BACKGROUND:   Alzheimer’s is the most common type of dementia that can cause problems with thinking, memory, and behavior.  Fifty to eighty percent of dementia cases are patients with Alzheimer’s.  The disease progressively gets worse, interfering with daily tasks.  The disease is fatal and there is currently not a known cure.  Although Alzheimer’s mostly affects people 65 and older, it is not just a disease of old age.  Close to four percent (or 200,000) of Americans, with the disease have early onset, also known as younger-onset, which appears when they are in their 40s or 50s.  In the early stages of Alzheimer’s, memory loss is mild.  However, as the disease progresses it can cause a person to lose their ability to respond to their surroundings and lose their ability to carry on a conversation. Alzheimer’s is the sixth leading cause of death in the United States.  On average, people live eight years after their symptoms are noticeable to others.  However, survival can range from four to 20 years depending on age and other health concerns.  (Source: www.alz.org)

7 STAGES OF ALZHEIMER’S:  Not everyone will experience the same symptoms or progress at the same rate.  However, Barry Reisberg, MD, clinical director of the New York University School of Medicine’s Silberstein Aging and Dementia Research Center, created a 7 stage framework for the disease:

• Stage 1:  No impairment.  The person does not have any memory problems
• Stage 2:  Very mild cognitive decline.  Person may feel as if they have memory lapses, but can’t be detected by an exam.
• Stage 3:  Mild Cognitive decline.  Family, friends, and co-workers begin to notice difficulties like remembering names, the right word, losing valuable objects, trouble organizing, etc.
• Stage 4: Moderate Cognitive decline (early-stage Alzheimer’s).  Medical interview should be able to detect it.  Symptoms include: forgetfulness of recent events, impaired ability to perform challenging mental arithmetic, forgetfulness about one’s own personal history, moody, and greater difficulty performing daily tasks.
• Stage 5:  Moderately severe cognitive decline.  Gaps in memory and thinking are noticeable and they begin to need help with day-to-day activities.  At this stage, they will not be able to recall their own address; they are confused about what day it is; and they need help choosing clothes.
• Stage 6:  Severe cognitive decline.  Memory continues to get worse, personality changes get worse, and they need extensive help with daily activities.
• Stage 7: Very severe cognitive decline.  They lose the ability to respond to their environment, to carry on a conversation, and eventually to control movement.  (Source: www.alz.org)  

NEW TECHNOLOGY:  An important aspect of treatment is early detection.  The FDA approved a new technology to detect Alzheimer’s, called Amyvid.  Its radioactive dye is used with positron emission tomography (PET) to visualize amyloid plaque buildup in the brain.  It’s designed to be used on adult patients with cognitive impairment.  A negative Amyvid scan shows scarce plaques and is inconsistent with a neuropathological diagnosis of Alzheimer’s.  It also reduces the likelihood that a patient’s cognitive impairment is caused by Alzheimer’s.  A positive Amyvid scan indicates moderate to frequent amyloid neuritic plaques; neuropathological examination has shown this amount of amyloid neuritic plaque is present in patients with the disease, but may also be present in patients with other types of neurologic conditions along with older people with normal cognition.  In other words, if a patient with dementia does not have amyloid buildup, then the cause of dementia is likely not to be Alzheimer’s.  If the scan shows they do have amyloid buildup, their chances of having Alzheimer’s increased.  A positive scan does not establish a diagnosis of Alzheimer’s, just increases their likelihood.  More research is needed to understand the appropriate use of florbetapir-PET imaging in Alzheimer’s diagnosis.  The FDA approval of Amyvid will expand the clinical and research opportunities for amyloid imaging.  The Alzheimer's Association has convened a task force with the Society of Nuclear Medicine to develop recommendations for the use of amyloid imaging for physicians, imaging and other medical specialists, Alzheimer families and the general public. (Source: www.alz.org)