Hello. My name is Anthony R. Ellis, M.D., and I am a psychiatrist who specializes in the treatment of mental health problems and brain illnesses in people over the age of 55. I wasn't always interested in working with the older and wiser portion of our population, but ever since my father was diagnosed with, and later died from, Alzheimer's disease, this area of psychiatry has been my primary focus. I am writing this e-book to answer a question that I am asked frequently by the spouses, family members, and other loved ones of patients with Alzheimer's disease.
In addition to struggling with the effects of Alzheimer's disease on their parent, relative or spouse, the next thing that seems to come up during family conference meetings on our geriatric psychiatry unit is “Will I get Alzheimer's?” This is an intriguing question for many of us as the number of cases of Alzheimer's disease is expected to go from roughly 5 million affected patients in the year 2000 to approximately 20 million patients in the year 2030. It's also an interesting question because it is very difficult to answer. However, by looking through the available psychiatric and neurological research, and by sharing insights that I've gained through treating thousands of patients with Alzheimer's disease, I hope to help you answer this question for yourself.
I intend to make the case that all of us would, in fact, develop signs of Alzheimer's disease if we lived long enough. That sounds depressing. However, I also hope to relay the current information with regard to prevention strategies and give you a perspective that will alleviate worry and anxiety and allow you to focus on doing what you can to mitigate your risk and otherwise forget about this question and this problem, no pun intended. You can consider this an “unauthorized biography” of Alzheimer's disease, as some of my ideas may not be in agreement with everything else you read about Alzheimer's disease. Rest assured that the things that I have placed in this book are based on my interactions and dealings with patients affected by this illness, including my own father and many of his siblings.
Chapter 1: What is Alzheimer's Disease?
Alzheimer's disease is an illness of the brain that slowly robs you of your ability to function. Many times in medicine we label something with the name “disease” and imply that it is a clearly definable syndrome with a specific cause and known treatment. This may not be the best way to think of Alzheimer's disease. It has previously been called dementia, senile dementia, and a variety of other names across human history, having to do with loss of function in old age. Alzheimer's “disease” is likely a group of conditions that vary in their exact cause, age of onset, and rapidity of progression. For example, there are some patients who develop “pre-senile onset Alzheimer's disease” who are known to have a specific genetic mutation that causes the illness. These patients have a change in the processing of a protein that can be found in everyone's brain called beta amyloid. This protein normally causes very little difficulty. In the patients with this type of mutation, the amyloid protein is processed differently and becomes toxic to the brain and accumulates in clumps that cause inflammation and brain cell death.
In other patients who develop this early onset type of Alzheimer's disease, there is a known mutation that affects another protein that is inside the structure of the brain cell called tau protein. There is a group of tubes inside brain cells that transport neurotransmitters and nutrients that allow the cell to function. In the patient's with the abnormal tau protein, these intracellular transport processes are disrupted as these tubes become tangled and don't function as well.
This specific form of Alzheimer's disease is different than the form of Alzheimer's disease that tends to show up after the age of seventy-five. The older onset form seems to be associated with aging and cumulative vascular damage to the brain. There are still amyloid protein deposits and neurofibrillary tangles, but also “vascular damage”. Vascular damage here refers to decreased blood flow and oxygen transport to areas of the brain as a result of blockages in very small arteries. Patients with high blood pressure, diabetes, high cholesterol, or those who smoke cigarettes, generally have more of these blockages at an earlier age and develop more over time than people who don't have these “vascular risk factors.”
The early onset forms of Alzheimer's disease are more than likely related to a variety of relatively rare genetic mutations. These cases make up less than 5% of all cases of Alzheimer's disease. This early onset form related to a genetic mutation is more likely to be inherited than the later onset form of Alzheimer's disease. The later onset form accounts for the bulk of patients who are diagnosed with Alzheimer's. It is clear that if you have a relative who develops early onset Alzheimer's disease, you are at increased risk for developing Alzheimer's disease yourself. I treated a patient once who was in his late 50s when I first met him and he had developed his first symptoms when he was in his early 50s. He had a history of late onset Alzheimer's disease in one parent and early onset Alzheimer's disease in the other parent. He had a particularly rapid course and passed away at around the age of sixty-two, having spent approximately the last eighteen months of his life in a nursing home.
