Forget me not when I can no longer remember you: how Alzheimer's disease affects families

The prospect of developing the disease is terrifying, but the idea of watching a loved one succumb is almost as frightening. As with many incurable diseases, the fallout is not limited to the patient. Alzheimer's disease affects everyone close to the sufferer. In the early stages, there is bewilderment and confusion as family members notice changes in their loved one, such as bursts of temper, forgetfulness, irrational beliefs, and an obsessive adherence to daily rituals and customs. Family members are often so shocked and pained at the startling and often unpleasant personality changes that they are reluctant or embarrased to seek help. Adele remembers how her mother would sit for hours on the front porch fingering her rosary, waiting for her husband to come home. When he was late - or when she perceived he was late - she would begin to cry. Her anxiety attacks became so bad that she would plead with her grown children to take her to her husband's workplace just minutes after he had left. When she tried to walk to the church she had attended for years and lost her way, the family realized they needed to seek help.

Increased BAEP latency and reduced brain cytochrome c oxidase activity observed in the Suzuki model of Alzheimer's disease [abstract]

Cytochrome c oxidase (COX), the terminal respiratory enzyme, is reported to be deficient and to exhibit reduced activity in a number of neurodegenerative disorders. The Alzheimer's rabbit model is based on the intracerebral injection of Holt's adjuvant, an aluminum salt solution. This model was used to compare the brain activity and the activity of brain COX in treated and controlled rabbits. Of a total of 26 New Zealand white rabbits, thirteen were injected intracerebrally with Holt's adjuvant solution, five with physiologically saline solution and the remainder were kept as controls. The auditory responses (BAEP) of the rabbits were monitored for 14 days before injections and 14 days thereafter. The animals were then sacrificed and brain mitochondrial extracts were used for SDS-PAGE analysis, difference spectra spectrophotometry and polarographic assays. The results of SDS-PAGE showed that there were no differences in the protein composition of the brain mitochondria of the three groups. Similarly, difference spectra (reduced minus oxidized, 400-630 nm) from both treated groups were identical to that of the control with characteristic maxima centered around 434, 550 and 604 nm. Polarographic assays, however, showed that while the enzyme from both treated groups displayed the characteristic biphasic kinetics, there was reduced activity in the enzymes from the brain of rabbits receiving the adjuvant but not the saline solution. This result is significant in light of the fact that several researchers have reported reduced activity of COX from Alzheimer's disease (AD) patients. Of particular significance, BAEP results reveal an increase in the interpeak latency between peaks III and V of the Holt's injected but not the saline injected or control rabbits. This latter result suggests that monitoring the BAEP might provide a simple non-invasive method for confirming AD. (AU)

Level of mental impairment in the Jamaican elderly and the issues of screening levels, caregiving, support systems, carepersons, and female burden

Jamaica, although a developing country, has an aging population and is facing the many issues confronting aging. A community-based study using the Folstein minimental screening tool identified 2.3 percent of the over-60 population as severely impaired and 11.8 percent as questionable. The family was identified as the main source of support, and female relatives the main carepersons. Mentally impaired persons were less likely than physically impaired persons not to have a support syustem or careperson needed (AU).

Alzheimer's disease: the care givers' concerns, knowledge, coping ability and views of a support system

