Progress Report on Alzheimer’s Disease

1. Progress Report on Alzheimer’s Disease Taking the Next Steps NIA NIH

2. Alzheimer’s Disease (AD) • Age-related • Irreversible brain disorder • Occurs gradually • Results: memory loss • behavior/personality changes • decline in thinking abilities

3. Course of disease varies from person to person • Rate of decline varies • Ave. after Dx: 8-10 years • Advances from mild forgetfulness to severe loss of mental fx

4. Symptoms appear after 60 • EARLY LATE • loss of recent memory faulty judgement & personality changes • easily confused forget simple tasks

5. FINALLY: • become completely dependent on others for everyday care • become debilitated, likely to develop other illnesses/infections • Usually die of pneumonia

6. “Although the risk of developing AD increases wih age, AD and dementia symptoms are not a part of normal aging”. (p.2)

7. IMPACT OF AD • Most common cause of dementia among those 65& older • Up to 4 million currently have AD • Prevalence doubles every 5 years beyond age 65 • Numbers are bound to increase as the population ages

8. A Question: Are there differences in AD risk, incidence & prevalence among various racial/ethnic groups? • Why? #s of over-65 non-Caucasians is growing rapidly--increase from 16 to 34% by 2050 • African Americans & Hispanic Americans may have higher overall risk of AD

9. Impact of AD • Heavy economic burden on society--annual cost of care: • mild AD:$18,408 • moderate AD: $30,96 • severe AD: $36,132 • Tremendous caregiver burden

10. Impact of delaying AD onset: an enormous public health impact • Fed AD research areas: • causes/risk factors • diagnosis • treatment/caregiving

11. General AD Progress • Destruction of cells in hippocampus--failure of short term memory and easy tasks become more difficult • Attack on cells in cerebral cortex--loss of language skills & judgement-making abilities

12. As more & more of the brain becomes involved (atrophies): • Personality changes • Emotional outbursts • Wandering • Agitation • Finally--bedridden, incontinent, helpless & unresponsive to outside world

13. Main AD Features: Plaques & Tangles • Amyloid Plaques • Insoluble deposits of beta-amyloid • portions of neurons • non-nerve cells such as microglia • Are they a cause, or an effect of AD?

14. Neurofibrillary tangles • Primary component: tau proteins, which normally stabilize a cell’s internal support structure by binding and stabilizing microtubules

15. Types of AD • Familial AD (FAD)--early onset--only 5-10% of cases • Sporadic AD--late onset

16. Brain changes with normal aging • Some neurons in some regions die--most important to learning don’t • Some neurons shrink & function less well • Tangles & plaques develop in some regions • Inflammation increases • Oxidative stress increases

17. Free radicals--product of normal metabolism • --may be helpful to cells in fighting infection • --highly reactive • Production of too many is oxidative stress

18. Exploration of rel. of AD with other “diseases of aging” • Possible link between brain infarcts & AD • Blood cholesterol and rate of plaque deposition. • Parallels between AD & other progressive neurodegenerative disorders--all involve deposits of abnormal proteins in the brain

19. Can AD be treated? • FDA has approved 3 meds • 1993: Cognex • 1996: Aricept • 2000: Exelon • Slows symptom advance, but will not stop or reverse AD • Act by inhibiting acetylcholinesterase (enzyme that breaks down a key neurontransmitter)

20. AD Research areas/goals • Understanding etiology of AD • Improving early Dx • Developing drug Tx’s • Improving support for caregivers