Prognosis---etc

Prognosis

There is considerable variability in the rate of Alzheimer disease progression. The Alzheimer Disease Association claims that the time from the onset of clinical symptoms to death can range from three to 20 years, with an average duration of eight years. There are probably many environmental and genetic factors that play a role in the progression of the disease. The accumulation of damage and loss of brain cells eventually results in the failure of many different organ systems in the body. According to the National Institute of Neurological Disorders and Stroke, the most common cause of death is due to infection.

Special concerns

Alzheimer disease should be distinguished from other forms of dementia. In some cases, depression can result in dementia-like symptoms. Other examples include chronic drug use, chronic infections of the central nervous system, thyroid disease, and vitamin deficiencies. These causes of dementia can often be treated. It is, therefore, important to obtain an accurate diagnosis to avoid complications associated with the inappropriate treatment and long-term care of these patients. There are also several genetically based syndromes in which dementia plays a role.

Genetic counseling

Genetic counseling is important for family members biologically related to patients with Alzheimer disease because each first-degree relative has as much as a 20% lifetime risk of also being affected. The risk to immediate relatives increases as more family members develop the disease. In the early-onset form of the disease, the inheritance pattern is thought to be autosomal dominant. This means that a carrier (who will eventually be affected) has a 50% chance of passing on the mutated gene to his or her offspring.

The general consensus in the scientific and medical community is to not test children or adolescents in the absence of symptoms for adult-onset disorders. There are many problems associated with predictive testing of asymptomatic individuals who are not yet adults. Children who undergo predictive testing lose the choice later in life (when they are capable of understanding the full ramifications of the disease) to know or not to know this information. It is, therefore, an important consideration that involves ethical and psychological implications.

Resources

BOOKS

Bird, T. D. "Memory Loss and Dementia." In Harrison's Principles of Internal Medicine, 15th ed. Edited by A. S. Franci, E. Daunwald, and K. J. Isrelbacher. New York: McGraw Hill, 2001.

Castleman, Michael, et al. There's Still a Person in There: The Complete Guide to Treating and Coping with Alzheimer's. New York: Perigee Books, 2000.

Mace, Nancy L., and Peter V. Rabins. The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life. New York: Warner Books, 2001.

PERIODICALS

Campion, D., et al. "Early-onset Autosomal Dominant Alzheimer Disease: Prevalence, Genetic Heterogeneity, and Mutation Spectrum." Am J Hum Genet 65 (1999): 664–70.

Green, R.C. "Risk Assessment for Alzheimer's Disease with Genetic Susceptibility Testing: Has the Moment Arrived?" Alzheimer's Care Quarterly (2002): 3,208–14.

Rogan, S., and C. F. Lippa. "Alzheimer's Disease and Other Dementias: A Review." Am J Alzheimers Dis Other Demen (2002) 17: 11–7.

Romas, S. N., et al. "Familial Alzheimer Disease among Caribbean Hispanics: A Reexamination of Its Association with APOE." Arch Neurol (2002) 59: 87–91.

Rosenberg, R. N. "The Molecular and Genetic Basis of AD: The End of the Beginning: The 2000 Wartenberg Lecture." Neurology 54 (2000): 2045–54.