Growing old is a cause for concern in the minds of many. Frequently people find themselves worrying daily over the lack of time that is left in their lives. This is natural. Once a person reaches this time period they find changes in themselves, both physical and mental. Physical symptoms of old age are wrinkles, hair color change, loss of finer athletic abilities, and possibly things such as Arthritis, eye sight loss, or hearing loss. Mental signs of old age are often associated with slower thinking, forgetfulness, and senility. These mental signs, however, are not a “natural” sign of old age (Frank 13). They may come in a mild form, but when anything more severe they may point to a life-threatening disease.

Alzheimer's Disease (AD) is a degenerative disease (Shan 33) of both the mental and physical body of a person (Frank 15). It is not a new disease, on the contrary it has been documented for centuries as a sign of old age. It was not until 1906 that it was finally identified by Alois Alzheimer (Frank 13). While this disease seems to be hidden with sufferers often being home bound, over five million Americans have been diagnosed (Alz.org). This number has been said to be around 5.4 million, about the current population of Minnesota. Those afflicted are said to face a “fading mental spiral for decades” (Ambrose). Three types seems to be predominant, these are: early onset, those younger than 65, late onset (SAD), those older than 65, and familial (FAD), which are those who have inherited the disease. Early onset acquaints to 2-5% of those diagnosed, late onset to 90% or more, and familial is rare (Shan 34). Statistics show that 50-70% of all dementia is from Alzheimer's Disease. Though it accounts for most of the dementia diagnosed, another form called Senile Dementia (SD) is also common. Experts aren't sure yet if it is defined differently from AD or if SD encompasses it. AD also takes a high economic and social toll on the world (Ambrose). In 2003, the worldwide cost was estimated to $248 billion (Sano 888) while the US cost for 2013 alone has been $203 billion. The cost and those suffering is continuing to rise steadily with no sign of stopping. Minnesota recorded 1,451 deaths in 2010 from Alzheimer's Disease. This number multiplied to represent every US state equals 75,550 deaths. With statistics like this, Alzheimer's Disease accounts for being the 6th leading cause of death in the US. While the disease itself isn't usually the killer, a secondary illness is (Frank 43). Most times someone with AD will have a weakened immune system from being bed ridden and unable to care for themselves in the final stages, leading to a contraction of an illness. When will it slow? This unknown has experts predicting that by 2050, more than 16 million people are estimated to have AD (Alz.org). While much is thought to be known about the scientific part of Alzheimer's Disease, that knowledge has yet to be translated into an effective cure when diagnosed.

The cause of Alzheimer's Disease is thought to be centered in the brain. This disease progresses in stages from mild to severe. There are approximately three stages an afflicted person goes through. The first stage affects the short term (recent) memories. Where are my keys? Did I call so-and-so? These are common early signs of AD. When they appear more often, in a person who was not normally forgetful, they could signal an underlying problem. The second stage is the 'early confusional stage.' Forgetting directions, newly learned information, and new places is a clue to this progression (Frank 16-17). The third stage is the most severe. In this stage, their everyday mood may even differ; they could act like a completely new person (Frank 37). Another sign of the final stage is the loss of long-term memories (Frank 39). Signs like these appear outwardly, though there are inward signals to the disease. These internal signs have been studied by scientists extensively. While what is known is still questioned, what we have gives some clues to the workings of AD. The previous stages are manifested in the appearance of actual physical brain damage, the internal signs of Alzheimer's Disease (Frank 13). This brain damage can be detected by CAT scans in the form of lesions (Frank 34). A brain lesion is a change in the brain's cells (Frank 23). Lesions are often found in the cerebral cortex of the brain in the case of AD. The cerebral cortex is the thought processing part of the brain. This structure controls a person's sensations, perceptions, planning, and decision making (Frank 28). Lesions also appear on the limbic system of the brain. One of the limbic system's functions is to control moods, this explains why (in the final stage of AD) a person may act differently (Frank 34). It also has been shown to control how we process and remember information (Frank 19), leading to changes in short term and long term memory (Frank 21). Another brain damage that occurs in AD patients are neurofibrillary tangles (NFT) and plaques. Plaques consist of peptide. Peptide is an amyloid-beta (Aß), these Aßs seem to have a major association with AD. This association is shown by the Amyloid Cascade Hypothesis (ACH) which states: the deposition of Aß has been an event linked to the progression of Alzheimer's Disease in afflicted patients. While this is a good model, the lack of understanding between plaques and NFTs lowers its credibility (Shan 33). So far, no prominent environmental factors have been found to cause AD so the focus is on the brain aspects for finding causes (Ambrose). As such, this speaks of how much is yet to be learned about Alzheimer's Disease.

