Alzheimer's disease: Difference between revisions

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| Name          = Alzheimer's disease
| Name          = Alzheimer's disease
| Image          = Alzheimer dementia (3) presenile onset.jpg
| Image          = Alzheimer dementia (3) presenile onset.jpg
| Caption        = [[Histopathology|Histopathologic]] image of senile plaques seen in the cerebral cortex in a patient with Alzheimer disease of presenile onset. Silver impregnation.
| Caption        = [[Histopathology|Histopathologic]] image of senile plaques seen in the cerebral cortex in a patient with Alzheimer disease of presenile onset. Silver impregnation (souce: wikipedia.org)
| DiseasesDB    = 490
| DiseasesDB    = 490
| ICD10          = {{ICD10|G|30||g|30}}, {{ICD10|F|00||f|00}}
| ICD10          = {{ICD10|G|30||g|30}}, {{ICD10|F|00||f|00}}
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| OMIM          = 104300
| OMIM          = 104300
| MedlinePlus    = 000760
| MedlinePlus    = 000760
| eMedicineSubj  =
| eMedicineTopic =
| MeshID        = D000544
| MeshID        = D000544
|}}
|}}
{| class="infobox" style="float:right;"
|-
| [[File:Siren.gif|30px|link=Alzheimer's disease resident survival guide]]|| <br> || <br>
| [[Alzheimer's disease resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
{{Alzheimer's disease}}
{{Alzheimer's disease}}


'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


'''Editor(s)-in-Chief:''' [[C. Michael Gibson]], M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Peter Pressman, M.D. [mailto:pspressman@gmail.com], Northwestern Memorial Hospital, Department of Neurology
{{CMG}}; {{AE}} {{HK}}, {{ARK}}, {{Akshun}}, {{ADS}}, {{KS}}, {{HW}}
<p> Dr. Pressman has nothing to disclose. </p>


{{SK}} AD; Alzheimer disease; senile dementia of the Alzheimer type; SDAT; Alzheimer's
{{SK}} AD; Alzheimer's; Alzheimer dementia; Alzheimer disease; Alzheimer sclerosis; Alzheimer's syndrome; Alzheimer-type dementia; Presenile and senile dementia; Primary senile degenerative dementia; Senile dementia of the Alzheimer type; SDAT; Alzhiemer dementia; Alzhiemer's; Alzheimer's dementia care; Alzheimer's caregiving


==[[Alzheimer's disease overview|Overview]]==
==[[Alzheimer's disease overview|Overview]]==
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==[[Alzheimer's disease pathophysiology|Pathophysiology]]==
==[[Alzheimer's disease pathophysiology|Pathophysiology]]==
==[[Alzheimer's disease causes|Causes]]==


==[[Alzheimer's disease epidemiology and demographics|Epidemiology and Demographics]]==
==[[Alzheimer's disease epidemiology and demographics|Epidemiology and Demographics]]==
==[[Alzheimer's disease risk factors|Risk Factors]]==


==[[Alzheimer's disease natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==[[Alzheimer's disease natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
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== Diagnosis ==  
== Diagnosis ==  


:[[Alzheimer's disease history and symptoms| History and Symptoms]] | [[Alzheimer's disease physical examination | Physical Examination]] | [[Alzheimer's disease laboratory studies | Lab Studies]] | [[Alzheimer's disease electrocardiogram|Electrocardiogram]] | [[Alzheimer's disease chest x ray|Chest X Ray]] |  [[Alzheimer's disease MRI|MRI]] | [[Alzheimer's disease CT|CT]] | [[Alzheimer's disease echocardiography|Echocardiography]] | [[Alzheimer's disease other imaging findings|Other imaging findings]]
[[Alzheimer's disease diagnostic criteria|Diagnostic criteria]] | [[Alzheimer's disease history and symptoms|History and Symptoms]] | [[Alzheimer's disease physical examination | Physical Examination]] | [[Alzheimer's disease laboratory findings | Laboratory findings]] | [[Alzheimer's disease electrocardiogram | Electrocardiogram]] | [[Alzheimer's disease X-ray | X-ray]] | [[Alzheimer's disease CT scan | CT scan]] | [[Alzheimer's disease MRI | MRI]] | [[Alzheimer's disease other imaging findings|Other Imaging Findings]] | [[Alzheimer's disease other diagnostic studies|Other diagnostic studies]]
 
==Background==
'''Alzheimer's disease''' ('''AD'''), also called '''Alzheimer disease''', '''Senile Dementia of the Alzheimer Type''' (SDAT) or simply '''Alzheimer's''', is the most common form of [[dementia]].
 
Although each sufferer experiences Alzheimer's in a unique way, there are many common symptoms.<ref name="alzheimers.org">
{{cite web
| title=What is Alzheimer’s disease?
| url=http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=100
| publisher=Alzheimers.org.uk
| year=2007
| month=August
| accessdate=2008-02-21
}}</ref> The earliest observable symptoms are often mistakenly thought to be 'age-related' changes, or manifestations of [[Stress (medicine)|stress]].<ref name="pmid17222085">{{cite journal
|author=Waldemar G, Dubois B, Emre M, ''et al''
|title=Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline
|journal=Eur. J. Neurol.
|volume=14
|issue=1
|pages=e1–26
|year=2007
|month=January
|pmid=17222085
|doi=10.1111/j.1468-1331.2006.01605.x
}}</ref> The most commonly recognized symptom of early Alzheimer's disease is [[memory loss]], usually the forgetting of recently learned facts. As the disease advances, symptoms include [[Mental confusion|confusion]], irritability and aggression, [[mood swing]]s, language breakdown, [[long-term memory]] loss, and the general withdrawal of the sufferer as their senses decline.<ref name="pmid17222085"/><ref name="pmid17823840">
{{cite journal
|author=Tabert MH, Liu X, Doty RL, Serby M, Zamora D, Pelton GH, Marder K, Albers MW, Stern Y, Devanand DP
|title=A 10-item smell identification scale related to risk for Alzheimer's disease
|journal=Ann. Neurol.
|volume=58
|issue=1
|pages=155–160
|year=2005
|pmid=15984022
|doi=10.1002/ana.20533
}}</ref> Gradually, bodily functions are lost, ultimately leading to death.<ref name="nihstages">
{{cite web
| title=Understanding stages and symptoms of Alzheimer's disease
| url=http://www.nia.nih.gov/Alzheimers/Publications/stages.htm
| publisher=National Institute on Aging
| date=2007-10-26
| accessdate=2008-02-21
}}</ref> When a doctor or physician has been notified, and AD is suspected, the diagnosis is usually further supported by behavioral assessments and [[cognitive tests]], often followed by a [[neuroimaging|brain scan]] if available.<ref name="alzres">
{{cite web
| title=Alzheimer's diagnosis of AD
| url=http://www.alzheimers-research.org.uk/info/diagnosis/
| publisher=Alzheimer's Research Trust
| accessdate=2008-02-29
}}</ref> Individual [[prognosis]] is difficult to assess, as the duration of the disease varies. AD develops for an indeterminate period of time before becoming fully apparent, and it can progress undiagnosed for years. The mean life expectancy following diagnosis is approximately seven years.<ref name="pmid3776457">{{cite journal
|author=Mölsä PK, Marttila RJ, Rinne UK
|title=Survival and cause of death in Alzheimer's disease and multi-infarct dementia
|journal=Acta Neurol. Scand.
|volume=74
|issue=2
|pages=103–7
|year=1986
|month=August
|pmid=3776457
|accessdate=2008-08-04
}}</ref> Fewer than three percent of individuals live more than fourteen years after diagnosis.<ref name="pmid7793228">{{cite journal
|author=Mölsä PK, Marttila RJ, Rinne UK
|title=Long-term survival and predictors of mortality in Alzheimer's disease and multi-infarct dementia
|journal=Acta Neurol. Scand.
|volume=91
|issue=3
|pages=159–64
|year=1995
|month=March
|pmid=7793228
}}</ref>
 
