Abstract
Alzheimer's disease remains the most common form of dementia. Dementia symptoms vary depending on individual personality, life experience, and social and cultural influences. As dementia progresses, involvement of multi-disciplinary health care professionals is needed to manage the disease. Alzheimer research is progressing rapidly. While 5% of all Alzheimer's disease may be genetically determined, the majority is not. Susceptibility genes can reveal the risk of contracting Alzheimer's disease. Early life risk factors such as education, nutrition, and vascular disease may increase the likelihood of dementia in later life. In the United States, two acetylcholinesterase inhibitors have been approved as cognitive enhancers. Possible prevention and symptomatic treatment interventions have focused on estrogen replacement therapy, antioxidants, and anti-inflammatory medications. Research advances have improved the clinical management of dementia. Ethical implications to the patient, family, and society are multiple and remain challenging.
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REFERENCES
Graves AB, Kukull WA. The epidemiology of dementia. In: Morris JC, ed. Handbook of Dementing Illnesses, 1994: 23–69.
Small GW, Rabins PV, Barry PP, et al. Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and theAmerican Geriatrics Society. JAMA 1997; 278: 1363–1371.
Ernst RL, Hay JW. The US economic and social costs of Alzheimer's disease revisited. Am J Public Health 1994; 84: 1261–1264.
Welch HG, Walsh JS, Larson EB. The cost of institutional care in Alzheimer's disease: nursing home and hospital use in a prospective cohort. J Am Geriatr Soc 1992; 40: 221–224.
Callahan CM, Hendrie HC, Tierney WM. Documentation and evaluation of cognitive impairment in elderly primary care patients. Ann Intern Med 1995; 122: 422–429.
Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter for diagnosis and evaluation of dementia. Summary statement. Neurology 1994; 44: 2203–2206.
Clarfield AM. The reversible dementias: Do they reverse? Ann InternMed 1988; 109: 476–486.
Mega MS, Cummings JL, Fiorello T, Gornbein J. The spectrum of behavioral changes in Alzheimer's disease. Neurology 1996; 46: 130–135.
Early Identification of Alzheimer's Disease and Related Dementias. Clinical Practice Guideline No. 19 Rockville, MD: Agency for Health Care Policy and Research: November 1996. US Department of Health and Human Services. AHCPR publication 97-0703.
Rovner BW, Steele CD, Shmuely Y, Folstein MF. A randomized trial of dementia care in nursing homes. J Am Geriatr Soc 1996; 44: 7–13.
Caregiver network helps temper significant hardship in laboring for Alzheimer relatives. Primary Psychiatry 1996; Nov: 20-21, 92.
Rabins PV, Fitting MD, Eastham J, Zabora J. Emotional adaptation over time in caregivers for chronically ill elderly people. Age and Aging 1990; 19: 185–190.
Work Group on Alzheimer's Disease and Related Dementias. Practice guideline for the treatment of patients with Alzheimer's disease and other dementias of late life. Am J Psychiatry 1997; 154 (suppl): 1–7.
Levy-Lahad E, Wasco W, Poorkaj P, et al. Candidate gene for the chromosome 1 familial Alzheimer's disease locus. Science 1995; 269: 973–977.
Sherrington R, Rogaev EI, Loang Y, et al. Cloning of a gene bearing missense mutations in early-onset familial Alzheimer's disease. Nature 1995; 375: 754–760.
Farrer LA, Cupples LA, Haines JL, et al. Effects of age, sex, and ethnicity on the association between apolipoprotein E genotype and Alzheimer disease. A meta-analysis. JAMA 1997; 278: 1349–1356.
National Institute on Aging/Alzheimer's Association Working Group. Apolipoprotein E genotyping in Alzheimer's disease. Lancet 1996; 347: 1091–1095.
Mayeux R, Saunders AM, Shea S, et al. Utility of the apolipoprotein E genotype in the diagnosis of Alzheimer's disease. N Engl J Med 1998; 338: 506–511.
Snowdon DA, Kemper SJ, Mortimer JA, Greiner, LH, Wekstein DR, Markesbery WR. Linguistic Ability in Early Life and Cognitive Function and Alzheimer's Disease in Late Life. JAMA 1996; 275(7): 528–532.
Colsher PL, Wallace RB. Longitudinal application of cognitive function measures in a defined population of community-dwelling elders. Annals of Epidemiology, 1991; 1(3): 215–230.
Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education. Neurology 1991; 41(12): 1886–1892.
Braak H, Griffing K, Braak E. Review article: Neuroanatomy of Alzheimer's Disease. Alzheimer's Research 1997; 3: 6.
Snowdon DA, Greiner LH, Mortimer JA, Riley KP, Greiner PA, Markesbery WR. Brain infarction and the clinical expression of Alzheimer disease: The nun study. JAMA 1997; 277(10): 813–817.
Tang MX, Jacobs D, Stern Y, et al. Effect of estrogen during menopause on risk and age at onset of Alzheimer's disease. Lancet 1996; 348: 429–432.
Launer LJ, Feskens EJ, Kalmijn S, Kromhout D. Smoking, drinking, and thinking: The Zutphen elderly study. American Journal of Epidemiology 143(3): 219–227, 1996 Feb. 1.
Perrig WJ, Perrig P, Stahelin HB. The relation between antioxidants and memory performance in the old and very old. JAGS 1997; 45(6): 718–724.
Gale CR, Martyn CN, Cooper C. Cognitive impairment and mortality in a cohort of elderly people. BMJ 1996; 312(7031): 608–611.
Perrig-Chiello P, Perrig WJ, Stahelin HB, Krebs-Roubicek E, Ehrsam R. Wellbeing, health and autonomy in old age: the Basal IDA study. [German] Zeitschrift fur Gerontologie und Geriatrie 1996; 29(2): 95–109.
Sano M, Ernesto C, Thomas RG, et al. A controlled trial of selegiline, alphatocopherol, or both as treatments for Alzheimer's disease. NEJM 1997; 336: 1216–1222.
Breitner JC, Gau BA, Welsh KA, Plassman BL, McDonald WM, Helms MJ, Anthony JC. Inverse association of anti-inflammatory treatments and Alzheimer's disease: initial results of a co-twin control study. Neurology 1994; 44(2): 227–232.
McGeer PL, McGeer E, Rogers J, Sibley J. Anti-inflammatory drugs and Alzheimer's disease [letter]. Lancet 1990; 335: 1037.
Stewart WF, Kawas C, Corada M, Metter EJ. Risk of Alzheimer's disease and duration of NSAID use. Neurology 1997; 48(3): 626–632.
McGeer PL, Schulzer M, McGeer EG. Arthritis and anti-inflammatory agents as possible protective factors for Alzheimer's disease: a review of 17 epidemiologic studies. Neurology 1996; 47: 425–432.
Le Bars PL, Katz MM, Berman N, et al. A placebo-controlled, double-blind, randomized trial of an extract of gingko biloba for dementia. JAMA 1997; 278: 1327–1332.
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Antuono, P., Beyer, J. The Burden of Dementia: A Medical and Research Perspective. Theor Med Bioeth 20, 3–13 (1999). https://doi.org/10.1023/A:1009915605467
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DOI: https://doi.org/10.1023/A:1009915605467