While neurofibrillary tangles, plaques, and lesions are associated with being a sign of Alzheimer's Disease, it is also noticeable by external signs. These signs can be combined to make a diagnoses. Things such as mental confusion, loss of memory, and dementia are signs of a person with Alzheimer's Disease (Frank 31). This is where finding an increase of forgetfulness can help diagnose the disease early. It is best to find signs early on, as the disease will progress and preparing for the future can help prevent disastrous events. While those with Alzheimer's may retain some of their presence of mind, they may also have lapses of judgment. Things such as: wandering from home and becoming lost, forgetting how to drive and causing an accident, or even forgetting to turn off a hot iron could cause harm to the individual or others. This adds to the importance of diagnoses and care. Even so, diagnosing Alzheimer's Disease is not easy (Frank 31), it's often hard to catch it in the early stages. AD is only diagnosed after a clear indication of the disease (Shan 32) because many forms of dementia mimic Alzheimer's Disease (Schmand 1708). The beginning speed of the disease is important (Frank 33); a common question asked by a doctor is how sudden the change in behavior was. Neuroimaging and neuropsychological assessments are tests used to find signs of AD. Neuroimaging is the term for taking pictures of the brain. This is used to check for lesions, tangles, and plaques, and one machine used for this is a CAT scan. Neuropsychological assessments are behavior based tests. These tests examine a person's behaviors to find signs of dementia (Schmand1708). When diagnosing, physical brain damage can be an indicator of AD, but as a person ages, plaques and neurofibrillary tangles have been shown to not clearly indicate a disease (Schmand 1705).

After finding signs of AD and receiving a diagnoses, patients are faced with the future effect of their disease and how they will be cared for. Alzheimer's Disease is incurable (Shan 33) as of now. Scientists have been searching for an answer to this disease. Those stricken can only hope for management or slowing (Shan 35) through medications. Those with mild to moderate progression of AD may be prescribed donepezil, rivastigmine, or galantamine, while moderate to severe AD patients may use memantine (Shane 37). Donepezil is a widely used medication for AD, it often improves symptoms but unfortunately doesn't delay disease progression. Some treatments of Alzheimer's Disease are in the trial stage. One practice, called immunotherapy, as shown to reduce plaques in mice. This progressed to human testing in a study named the Elan Pharmaceutical trial. The program was stopped in 2002 after 18 patients died of brain inflammation. While these results are appalling, the autopsy's of those treated this way showed a significant loss of plaques on the brain (Sano 891). Studies like this offer some hope to patients and caregivers. Caretakers of AD patients are often nurses and/or guardians (such as the adult children of the person) (Frank 40). Support groups are an option for the family of the afflicted. They help those find the help they need and offer a place to explain the everyday struggle of the family and their loved one (Frank 41). Family members, however, are often unable to care for their loved one themselves. Often they are sent to nursing homes (Frank 43). This is because care giving is usually stressful, and often it is the person's spouse (Werner 542), who may have reduced mobility from old age themselves. In 2012, it is believed that AD caretakers delivers around 17.5 billion unpaid hours of care, equaling around $216.4 billion of unpaid work (Alz.org). Scientists are looking to cure AD, and at the same time finding ways to make caretakers jobs easier. Things such as GPS monitoring of Alzheimer's patients outside the home are now becoming available (Werner 542), however it is under scrutiny. While elders and family caregivers approve of the tracking, saying it makes the person more secure and allows individual movement, the op posers label this as dehumanizing and an invasion of privacy. As research continues, views may change and hopefully even more effective methods will become available.

Alzheimer's Disease has a long way to go in terms of research. Much is not known about this silent killing disease, it is instead a hidden plague of the 21st century. Thousands of people die each year from it, and thousands are seeming to be diagnosed. The numbers are rising each day and finding its cause is not turning out to be easy. While people often remark about finding a cure for cancer, Alzheimer's Disease is as mysterious as cancer. It is costing millions of dollars to just the US alone, and in some countries care might not even be available. Research about lesions, plaques, and neurofibrillary tangles and their relationships are continuing daily. Hopefully a breakthrough of this terrible disease will surface and thousands of sufferers will regain their lives.

Works Cited
“Alzheimer's Facts and Figures.” Alzheimer's Association. N.p., 2013. Web. 24 Oct. 2013.
Ambrose, Charles T. “Alzheimer's Disease: The Great Morbidity of The 21st Century.” American Scientist. 101.3 (2013): 194-201. Print.
Frank, Julia. Alzheimer's Disease: The Silent Epidemic. Minneapolis: Lerner Publications, 1985. Print.
Sano, Mary, Hillel Grossman, and Kathleen Van Dyk. “Preventing Alzheimer's Disease: Separating Fact From Fiction.” CNS Drugs. 22.11 (2008): 887-902. Print.
Shan, Yaso. “Treatment of Alzheimer's Disease.” Primary Health Care. 30 (2013): 32-38. Print.
Werner, Shirli, and Ruth Landau. “Social Workers' and Students' Attitudes Toward Electronic Tracking of People With Alzheimer's Disease.” Social Work Education. 30.5 (2011): 541-57. Print.