The cause of Alzheimer's disease is poorly understood.  Research indicates that the disease is associated with [[Senile plaques|plaques]] and [[neurofibrillary tangles|tangles]] in the [[brain]].<ref name="pmid15184601"/> Currently-used treatments offer a small symptomatic benefit.  No treatments to halt the progression of the disease are yet available. As of 2010, more than 700 [[clinical trials]] were investigating possible treatments for AD, but it is unknown if any of them will prove successful.<ref>{{cite web
|url=http://www.clinicaltrials.gov/ct2/results?term=alzheimer
|title= Alzheimer's Disease Clinical Trials
|accessdate= 2008-08-18
|publisher= US National Institutes of Health
}}</ref> Many measures have been suggested for the [[preventive medicine|prevention]] of Alzheimer's disease, but the value of these measures is unproven in slowing the course and reducing the severity of the disease. Mental stimulation, [[exercise]], and a [[balanced diet]] are often recommended as both a possible prevention and a sensible way of managing the disease.<ref name="prevention1">
{{cite web
| title=Can Alzheimer's disease be prevented
| url=http://www.nia.nih.gov/NR/rdonlyres/63B5A29C-F943-4DB7-91B4-0296772973F3/0/CanADbePrevented.pdf
| format=pdf
| publisher=National Institute on Aging
| accessdate=2008-02-29
| date =2006-08-29
}}</ref>
 
Because AD cannot be cured, management of patients is essential as the disease progresses. The role of the main caregiver is often taken by a spouse or a close relative.<ref name="metlife.com">{{cite web
| title= The MetLife study of Alzheimer’s disease: The caregiving experience
| month= August | year= 2006
| url=http://www.metlife.com/WPSAssets/14050063731156260663V1FAlzheimerCaregivingExperience.pdf
| publisher=MetLife Mature Market Institute
| format=PDF
| accessdate=2008-02-12
}}</ref> Alzheimer's disease is known for [[caregiving and dementia|placing a great burden on caregivers]]; the pressures can be wide-ranging, affecting social, psychological, physical, and economic components of the caregiver's life.<ref name="pmid17662119">{{cite journal
|author=Thompson CA, Spilsbury K, Hall J, Birks Y, Barnes C, Adamson J
|title=Systematic review of information and support interventions for caregivers of people with dementia
|journal=BMC Geriatr
|volume=7
|pages=18
|year=2007
|pmid=17662119
|pmc=1951962
|doi=10.1186/1471-2318-7-18
}}</ref><ref name="pmid10489656">{{cite journal
|author=Schneider J, Murray J, Banerjee S, Mann A
|title=EUROCARE: a cross-national study of co-resident spouse carers for people with Alzheimer's disease: I—Factors associated with carer burden
|journal=International Journal of Geriatric Psychiatry
|volume=14
|issue=8
|pages=651–661
|year=1999
|month=August
|pmid=10489656
|doi=10.1002/(SICI)1099-1166(199908)14:8<651::AID-GPS992>3.0.CO;2-B
|accessdate=2008-07-04
}}</ref><ref name="pmid10489657">{{cite journal
|author=Murray J, Schneider J, Banerjee S, Mann A
|title=EUROCARE: a cross-national study of co-resident spouse carers for people with Alzheimer's disease: II--A qualitative analysis of the experience of caregiving
|journal=International Journal of Geriatric Psychiatry
|volume=14
|issue=8
|pages=662–667
|year=1999
|month=August
|pmid=10489657
|doi=10.1002/(SICI)1099-1166(199908)14:8<662::AID-GPS993>3.0.CO;2-4
}}</ref> In developed countries, AD is one of the most economically costly diseases to society.<ref name="pmid15685097">{{cite journal
|author=Bonin-Guillaume S, Zekry D, Giacobini E, Gold G, Michel JP
|title=Impact économique de la démence (English: The economical impact of dementia)
|language=French
|journal=Presse Med
|issn=0755-4982
|volume=34
|issue=1
|pages=35–41
|year=2005
|month=January
|pmid=15685097
}}</ref><ref name="pmid9543467">{{cite journal
|author=Meek PD, McKeithan K, Schumock GT
|title=Economic considerations in Alzheimer's disease
|journal=Pharmacotherapy
|volume=18
|issue=2 Pt 2
|pages=68–73; discussion 79–82
|year=1998
|pmid=9543467
}}</ref>
 
==Prevention==
[[Image:Honoré Daumier 032.jpg|left|thumb|220px|Intellectual activities such as playing chess or regular social interaction have been linked to a reduced risk of AD in epidemiological studies, although no causal relationship has been found.]]
 
