Alzheimer disease

David S Geldmacher MD (Dr. Geldmacher, Director of the Division of Memory Disorders and Behavioral Neurology at the University of Alabama at Birmingham, received research grants from Abbvie, Biogen, BristolMyersSquibb, Eisai, and Lundbeck, and consultation fees from Axovant and GlaxoSmithKline.)
Martin R Farlow MD, editor. (Dr. Farlow of Indiana University received research grant support from Accera, Biogen, Eisai,  Eli Lilly, Genentech, Roche, Lundbeck, Chase Pharmaceuticals, Novartis, Suven Life Sciences Ltd, and Boehringer Ingelheim; honorariums from Eisai, Forest Laboratories, Pfizer, Eli Lilly and Company and Novartis for speaking engagements; and fees from Accera, Alltech, Avanir, Axovant, Biogen, Eisai Med Res, Inc., Eli Lilly and Company, FORUM Pharmaceuticals, Genentech, Inc., Grifols, Helicon, INC Research, Lundbeck, Medavante, Medivation, Merck, Neurotrope Biosciences, Novartis, Pfizer, Prana, QR Pharm., Riovant Sciences Inc., Roche, Sanofi-Aventis, Schering-Plough, Toyama Pharm, Stemedica Cell Technologies Inc., vTv Therapeutics and UCB Pharma for consultancy. His spouse was employed by Eli Lilly.)
Originally released June 27, 1994; last updated July 18, 2016; expires July 18, 2019

Overview

Alzheimer disease is the prototypical and, by far, most common dementia. In this article, the author presents an overview of the disease including clinical manifestations, pathophysiology, etiology, and diagnostic workup. Also included is information on results from clinical trials of diet and exercise.

Key points

 

• Alzheimer disease is the most common cause of dementia.

 

Memory loss is the dominant feature in most patients, often accompanied by anomia, visuospatial deficits, and executive dysfunctions.

 

• Current anti-dementia drugs often reduce decline rather than improve cognition.

 

• Apathy, depression, and agitation are frequent noncognitive symptoms.

 

• The usefulness of antipsychotic drugs for treatment of agitation is modest and limited by increased mortality risks; SSRIs may offer a better safety and efficacy profile than antipsychotics for agitation without psychosis.

Historical note and terminology

Although cognitive decline in advanced age has been recognized throughout history, the understanding that it represents the result of specific disease states is more recent. In 1907 the German neurologist and pathologist Alois Alzheimer reported the case of a 56-year-old woman with progressive cognitive decline and behavior change associated with distinctive neuropathological features of senile plaques and neurofibrillary tangles (Alzheimer 1907). Although the term “Alzheimer disease” is often used synonymously with “dementia,” current theoretical frameworks distinguish the pathology of Alzheimer disease from the symptomatic expression, accounting for constructs like “preclinical Alzheimer disease” and “mild cognitive impairment due to Alzheimer disease.”

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