Alzheimer's disease affects the aged population worldwide. Initially it was considered rare and was believed to occur in people under 60, now research findings indicate that it is seen mostly in the older population. The incidence increases further with age; approximately 20 percent are aged over 80 years. It is a leading cause of death in the United States and studies indicate that up to 50 percent of nursing home population is afflicted with Alzheimer's disease although many may not have been diagnosed. Patients will need constant help when they develop cognitive, physical, emotional or social disabilities. The care-giving role can be demanding and the ability of public health practitioners and community groups to offer support can help to create a positive emotional climate for caregivers. This study was carried out in the Kingston and St. Andrew parishes of Jamaica during the period January to April 1995. Information collected examined Alzheimer's disease and the knowledge and attitude of caregivers. Caregivers identified were family doctors, registered nurses, practical nurses, a house mother, domestic helpers and family members. Findings revealed Alzheimer's disease was more common over age 60. The incidence is higher in females, and the disease knows no socio-economic boundary. Main caregivers are health workers and the majority of patients are cared for in nursing homes. Major fears of doctors was the patients hyperactivity, while for nurse managers it was the increase stress for the caregiver, and communication difficulties the patient may experience. Families are concerned about finding a cure and the safety of the patient. Caregivers were not found to be unduly stressed but there was a knowledge gap about the disease. All categories of caregivers identified the need for support systems. The primary function for an Alzheimer's disease association as seen by the caregivers would be education of all persons. (AU)

Recognition of tau epitopes by ubiquitin antibody in Alzheimer's paired helical filaments

Ubiquitin, an intracellular marker of non-lysosomal protein degradation was immunocytochemically and biochemically detected in paired helical filaments (PHF) of aged and Alzheimer's disease brains. Seven micron thick paraffin serial sections of the hippocampus were stained with PHF, or UBIQUITIN, or TAU antibodies using an indirect immunoperoxidase technique. The neuroplasm, axons, dendrites, neurophil threads of degenerating neurons from the stratum pyramidale and surrounding neuroparenchyma were intensely stained by the above types of antibodies. The cell bodies of these neurons had a specific shape, implicating the accumulation of intracellular cytoskeletal components. Using gel electrophoresis, Western blot and immunoblot techniques, ubiquitin epitopes were detected in PHF, where they were linked to tau protein. These results suggest that ubiquitin may be involved in the regulation of cellular events or degradation of the cytoskeletal protein tau,incorporated into PHF. Deposition of PHF in the perikarya of susceptible neurons may lead to their metabolic changes, reorganization of cytoskeletal components, impaired neuronal function, cell degeneration and death. (AU)

Immunocytochemical localization of PHF-TAU in clinically diagnosed non-demented aged human brain - abstract

Paired helical filament (PHF), a molecular component of Alzheimer's Neurofibrillary Tangles, was immunocytochemically detected in clinically non-demented human brain. Brains from both sexes were examined. Cryostat cut sections from the cerebral hemisphere were stained with antibodies raised against PHF and TAU, and Thioflavine-D and examined with a microscope (Riechert-Jung), equipped for light and fluorescence transmission viewing. Several regions of the cerebral hemisphere reacted positively to all antibodies used and Thioflavine-S. Neurons in the stratum pyramidale of the hippocampus in all brains showed consistent and significant staining profiles. PHF-TAU molecules were observed in the cytoplasm and axoplasm of a large population of stratum pyramidale neurons. In some neurons, the entire cytoplasm and axoplasm were invaded by these molecules. PHF-TAU molecules also appeared in the adventitia of small blood vessels in the hippocampus and to a lesser extent in blood vessels of other regions. It was not possible to delineate or identify whether these vascular associated PHF-TAU molecules were present in perivascular nerve or glial processes or in the extracellular space. This may be the first indication that perivascular astrocytic processes may sequester PHF-TAU molecules. The hippocampus has been reported to be implicated in both long- and short-term memory. The present study has shown that neurons in the stratum pyramidale are structurally and metabolically affected by PHF-TAU molecules which may be the most important cause of cell damage, thus propagating memory impairment. It is not known what role the vascular associated molecules play in the pathology of Alzheimer's disease (AU)

Common psychological illnesses in the elderly

The elderly are especially prone to psychological illness. Cognitive impairment increases with age and as this is a primary symptom of many common disorders, it constitutes a major health problem. The elderly also frequently become depressed and have the highest suicide rate of all age groups. Given the increasing numbers of elderly persons in the population, the primary care physician must assume the reponsibility of evaluating, diagnosing and initiating psychiatric treatment with an emphasis on early and accurate diagnosis, and the detection of underlying causes, many of which are reversible (AU)