Specific measures to delay or prevent the onset of AD are lacking.  This is due to contradictory results in global studies, as well as a paucity of proven causal relationships between risk factors and the disease.<ref>Prevention recommendations not supported:
* {{cite journal |author=Kawas CH |title=Medications and diet: protective factors for AD? |journal=Alzheimer Dis Assoc Disord |volume=20 |issue=3 Suppl 2 |pages=S89–96 |year=2006 |pmid=16917203 |doi=}}
* {{cite journal |author=Luchsinger JA, Mayeux R |title=Dietary factors and Alzheimer's disease |journal=Lancet Neurol |volume=3 |issue=10 |pages=579–87 |year=2004 |pmid=15380154 |doi=10.1016/S1474-4422(04)00878-6}}
* {{cite journal |author=Luchsinger JA, Noble JM, Scarmeas N |title=Diet and Alzheimer's disease |journal=Curr Neurol Neurosci Rep |volume=7 |issue=5 |pages=366–72 |year=2007 |pmid=17764625 |doi=10.1007/s11910-007-0057-8 }}
</ref>
Modifiable factors such as diet, cardiovascular risks, pharmaceutical products, or intellectual activities have all been evaluated with epidemiological studies to see if they increase a population's risk of developing AD.<ref>
{{cite journal
|author=Szekely CA, Breitner JC, Zandi PP
|title=Prevention of Alzheimer's disease
|journal=Int Rev Psychiatry
|volume=19
|issue=6
|pages=693–706
|year=2007
|pmid=18092245
|doi=10.1080/09540260701797944
}}</ref>
 
