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.
Alzheimer disease (AD) is characterized by progressive cognitive decline including memory loss, disorientation, and impaired judgment and learning. Currently, it is 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 can be profoundly affected by the increased dependence of their loved ones as the disease progresses. Advocacy organizations, such as the Alzheimer Association, can provide early education and social support for both the patient and family. The Alzheimer Association has developed a list of common warning signs, which include memory loss, difficulty completing familiar tasks, disorientation, 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 5.5 million Americans in 2017.2 The majority (5.3 million) are 65 years and older. 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 Alzheimer type dementia.
The prevalence of AD increases with age. Of those affected, one in ten are 65 years of age or older, and one in three are 85 years of age or older.2 It is projected that by 2050, there will be a threefold increase in prevalence due to a population increase in persons older than 65 years.2 The severity of AD also correlates with increasing age and is classified as mild, moderate, or severe. Other risk factors for AD include family history, female gender, and vascular risk factors such as diabetes, hypertension, heart disease, and current smoking.4 It is unknown how factors such as environment contribute and interact with the genetic predisposition for AD.
The mean survival time of persons with AD is approximately 4 to 8 years from symptom onset. ...