Upon completion of the chapter, the reader will be able to:
Describe the epidemiology of Alzheimer disease (AD) and its effects on society.
Describe the pathophysiology, including genetic and environmental factors that may be associated with AD.
Detail the clinical presentation of the typical patient with AD.
Describe the clinical course of the disease and typical patient outcomes.
Explain how nonpharmacologic therapy is combined with pharmacologic therapy for patients with AD.
Recognize and recommend treatment options for disease-specific symptoms as well as behavioral/noncognitive symptoms associated with AD.
Educate patients and/or caregivers about the expected outcomes for patients with AD, and provide contact information for support/advocacy agencies.
KEY CONCEPT Alzheimer disease (AD) is characterized by progressive cognitive decline including memory loss, disorientation, and impaired judgment and learning. It is primarily diagnosed by exclusion of other potential causes for dementias. There is no single symptom unique to AD; therefore, diagnosis relies on a thorough patient history. The exact pathophysiologic mechanism underlying AD is not entirely known, although certain genetic and environmental factors may be associated with the disease. There is no cure for AD; however, drug treatment can slow symptom progression.
Family members of AD patients are profoundly affected by the increased dependence of their loved ones as the disease progresses. Referral to an advocacy organization, such as the Alzheimer Association, can provide early education and social support of both the patient and family. The Alzheimer Association has developed a list of common warning signs, which include memory loss, difficulty planning and doing usual tasks, disorientation, difficulty with visual images, problems with word finding, misplacing things, impaired judgment, social withdrawal, and changes in mood.1
EPIDEMIOLOGY AND ETIOLOGY
AD is the most common type of dementia, affecting an estimated 5.2 million Americans in 2014.2 It is the sixth leading cause of death across all age groups in the United States and the fifth leading cause of death for individuals 65 years of age and older.2 Various classifications of dementia include dementia of the Alzheimer type, vascular dementia, and dementia due to human immunodeficiency virus (HIV) disease, head trauma, Parkinson disease, Huntington disease, Pick disease, or Creutzfeldt-Jakob disease.3 This chapter addresses only dementia of the Alzheimer type.
The prevalence of AD increases with age. One in nine people age 65 and older has AD.2 It is projected that by the year 2050, there will be a threefold increase in prevalence, yielding potentially 13.8 million AD patients due to a population increase in persons older than 65 years.2 Additionally, total spending for AD is projected to increase from $214 billion in 2014 to over $1.2 trillion in 2050.4 Furthermore, AD costs paid by Medicare and Medicaid in 2050 will have increased from 2010 by more than 600% and 400%, ...