The components of a [[Mediterranean diet]], which include fruit and vegetables, [[bread]], [[wheat]] and other [[cereal]]s, [[olive oil]], [[fish]], and [[red wine]], may reduce the risk and course of Alzheimer's disease. There is evidence that frequent and moderate consumption of alcohol (beer, wine or distilled spirits) reduces the risk of the disease,<ref>Alcohol:
*{{cite journal |author=Mulkamal KJ, et al. |title=Prospective study of alcohol consumption and risk of dementia in older adults. |journal=Journal of the American Medical Association |date=2003-03-19 |volume=289|pages=1405-1413}}
*{{cite journal |author=Ganguli M, et al. |title=Alcohol consumption and cognitive function in late life: A longitudinal community study. |journal=Neurology |year=2005 |volume=65 |pages=1210-1217}}
*{{cite journal |author=Huang W, et al. |title=Alcohol consumption and incidence of dementia in a community sample aged 75 years and older. |journal=Journal of Clinical Epidemiology |year=2002 |volume=55|issue=10 |pages=959-964}}
*{{cite journal |author=Rodgers B, et al. |title=Non-linear relationships between cognitive function and alcohol consumption in young, middle-aged and older adults: The PATH Through Life Project. |journal=Addiction |year=2005|volume=100|issue=9 |pages=1280-1290 }}
*{{cite journal |author=Anstey KJ, et al. |title=Lower cognitive test scores observed in alcohol are associated with demographic, personality, and biological factors: The PATH Through Life Project. |journal=Addiction |year=2005 |volume=100 |issue=9 |pages=1291-1301; }}{{cite journal|author=Espeland, M., et al. |title=Association between alcohol intake and domain-specific cognitive function in older women. |journal=Neuroepidemiology |year=2006 |volume=1 |issue=27 |pages=1-12 }}
*{{cite journal |author=Stampfer MJ, et al. |title=Effects of moderate alcohol consumption on cognitive function in women. |journal=New England Journal of Medicine |year=2005 |volume=352 |pages=245-253}}
*{{cite journal |author=Ruitenberg A, et al. |title=Alcohol consumption and risk of dementia: the Rotterdam Study. |journal=Lancet |year=2002 |volume=359 |issue=9303 |pages=281-286}}
*{{cite journal |author=Scarmeas N, et al. |title=Mediterranean diet and risk for Alzheimer’s disease. |journal=Annals of Neurology |year=2006 |date=2006-04-18}}
</ref> <ref> Mediterranean diet:
* {{cite journal
|author=Scarmeas N, Stern Y, Mayeux R, Luchsinger JA
|title=Mediterranean diet, Alzheimer disease, and vascular mediation
|journal=Arch. Neurol.
|volume=63
|issue=12
|pages=1709–1717
|year=2006
|pmid=17030648
|doi=10.1001/archneur.63.12.noc60109
}}
* {{cite journal
|author=Scarmeas N, Luchsinger JA, Mayeux R, Stern Y
|title=Mediterranean diet and Alzheimer disease mortality
|journal=Neurology
|volume=69
|issue=11
|pages=1084–93
|year=2007
|pmid=17846408
|doi=10.1212/01.wnl.0000277320.50685.7c
}}
* {{cite journal
|author=Barberger-Gateau P, Raffaitin C, Letenneur L, Berr C, Tzourio C, Dartigues JF, Alpérovitch A
|title=Dietary patterns and risk of dementia: the Three-City cohort study
|journal=Neurology
|volume=69
|issue=20
|pages=1921–1930
|year=2007
|pmid=17998483
|doi=10.1212/01.wnl.0000278116.37320.52
}}
* {{cite journal
|author=Dai Q, Borenstein AR, Wu Y, Jackson JC, Larson EB
|title=Fruit and vegetable juices and Alzheimer's disease: the Kame Project
|journal=American Journal of Medicine
|volume=119
|issue=9
|pages=751–759
|year=2006
|pmid=16945610
|doi=10.1016/j.amjmed.2006.03.045
}}
* {{cite journal
|author=Savaskan E, Olivieri G, Meier F, Seifritz E, Wirz-Justice A, Müller-Spahn F
|title=Red wine ingredient resveratrol protects from beta-amyloid neurotoxicity
|journal=Gerontology
|volume=49
|issue=6
|pages=380–383
|year=2003
|pmid=14624067
|doi=10.1159/000073766
}}</ref> but it is still considered premature to make dietary recommendations on this basis.<ref>
{{cite journal|quote=Available data do not permit definitive conclusions regarding diet and AD or specific recommendations on diet modification for the prevention of AD. ||title=Dietary factors and Alzheimer's disease. |author=Luchsinger JA, Mayeux R |pmid=15380154 |journal=Lancet Neurology |date=2004 Oct |volume=3 |issue=10 |pages=579-587 }}</ref><ref>
{{cite journal
|title=Medications and diet: protective factors for AD?
|author=Kawas CH
|pmid=16917203
|journal=Alzheimer Dis Assoc Disord
|date=2006 Jul-Sep
|volume=20
|issue=3 Suppl 2
|pages=S89-96
|quote=Evidence regarding dietary and supplemental intake of vitamins E, C, and folate, and studies of alcohol and wine intake are also reviewed. At present, there is insufficient evidence to make public health recommendations, but these studies can provide potentially important clues and new avenues for clinical and laboratory research.
}}</ref> [[vitamin E|Vitamins E]], [[B-vitamins|B]], and [[vitamin C|C]], or [[folic acid]] have appeared to be related to a reduced risk of AD,<ref>Vitamins:
* {{cite journal
|author=Morris MC, Schneider JA, Tangney CC
|title=Thoughts on B-vitamins and dementia
|journal=J. Alzheimers Dis.
|volume=9
|issue=4
|pages=429–33
|year=2006
|pmid=16917152
|doi=
}}
* {{cite web
|url=http://www.alz.org/alzheimers_disease_10428.asp
|author=Alzheimer's Association
|title=Vitamin E
}}
* {{cite journal
|author=Landmark K
|title=[Could intake of vitamins C and E inhibit development of Alzheimer dementia?]
|language=Norwegian
|journal=Tidsskr. Nor. Laegeforen.
|volume=126
|issue=2
|pages=159–61
|year=2006
|pmid=16415937
|doi=
}}
* {{cite journal
|author=Luchsinger JA, Tang MX, Miller J, Green R, Mayeux R
|title=Relation of higher folate intake to lower risk of Alzheimer disease in the elderly
|journal=Arch. Neurol.
|volume=64
|issue=1
|pages=86–92
|year=2007
|pmid=17210813
|doi=10.1001/archneur.64.1.86
}}</ref>
but other studies indicate that they do not have any significant effect on the onset or course of the disease, but may have important secondary effects in conjunction with other therapies.<ref>Vitamins only of secondary benefit:
* {{cite journal
|author=Morris MC, Evans DA, Schneider JA, Tangney CC, Bienias JL, Aggarwal NT
|title=Dietary folate and vitamins B-12 and B-6 not associated with incident Alzheimer's disease
|journal=J. Alzheimers Dis.
|volume=9
|issue=4
|pages=435–43
|year=2006
|pmid=16917153
|doi=
}}
* {{cite journal
|author=Malouf M, Grimley EJ, Areosa SA
|title=Folic acid with or without vitamin B12 for cognition and dementia
|journal=Cochrane Database Syst Rev
|volume=
|issue=4
|pages=CD004514
|year=2003
|pmid=14584018
|doi=10.1002/14651858.CD004514
}}
* {{cite journal
|author=Sun Y, Lu CJ, Chien KL, Chen ST, Chen RC
|title=Efficacy of multivitamin supplementation containing vitamins B6 and B12 and folic acid as adjunctive treatment with a cholinesterase inhibitor in Alzheimer's disease: a 26-week, randomised, double-blind, placebo-controlled study in Taiwanese patients
|journal=Clin Ther
|volume=29
|issue=10
|pages=2204–14
|year=2007
|pmid=18042476
|doi=10.1016/j.clinthera.2007.10.012
}}
* {{cite journal
|author=Boothby LA, Doering PL
|title=Vitamin C and vitamin E for Alzheimer's disease
|journal=Ann Pharmacother
|volume=39
|issue=12
|pages=2073–80
|year=2005
|pmid=16227450
|doi=10.1345/aph.1E495
}}
* {{cite journal
|author=Gray SL, Anderson ML, Crane PK, Breitner JC, McCormick W, Bowen JD, Teri L, Larson E
|title=Antioxidant vitamin supplement use and risk of dementia or Alzheimer's disease in older adults
|journal=J Am Geriatr Soc
|volume=56
|issue=2
|pages=291–295
|year=2008
|pmid=18047492
|doi=10.1111/j.1532-5415.2007.01531.x
}}</ref> [[Curcumin]] in curry has shown some effectiveness in preventing brain damage in [[mouse model]]s.<ref>Curcumin in diet:
* {{cite journal
|author=Garcia-Alloza M, Borrelli LA, Rozkalne A, Hyman BT, Bacskai BJ
|title=Curcumin labels amyloid pathology in vivo, disrupts existing plaques, and partially restores distorted neurites in an Alzheimer mouse model
|journal=Journal of Neurochemistry
|volume=102
|issue=4
|pages=1095–1104
|year=2007
|pmid=17472706
|doi=10.1111/j.1471-4159.2007.04613.x
}}
* {{cite journal
|author=Lim GP, Chu T, Yang F, Beech W, Frautschy SA, Cole GM
|title=The curry spice curcumin reduces oxidative damage and amyloid pathology in an Alzheimer transgenic mouse
|journal=Journal of Neuroscience
|volume=21
|issue=21
|pages=8370–8377
|year=2001
|pmid=11606625
|doi=
}}</ref>
 
