Any discussion of aging with someone older than fifty invariably makes them anxious about eventually losing their "marbles." Most of the other devastating ailments of mankind---cancer, heart trouble, stroke, even AIDS---don't usually produce the kind of terror associated with Alzheimer's disease. Cancer is certainly something to worry about, but it can often be detected early enough to be cured; its symptoms can be controlled, and patients may survive for months or even years. Everyone knows someone who has "conquered" a malignancy or coped with it for a long time. Stroke is also viewed with more equanimity these days; it can be prevented by effective treatment of high blood pressure; the likelihood of it causing permanent paralysis is not nearly as great as it used to be, thanks to sophisticated new medications and physical rehabilitation techniques. Proper diet, cholesterol-lowering drugs, and aspirin can prevent or delay heart disease. And if these measures don't work, there is a host of new procedures to treat most cardiac conditions: angioplasty, bypass surgery, valve replacement, laser beams directed into heart muscle, and gene therapy that forms new blood vessels. As a last resort, there's the option of a heart transplant. Even the outlook for AIDS has improved. New drugs prolong life and improve its quality among those afflicted, and HIV infections sometimes even disappear spontaneously.
I am not suggesting that these illnesses always end happily, but they rarely have the emotional impact of chronic dementia. When your mind is intact, you retain some control over your life; you can try to cope with adversity; you can make decisions about your care; you can plan; you can still hope. You have your soul. None of this is true for Alzheimer's disease. Most victims eventually end up in a vegetative state, totally estranged from their environment and unable to communicate with or even recognize their closest loved ones. Tragically, many of them are physically strong enough to hang on to "life" for twenty years or more, during which time the strain on family and friends is unrelenting and unbearable.
Close blood relatives of Alzheimer's patients naturally worry about their own long-term outlook, and for good reason. They read into every minor memory lapse the portents of the disease; they panic when they can't remember a name or where they've put their car keys---even though such lapses are experienced now and then by everyone at every age.
Alzheimer's is a terrible disease, for which there is no cure. Although its rate of progress varies, the road is inexorably downhill. However, there are things you can do, and medications you can take, to delay or possibly even prevent its onset. The sooner you start them, the better.
The Alzheimer's Brain
Until the early 1900s, people believed that if they lived long enough they would inevitably develop "senile dementia" and that losing their mind was a normal accompaniment of aging. But in 1906 a German neuropathologist named Alois Alzheimer looked under the microscope at the brains of relatively young "demented" people who had died in their fifties and sixties. He noted that there were areas in which the nerve fibers had lost their normal orderly appearance and become all tangled up. He termed this disarray "neurofibrillary tangles" and believed that they were only present in young persons who were prematurely deranged. So for many years, doctors limited the diagnosis of "Alzheimer's disease" to young people who were demented. We now know that the brains of elderly persons with "senile dementia" also have these twisted fibers. (They are also occasionally present in other neurological disorders such as Lou Gehrig's disease---amyotrophic lateral sclerosis---and Down's syndrome.) In other words, Alzheimer's is a disease that can occur at any age and is not an inevitable accompaniment of aging.
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