education and improved control of cardiovascular risk factors., , , , , Such findings are promising and suggest that identifying and reducing risk factors for Alzheimer’s and other dementias may be effective. Although these findings indicate that a person’s risk of dementia at any given age may be decreasing slightly, the total number of people with Alzheimer’s or other dementias in the United States and other high-income Western countries is expected to continue to increase dramatically because of the increase in the number of people at the oldest ages.
3.7.1 Looking to the future: Aging of the baby boom generation
- By 2025, the number of people age 65 and older with Alzheimer’s dementia is projected to reach 7.1 million â almost a 22% increase from the 5.8 million age 65 and older affected in 2020.,
- By 2050, the number of people age 65 and older with Alzheimer’s dementia is projected to reach 13.8 million, barring the development of medical breakthroughs to prevent, slow or cure Alzheimer’s disease.,
FIGURE 5
Use And Costs Of Health Care And Long
Among Medicare beneficiaries with Alzheimer’s or other dementias, black/African Americans had the highest Medicare payments per person per year, while whites had the lowest payments . The largest difference in payments was for hospital care, with black/African Americans incurring 1.7 times as much in hospital care costs as whites .
| Race/Ethnicity |
|---|
| 2,756 |
- Created from unpublished data from the National 5% Sample Medicare Fee-for-Service Beneficiaries for 2014.
In a study of Medicaid beneficiaries with a diagnosis of Alzheimer’s dementia that included both Medicaid and Medicare claims data, researchers found significant differences in the costs of care by race/ethnicity. These results demonstrated that black/African Americans had significantly higher costs of care than whites or Hispanics/Latinos, primarily due to more inpatient care and more comorbidities. These differences may be attributable to later-stage diagnosis, which may lead to higher levels of disability while receiving care; delays in accessing timely primary care; lack of care coordination; duplication of services across providers; or inequities in access to care. However, more research is needed to understand the reasons for this health care disparity.
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