Although cardiovascular risk factors, such as [[hypercholesterolemia]], [[hypertension]], [[diabetes]], and smoking, are associated with a higher risk of onset and course of AD,<ref name="pmid17483665">{{cite journal |author=Rosendorff C, Beeri MS, Silverman JM |title=Cardiovascular risk factors for Alzheimer's disease |journal=Am J Geriatr Cardiol |volume=16 |issue=3 |pages=143–9 |year=2007 |pmid=17483665 |doi=10.1111/j.1076-7460.2007.06696.x}}</ref><ref name="obesity">{{cite journal
|author=Gustafson D, Rothenberg E, Blennow K, Steen B, Skoog I
|title=An 18-year follow-up of overweight and risk of Alzheimer disease
|journal=Arch. Intern. Med.
|volume=163
|issue=13
|pages=1524–1528
|year=2003
|pmid=12860573
|doi=10.1001/archinte.163.13.1524
}}</ref> [[statins]], which are [[cholesterol]] lowering drugs, have not been effective in preventing or improving the course of the disease.<ref name="pmid17927279">{{cite journal |author=Reiss AB, Wirkowski E |title=Role of HMG-CoA reductase inhibitors in neurological disorders : progress to date |journal=Drugs |volume=67 |issue=15 |pages=2111–2120 |year=2007 |pmid=17927279 |doi=}}</ref><ref name="pmid17877925">{{cite journal |author=Kuller LH |title=Statins and dementia |journal=Current Atherosclerosis Reports |volume=9 |issue=2 |pages=154–161 |year=2007 |pmid=17877925 |doi=10.1007/s11883-007-0012-9 }}</ref> However long-term usage of [[non-steroidal anti-inflammatory drug]] (NSAIDs), is associated with a reduced likelihood of developing AD in some individuals.<ref name="pmid18003940">
{{cite journal
|author=Szekely CA, Breitner JC, Fitzpatrick AL, Rea TD, Psaty BM, Kuller LH, Zandi PP
|title=NSAID use and dementia risk in the Cardiovascular Health Study: role of APOE and NSAID type
|journal=Neurology
|volume=70
|issue=1
|pages=17–24
|year=2008
|pmid=18003940
|doi=10.1212/01.wnl.0000284596.95156.48
}}</ref><ref>
{{cite news
|title=Long-term use of ibuprofen may reduce the risk of developing Alzheimer's disease, a large US study reports.
|publisher=BBC
|date=2008-05-05
|url=http://news.bbc.co.uk/1/hi/health/7380064.stm
}}</ref><ref>
{{cite news
|title=Ibuprofen Linked to Reduced Alzheimer's Risk
|publisher=Washington Post
|date=2008-05-05
|url=http://www.washingtonpost.com/wp-dyn/content/article/2008/05/05/AR2008050501839.html
}}</ref>
 
Other pharmaceutical therapies such as female [[hormone replacement therapy]] are no longer thought to prevent dementia,<ref name="pmid17882683">{{cite journal |author=Craig MC, Murphy DG |title=Estrogen: effects on normal brain function and neuropsychiatric disorders |journal=Climacteric |volume=10 Suppl 2 |issue= |pages=97–104 |year=2007 |pmid=17882683 |doi=10.1080/13697130701598746}}</ref><ref name="pmid17767023">{{cite journal |author=Mori K, Takeda M |title=Hormone replacement Up-to-date. Hormone replacement therapy and brain function|language=Japanese |journal=Clin Calcium |volume=17 |issue=9 |pages=1349–1354 |year=2007 |pmid=17767023 |doi=CliCa070913491354}}</ref> and a 2007 [[systematic review]] concluded that there was inconsistent and unconvincing evidence that [[Ginkgo Biloba|ginkgo]] has any positive effect on dementia or cognitive impairment.<ref>{{cite journal
|author=Birks J, Grimley Evans J
|title=Ginkgo biloba for cognitive impairment and dementia
|journal=Cochrane Database Syst Rev
|volume=
|issue=2
|pages=CD003120
|year=2007
|pmid=17443523
|doi=10.1002/14651858.CD003120.pub2
|url= http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003120/frame.html
|accessdate=2008-02-22
}}</ref>
 
Intellectual activities such as playing chess, completing crossword puzzles or regular social interaction may also delay the onset or reduce the severity of Alzheimer's disease.<ref>{{cite journal | author=Verghese J, Lipton R, Katz M, Hall C, Derby C, Kuslansky G, Ambrose A, Sliwinski M, Buschke H | title=Leisure activities and the risk of dementia in the elderly. |journal=N Engl J Med | volume=348 | issue=25 | pages=2508–2516 | year=2003 | pmid=12815136 |doi=10.1056/NEJMoa022252 }}</ref><ref name="pmid16632311">{{cite journal
|author=Bennett DA, Schneider JA, Tang Y, Arnold SE, Wilson RS
|title=The effect of social networks on the relation between Alzheimer's disease pathology and level of cognitive function in old people: a longitudinal cohort study
|journal=Lancet Neurol
|volume=5
|issue=5
|pages=406–412
|year=2006
|pmid=16632311
|doi=10.1016/S1474-4422(06)70417-3
}}</ref> Bilingualism is also related to a later onset of Alzheimer's disease.<ref>{{cite journal | author=Bialystok E, Craik FIM, Freedman M |title=Bilingualism as a protection against the onset of symptoms of dementia|journal=Neuropsychologia |volume=42 |issue=2 |pages=459-464 |year=2007 |pmid= |doi=10.1016/j.neuropsychologia.2006.10.009}}</ref>
 
==Management==
There is no known cure for Alzheimer's disease. Available treatments offer relatively small symptomatic benefit but remain [[palliative care|palliative]] in nature. Current treatments can be divided into pharmaceutical, psychosocial and caregiving.
 
===Psychosocial intervention===
[[Image:Snoezelruimte.JPG|righ|220px|thumb|A specifically designed room for sensory integration therapy, or snoezelen; an emotion-oriented psychosocial intervention for people with dementia]]
[[Psychosocial]] interventions are used as an adjunct to pharmaceutical treatment and can be classified within behavior, emotion, cognition or stimulation oriented approaches. Research on efficacy is unavailable and rarely specific to Alzheimer's disease, focusing instead on dementia as a whole.<ref name="pracGuideAPA">{{cite web
| url=http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007
| format=PDF
| title =Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias
| publisher =[[American Psychiatric Association]]
| date=October 2007
| accessdate=2007-12-28
| doi=10.1176/appi.books.9780890423967.152139
}}</ref>
 
[[Behavior modification|Behavioral interventions]] attempt to identify and reduce the antecedents and consequences of problem behaviors. This approach has not shown success in the overall functioning of patients,<ref name="pmid16323385">{{cite journal
|author=Bottino CM, Carvalho IA, Alvarez AM, ''et al''
|title=Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study
|journal=Clin Rehabil
|volume=19
|issue=8
|pages=861–869
|year=2005
|pmid=16323385
|doi=10.1191/0269215505cr911oa
}}</ref>
but can help to reduce some specific problem behaviors, such as [[Urinary incontinence|incontinence]].<ref name="pmid11342679">{{cite journal
|author=Doody RS, Stevens JC, Beck C, ''et al''
|title=Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology
|journal=Neurology
|volume=56
|issue=9
|pages=1154–1166
|year=2001
|pmid=11342679
|doi=
}}</ref> There is still a lack of high quality data on the effectiveness of these techniques in other behavior problems such as wandering.<ref name="pmid17253573">{{cite journal
|author=Hermans DG, Htay UH, McShane R
|title=Non-pharmacological interventions for wandering of people with dementia in the domestic setting
|journal=Cochrane Database Syst Rev
|volume=
|issue=1
|pages=CD005994
|year=2007
|pmid=17253573
|doi=10.1002/14651858.CD005994.pub2
}}</ref><ref name="pmid17096455">{{cite journal
|author=Robinson L, Hutchings D, Dickinson HO, ''et al''
|title=Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review
|journal=Int J Geriatr Psychiatry
|volume=22
|issue=1
|pages=9–22
|year=2007
|pmid=17096455
|doi=10.1002/gps.1643
}}</ref>
 
