November 15, 2006
It was 100 years ago that German physician Alois Alzheimer presented to his fellow doctors the first case history of the memory-robbing ailment that would come to bear his name. Progressive memory loss, accompanied by behavioral problems such as delusions and wandering, had afflicted his patient, Auguste Deter, for several years, leading to her death from Alzheimer's disease in 1906, at age 51.
Since that time, the medical profession has developed new medicines and made new progress in the care of those afflicted with the disease. Still, a cure for Alzheimer's has yet to be realized. Scientists around the world, aided by groups like the Fisher Center for Alzheimer's Research Foundation, continue to delve into the underlying causes of the disease as they search for a cure.
In this anniversary year, physicians from the U.K., the U.S., and Australia looked at the care of Alzheimer's 100 years ago, and compared it to care today. They note that the main advance in recent decades has been the development of drugs to treat the symptoms of Alzheimer's. Still, core principles of management remain the same. Their findings were published in The Lancet, a prominent medical journal in the U.K.
A look at various aspects of care, then and now, provides some illuminating insight into the need for continued research into this devastating ailment that affects some 25 million men and women worldwide.
Fortunately for Mrs. Deter, Dr. Alzheimer was a compassionate physician who paid close attention to creating a tolerant and appropriately stimulating environment for his patient. He also continued to see her as her disease progressed and became more difficult to manage. During the late stages of disease, keeping up morale and strong leadership are important for top-quality care. The authors note that in today's medical world, these close ties between a primary doctor and his or her patient is in jeopardy, as care becomes more dependent on medical specialists and high-tech services.
Today, a medical team may be called on to assess the person with Alzheimer's and memory loss. Doctors will conduct a thorough physical exam and medical history to rule out physical problems, such as constipation or drug side effects, that may be making symptoms worse. Friends and family would also be referred to patient support and education groups.
People with Alzheimer's are now diagnosed at a much earlier stage than when Dr. Alzheimer first saw Mrs. Deter more than 100 years ago, but today other, potentially treatable causes of dementia can at least be ruled out. Today, family members tend to be well informed about diseases such as Alzheimer's and the availability of drugs to treat it. Family members today might persuade a person like Auguste Deter to visit her doctor at the early stages of memory loss, and she might be given a diagnosis of mild cognitive impairment (MCI) after visiting a memory clinic.
At these earlier stages, it is important for people with MCI or early Alzheimer's to plan future financial matters. Patients and families can also be provided with information and details about organizations, such as The Fisher Center for Alzheimer's Research, who can provide support through Web sites such as www.ALZinfo.org.
The person with Alzheimer's might also be referred today to a team of specialists in early-stage Alzheimer's. They might also be offered help in terms of day-care or home aid. Support services are also available for the person with Alzheimer's. Doctors trained in behavioral problems might offer medications for problem behaviors like agitation and wandering. Much can be done before it is necessary for a person with Alzheimer's to enter a hospital or long-term-care facility.
For a person like Auguste Deter, suffering from behavioral disturbances like agitation, delusions, and wandering, care required a positive, tolerant, and calming approach. Dr. Alzheimer would know which of the nurses in his hospital had those traits and might see that they cared for his patient. Whether a person with Alzheimer's today is cared for in a hospital, a long-term-care facility, or at home, those same attributes are equally important. Research must be guided to develop effective management strategies that ease the burden of caregiving for the millions of people with Alzheimer's.
Alzheimer's disease is accompanied not just by memory loss and personality changes but by a wide range of behavioral disturbances as well. Auguste Deter suffered from anxiety, restlessness, wandering, agitation, delusions, and night-time behavioral disturbances. Such symptoms were distressing to her and made care difficult. Dr. Alzheimer began by treating her with non-drug treatments, such as recommending exercise as well as alcohol to promote sleep. He then moved on to the medications available at the time, such as sedatives.
A similar approach would be used today, with some notable differences because new drugs are available to treat Alzheimer's and its complications. Today, someone with Alzheimer's would probably be treated with a so-called cholinesterase inhibitor drug upon diagnosis. Such drugs slow progression of disease in the early stages and include Aricept, Exelon, and Razadyne. As symptoms grow worse, Namenda (generic name memantine) is often added to the drug regimen. Unfortunately, none of these drugs were available in Dr. Alzheimer's day. In addition, they do not work for everyone, and they do nothing to stop the relentless downward progression of the disease.
Drugs are also used to treat behavioral problems. Psychosis-fighting drugs, such as risperidone, are often prescribed. Unfortunately, these drugs have been linked to an increased risk of strokes and death. Although the risk is small, benefits and risks must be weighed carefully in people taking these drugs. Other drugs commonly prescribed include antidepressants, sleep aids, and anxiety-reducing medications.
Today, non-drug treatments are also often used to allay symptoms of Alzheimer's disease and ease stress, though few rigorous studies have been done on these therapies. Such treatments include bright light therapy, music therapy, aromatherapy (the use of pleasing scents), pet therapy, and psychological counseling.
A highly agitated patient might need to be put into the hospital or a special psychiatric unit that can offer targeted care. There, an occupational therapist might try non-drug treatments, such as doll therapy, aromatherapy. Nursing staff might ease night-time agitation with warm drinks, a soothing bath, and reassurance.
If long-term nursing care is necessary, nursing homes that specialize in management of Alzheimer's may be appropriate, particularly for those with serious behavioral problems like aggression. There, specially trained staff can provide psychological and behavioral counseling and programs. Doctors can provide medical care.
The Fisher Center for Alzheimer's Research Foundation funds vital research into the cause, care, and cure of Alzheimer's disease. To join the fight to end Alzheimer's, donate now at www.ALZinfo.org.
Konrad Maurer, Ian McKeith, Jeffrey Cummings, David Ames, Alistair Burns: "Has the Management of Alzheimer's Disease Changed Over the Past 100 Years?" The Lancet, Volume 368, November 4, 2006, pages 1619-1621.