A little over 100 years ago, Dr. Alzheimer, a neuropathologist and psychiatrist, discovered Alzheimer’s disease in a relatively young woman (age 52). 

Then, the average lifespan was only about 48 years.  Dr. Alzheimer himself died when he was in his early 50’s due to complications from a strep throat.  We now know, however, that the largest risk factor for the development of Alzheimer’s disease is age, and with the population over 65 years old doubling and the population over 85 years old quadrupling, Alzheimer’s disease is becoming an epidemic, and if the trends continue, as expected, the “senile tsunami” will be hitting us within the next 40 years. 

Alzheimer’s disease is really the only one of the top 10 killers that we do not have a good idea of the cause (or causes).  Therefore, it is difficult to develop an effective disease-specific treatment.  We currently have four FDA-approved treatments that in many patients can offer stabilization and in some patients significant improvement, though in general the results of medication treatment are not consistently rewarding and do not appear to have a “disease-modifying effect,” i.e., have an effect on the progressive destructive disease process. 

What we do know is that “dementia” (the manifestation of memory loss, loss of ability to function, as well as behavior changes) represents the late stages of Alzheimer’s disease, and Alzheimer’s disease actually most likely begins decades prior to the onset of the memory decline.  We may simply be getting in “too late” to have a strong positive effect on the disease, and, therefore, efforts should continue to be able to identify people as early as possible who are manifesting subtle signs of dementia, and even better, be able to identify patients who are asymptomatic but are prone to subsequently develop Alzheimer’s disease. 

From a diagnostic standpoint, more and more tools are becoming available, and, in fact, it is expected this year a new technique to label the abnormal protein in the brains of patients with Alzheimer’s disease will be available and can identify patients prior to the onset of symptoms.  From a treatment standpoint, the approach of “an ounce of prevention is worth a pound of cure” may certainly apply to Alzheimer’s disease, and strategies, such as mental and physical activity, a Mediterranean diet, as well as socialization, all may be effective in slowing down the cognitive decline as one ages.  Our understanding of these nonpharmacologic approaches, as well as the efforts from the NIH, along with the pharmaceutical industry, to develop effective pharmacologic treatments are beginning to brighten our outlook on this disease that is devastating to

both the patient, as well as family. 

Gene therapy, as well as stem cell therapy, may hold the answer for the very effective treatment and possibly eventual cure of this disease.  The attitude of “diagnose and adios” will be becoming less and less prevalent as we learn more about the disease.  As we learn more and more about the mechanism of Alzheimer’s disease, more medications are becoming available in the form of clinical drug trials, to complement the current available, best available, FDA-approved treatments, as well as nonpharmacologic strategies. 

Ira J. Goodman, M.D. is a board certified neurologist with a private practice at the Compass Clinic in downtown Orlando.  He graduated from the Medical College of Pennsylvania in 1979 and held his residency at Orlando Regional Medical Center in internal medicine.  His neurology residency was held at Shands Teaching Hospital at the University of Florida.  He is the founder of the state funded Memory Disorder Center of Central Florida, of which he has been the director for the past 15 years.  Dr. Goodman has been selected as the top neurologist in Central Florida for 12 consecutive years by Orlando Magazine. He can be reached at drgoodman@compass-clinic.com.

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