Emotion-oriented interventions include [[reminiscence therapy]], [[validation therapy]], supportive [[psychotherapy]], sensory integration or [[snoezelen]], and [[simulated presence therapy]]. Supportive psychotherapy has received little or no formal scientific study, but some clinicians find it useful in helping mildly impaired patients adjust to their illness.<ref name="pracGuideAPA">{{{{cite web
| url=http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007
| format=PDF
| title =Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias
| publisher =[[American Psychiatric Association]]
| date=October 2007
| accessdate=2007-12-28
| doi=10.1176/appi.books.9780890423967.152139
}}</ref>
Reminiscence therapy (RT) involves the discussion of past experiences individually or in group, often with the aid of photographs, household items, music and sound recordings, or other familiar items from the past. Although there are few quality studies on the effectiveness of RT it may be beneficial for [[cognition]] and [[Mood (psychology)|mood]].<ref name="pmid15846613">{{cite journal
|author=Woods B, Spector A, Jones C, Orrell M, Davies S
|title=Reminiscence therapy for dementia
|journal=Cochrane Database Syst Rev
|volume=
|issue=2
|pages=CD001120
|year=2005
|pmid=15846613
|doi=10.1002/14651858.CD001120.pub2
}}</ref>
Simulated presence therapy (SPT) is based on [[Attachment theory|attachment theories]] and is normally carried out playing a recording with voices of the closest relatives of the patient. There is preliminary evidence indicating that SPT may reduce [[anxiety]] and [[Challenging behaviour|challenging behaviors]].<ref name="pmid11827626">{{cite journal
|author=Peak JS, Cheston RI
|title=Using simulated presence therapy with people with dementia
|journal=Aging Ment Health
|volume=6
|issue=1
|pages=77–81
|year=2002
|pmid=11827626
|doi=10.1080/13607860120101095
}}</ref><ref name="pmid10203120">{{cite journal
|author=Camberg L, Woods P, Ooi WL, ''et al''
|title=Evaluation of Simulated Presence: a personalised approach to enhance well-being in persons with Alzheimer's disease
|journal=J Am Geriatr Soc
|volume=47
|issue=4
|pages=446-452
|year=1999
|pmid=10203120
|doi=
}}</ref>
Finally, validation therapy is based on acceptance of the reality and personal truth of another's experience, while sensory integration is based on exercises aimed to stimulate [[sense]]s. There is little evidence to support the usefulness of these therapies.<ref name="pmid12917907">{{cite journal
|author=Neal M, Briggs M
|title=Validation therapy for dementia
|journal=Cochrane Database Syst Rev
|volume=
|issue=3
|pages=CD001394
|year=2003
|pmid=12917907
|doi=10.1002/14651858.CD001394
}}</ref><ref name="pmid12519587">{{cite journal
|author=Chung JC, Lai CK, Chung PM, French HP
|title=Snoezelen for dementia
|journal=Cochrane Database Syst Rev
|volume=
|issue=4
|pages=CD003152
|year=2002
|pmid=12519587
|doi=10.1002/14651858.CD003152
}}</ref>
 
The aim of cognition-oriented treatments, which include reality orientation and [[Rehabilitation (neuropsychology)|cognitive retraining]] is the restoration of [[cognitive deficit]]s. Reality orientation consists of the presentation of information about time, place or person in order to ease the the patient's understanding of their surroundings. On the other hand, cognitive retraining tries to improve impaired capacities by exercising mental abilities. Both have shown some efficacy improving cognitive capacities,<ref name="pmid17636652">{{cite journal
|author=Spector A, Orrell M, Davies S, Woods B
|title=WITHDRAWN: Reality orientation for dementia
|journal=Cochrane Database Syst Rev
|volume=
|issue=3
|pages=CD001119
|year=2000
|pmid=17636652
|doi=10.1002/14651858.CD001119.pub2
}}</ref><ref name="pmid12948999">{{cite journal
|author=Spector A, Thorgrimsen L, Woods B, ''et al''
|title=Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial
|journal=Br J Psychiatry
|volume=183
|issue=
|pages=248–254
|year=2003
|pmid=12948999
|doi=10.1192/bjp.183.3.248
}}</ref> although in some works these effects were transient. Negative effects, such as frustration, have also been reported.<ref name="pracGuideAPA">{{{{cite web
| url=http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007
| format=PDF
| title=Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias
| publisher=[[American Psychiatric Association]]
| date=October 2007
| accessdate=2007-12-28
| doi=10.1176/appi.books.9780890423967.152139
}}</ref>
 
Stimulation-oriented treatments include [[Art therapy|art]], [[Music therapy|music]] and [[Animal-assisted therapy|pet]] therapies, [[Physical therapy|exercise]], and any other kind of [[Recreational therapy|recreational activities]] for patients. Stimulation has modest support for improving behavior, mood, and, to a lesser extent, function. Nevertheless, as important as these effects are, the main support for the use of stimulation therapies is the improvement in the patient's daily life, as opposed to improving the underlying disease course.<ref name="pracGuideAPA">{{cite web
| url=http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007
| format=PDF
| title =Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias
| publisher =[[American Psychiatric Association]]
| date=October 2007
| accessdate=2007-12-28
| doi=10.1176/appi.books.9780890423967.152139
}}</ref>
 
===Caregiving===
{{Further|[[Caregiving and dementia]]}}
 
Since there is no cure for Alzheimer's, caregiving is an essential part of the treatment. Due to the eventual inability for the sufferer to self-care, Alzheimer's has to be carefully care-managed. Home care in the familiar surroundings of home may delay onset of some symptoms and delay or eliminate the need for more professional and costly levels of care.<ref>{{cite journal
|author=Gaugler JE, Kane RL, Kane RA, Newcomer R
|title=Early community-based service utilization and its effects on institutionalization in dementia caregiving
|journal=Gerontologist
|volume=45
|issue=2
|pages=177–85
|year=2005
|month=April
|pmid=15799982
|doi=
|url=http://gerontologist.gerontologyjournals.org/cgi/pmidlookup?view=long&pmid=15799982
|accessdate=2008-05-30
}}</ref> Many family members choose to look after their relative,<ref name="burden1"/> but two-thirds of nursing home residents have dementias.<ref>
{{cite web
| url=http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=AlzPG101007
| format=PDF
| title =Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias
| publisher =[[American Psychiatric Association]]
| date=October 2007
| accessdate=2007-12-28
| doi=10.1176/appi.books.9780890423967.152139
}}</ref>
 
Modifications to the living environment and lifestyle of the Alzheimer's patient can improve functional performance and ease caretaker burden. Assessment by an [[occupational therapist]] is often indicated. Adherence to simplified routines and labeling of household items to cue the patient can aid with [[activities of daily living]], while placing safety locks on cabinets, doors, and gates and securing hazardous chemicals can prevent accidents and wandering. Changes in routine or environment can trigger or exacerbate agitation, whereas well-lit rooms, adequate rest, and avoidance of excess stimulation all help prevent such episodes.<ref>
{{cite web
|url=http://web.archive.org/web/20060925112503/http://www.alz.org/Health/Treating/agitation.asp
|title= Treating behavioral and psychiatric symptoms
|date=2006
|accessdate=2006-09-25
|publisher = Alzheimer's Association
}}</ref><ref>{{cite journal
|author=Wenger GC, Burholt V, Scott A
|title=Dementia and help with household tasks: a comparison of cases and non-cases
|journal=Health Place
|volume=4
|issue=1
|pages=33–44
|year=1998
|pmid=10671009
|doi=10.1016/S1353-8292(97)00024-5
}}</ref> Appropriate social and visual stimulation can improve function by increasing awareness and orientation. For instance, boldly colored tableware aids those with severe AD, helping people overcome a diminished sensitivity to visual contrast to increase food and beverage intake.<ref name="pmid15297089">
{{cite journal
| author = Dunne TE, Neargarder SA, Cipolloni PB, Cronin-Golomb A
| title = Visual contrast enhances food and liquid intake in advanced Alzheimer's disease
| journal = Clinical Nutrition
| volume = 23
| issue = 4
| pages = 533–538
| year = 2004
| pmid = 15297089
| doi = 10.1016/j.clnu.2003.09.015
}}</ref>
 
== Clinical research ==
{{Main|Alzheimer's disease clinical research}}
 
As of 2008, the safety and efficacy of more than 400 pharmaceutical treatments are being investigated in [[clinical trial]]s worldwide, and approximately one-fourth of these compounds are in [[Phase III]] trials, which is the last step prior to review by regulatory agencies.<ref>{{cite web
|url=http://www.clinicaltrials.gov/ct2/results?term=alzheimer
|title= Clinical Trials. Found 459 studies with search of: alzheimer
|accessdate= 2008-03-23
|publisher= US National Institutes of Health
}}</ref> It is unknown as to whether any of these trials will ultimately prove successful in treating the disease.
 
A critical area of clinical research is focused on treating the underlying disease pathology. Reduction of [[amyloid beta]] levels is a common target of compounds under investigation. [[Immunotherapy]] or [[vaccination]] for the amyloid protein is one treatment modality under study. Unlike vaccines which seek to prevent disease, this therapy would be used to treat diagnosed patients, and is based upon the concept of training the immune system to recognize, attack, and reverse deposition of amyloid, thereby altering the course of the disease.<ref>Vaccination:
* {{cite journal |author=Hawkes CA, McLaurin J |title=Immunotherapy as treatment for Alzheimer's disease |journal=Expert Reviews of Neurotherapy |volume=7 |issue=11 |pages=1535–1548 |year=2007 |pmid=17997702 |doi=10.1586/14737175.7.11.1535
}}
* {{cite journal |author=Solomon B |title=Clinical immunologic approaches for the treatment of Alzheimer's disease |journal=Expert Opin Investig Drugs |volume=16 |issue=6 |pages=819–828 |year=2007 |pmid=17501694 |doi=10.1517/13543784.16.6.819
}}
* {{cite journal |author=Woodhouse A, Dickson TC, Vickers JC |title=Vaccination strategies for Alzheimer's disease: A new hope? |journal=Drugs Aging |volume=24 |issue=2 |pages=107–119 |year=2007 |pmid=17313199 |doi=10.2165/00002512-200724020-00003
}}</ref> An example of such a vaccine under investigation is ACC-001.<ref>{{cite web |url=http://www.clinicaltrials.gov/ct/show/NCT00498602 |title = Study Evaluating ACC-001 in Mild to Moderate Alzheimers Disease Subjects |work = Clinical Trial |publisher = [FDA clinicaltrials.gov] |date = 2008-03-11}}</ref><ref>{{cite web
|url=http://clinicaltrials.gov/ct2/show/NCT00479557 |title=Study Evaluating Safety, Tolerability, and Immunogenicity of ACC-001 in Subjects With Alzheimer's Disease
}}</ref> Similar agents are [[bapineuzumab]], an antibody designed as identical to the naturally-induced anti-amyloid antibody,<ref>{{cite web
|url=http://clinicaltrials.gov/ct2/show/NCT00574132
|title= Bapineuzumab in Patients With Mild to Moderate Alzheimer's Disease/ Apo_e4 non-carriers
|work = Clinical Trial
|accessdate=2008-03-23
|publisher= US National Institutes of Health
|date= 2008-02-29
}}</ref> and [[Tarenflurbil|MPC-7869]], a selective amyloid beta-42 lowering agent.<ref>{{cite web
|url = http://clinicaltrials.gov/ct2/show/NCT00105547
|title= Efficacy Study of MPC-7869 to Treat Patients With Alzheimer's
|work = Clinical Trial
|accessdate=2008-03-23
|publisher= US National Institutes of Health
|date = 2007-12-11
}}</ref> Other approaches are neuroprotective agents, such as AL-108,<ref>{{cite web
|url = http://clinicaltrials.gov/ct2/show/NCT00422981
|title = Safety, Tolerability and Efficacy Study to Evaluate Subjects With Mild Cognitive Impairment
|work = Clinical Trial
|accessdate=2008-03-23
|publisher= US National Institutes of Health
|date = 2008-03-11
}}</ref> metal-protein interaction attenuation agents, such as PBT2,<ref>{{cite web
|url = http://clinicaltrials.gov/ct2/show/NCT00471211
|title = Study Evaluating the Safety, Tolerability and Efficacy of PBT2 in Patients With Early Alzheimer's Disease
|work = Clinical Trial
|accessdate=2008-03-23
|publisher= US National Institutes of Health
|date = 2008-01-13
}}</ref> or [[tumor necrosis factor-alpha]] [[receptor]] fusion proteins, such as [[etanercept]].<ref name="pmid16926764">
{{cite journal
|author=Tobinick E, Gross H, Weinberger A, Cohen H
|title=TNF-alpha modulation for treatment of Alzheimer's disease: a 6-month pilot study
|journal=MedGenMed
|volume=8
|issue=2
|pages=25
|year=2006
|pmid=16926764
|doi=
}}</ref><ref>{{cite journal
|author=Griffin WS
|title=Perispinal etanercept: potential as an Alzheimer therapeutic
|journal=J Neuroinflammation
|volume=5
|issue=
|pages=3
|year=2008
|pmid=18186919
|doi=10.1186/1742-2094-5-3
}}</ref><ref>{{cite journal
|author=Tobinick E
|title=Perispinal etanercept for treatment of Alzheimer's disease
|journal=Curr Alzheimer Res
|volume=4
|issue=5
|pages=550-552
|year=2007
|pmid=18220520
|doi=10.2174/156720507783018217
}}</ref> There are also many basic investigations attempting to increase the knowledge on the origin and mechanisms of the disease that may lead to new treatments.
 
==Society and culture==
===Social costs===
Because the median age of the industrialised world's population is gradually increasing, Alzheimer's is a major public health challenge. Much of the concern about the solvency of governmental social safety nets is founded on estimates of the costs of caring for baby boomers, assuming that they develop Alzheimer's in the same proportions as earlier generations. For this reason, money spent informing the public of available effective prevention methods may yield disproportionate benefits.<ref name="pmid11910061">
{{cite journal
|author=Sloane PD, Zimmerman S, Suchindran C, Reed P, Wang L, Boustani M, Sudha S
|title=The public health impact of Alzheimer's disease, 2000–2050: potential implication of treatment advances
|journal=Annual Review of Public Health
|volume=23
|pages=213–231
|year=2002
|pmid=11910061
|doi=10.1146/annurev.publhealth.23.100901.140525
}}</ref>
 
===Caregiving burden===
{{Further|[[Caregiving and dementia]]}}
 
The role of family [[carers|caregivers]] has become more prominent in both reducing the social cost of care and improving the quality of life of the patient. Home-based [[elderly care|care]] also can have economic, emotional, and psychological costs to the patient's family. Although family members in particular often express the desire to care for the sufferer to the end,<ref name="glam">{{
cite journal
|url=http://www.cncforum.me.uk/S.O'Donovan%20PhD%20Thesis%20Exec%20Summary%202004.pdf
|author=O’Donovan ST
|title=Dementia caregiving burden and breakdown
|format=PDF
|publisher=Forum of Consultant Nurses, Midwives and Allied Health Professionals
|accessdate=2008-02-29
}}</ref>
Alzheimer's disease is known for effecting a high burden on caregivers.<ref name="burden1">{{
cite journal
|author=Selwood A, Johnston K, Katona C, Lyketsos C, Livingston G
|title=Systematic review of the effect of psychological interventions on family caregivers of people with dementia
|journal=Journal of Affective Disorders
|volume=101
|issue=1-3
|pages=75–89
|year=2007
|pmid=17173977
|doi=10.1016/j.jad.2006.10.025
}}</ref>
 
Alzheimer's disease can incur a variety of stresses on the caregivers: typical complaints are [[stress]], depression, and an inability to cope. Reasons for these complaints can include: high-demands on the caregiver's concentration, as Alzheimer's sufferers have a decreasing regard for their own safety (and can wander when unattended, for example); the lack of gratitude received when the sufferer is unaware of the help being given; and the lack of satisfaction when the sufferer's condition does not abate. Alzheimer's sufferers can be verbally and physically aggressive, and can stubbornly refuse to be helped. Aggression in particular can lead to a temptation to retaliate, which can put both the sufferer and carer at risk. It is additionally stressful for caregivers who are friends and family to witness a sufferer lose his or her identity, and eventually be unable to recognise them.<ref name="burden1"/>


Family caregivers often give up time from work and forego pay to spend 47&nbsp;hours per week on average with the person with AD. From a 2006 survey of US patients with [[long term care insurance]], direct and indirect costs of caring for an Alzheimer's patient average $77,500 per year.<ref>
==Treatment==
{{cite web
| title= The MetLife Study of Alzheimer’s Disease: The Caregiving Experience
| journal= MetLife Mature Market Institute
| date= August 2006
| url=http://www.metlife.com/WPSAssets/14050063731156260663V1FAlzheimerCaregivingExperience.pdf
| format=PDF
| accessdate=2008-02-12
}}</ref>


[[Alzheimer's disease medical therapy| Medical Therapy]] | [[Alzheimer's disease surgery| Surgery]] | [[Alzheimer's disease primary prevention|Prevention]] | [[Alzheimer's disease future or investigational therapies|Future or Investigational Therapies]] | [[Alzheimer's disease social impact|Social Impact]] | [[Alzheimer's disease family impact|Family Impact]]


==References ==
==Related Chapters==
{{reflist|2}}
* [[Biochemistry of Alzheimer's disease]]




Latest revision as of 21:47, 8 January 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2], Aravind Reddy Kothagadi M.B.B.S[3], Akshun Kalia M.B.B.S.[4], Amandeep Singh M.D.[5], Kiran Singh, M.D. [6], Haleigh Williams, B.S.

Synonyms and keywords: AD; Alzheimer's; Alzheimer dementia; Alzheimer disease; Alzheimer sclerosis; Alzheimer's syndrome; Alzheimer-type dementia; Presenile and senile dementia; Primary senile degenerative dementia; Senile dementia of the Alzheimer type; SDAT; Alzhiemer dementia; Alzhiemer's; Alzheimer's dementia care; Alzheimer's caregiving

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