A Long and Painful Farewell—Alzheimer's Disease

In 1906, the German psychiatrist Alois Alzheimer noticed some unusual changes in the brain of a female patient named Auguste D, who had died at the age of 51 from memory loss, disorientation, paranoia, and unpredictable behavior. After the patient's death, Alzheimer performed an autopsy on her brain and found deformed protein clumps (later called plaques) and twisted bundles of fibers (tangles); the patient's brain structure differed from that of healthy people.

In 1910, Alzheimer's colleague, another psychiatrist, Emil Kraepelin, organized Alzheimer's findings and named the disease Alzheimer's disease (abbreviated AD) in honor of Dr. Alzheimer's contributions. Alzheimer's disease is a brain disorder that slowly destroys memory and thinking ability, and it is associated with the decline of brain function. Many well-known figures in their later years have suffered from Alzheimer's disease; both the former British Prime Minister Margaret Thatcher and the former U.S. President Ronald Reagan were AD patients.

Alzheimer's disease affects countless elderly people. Among dementia patients, about 60–70% have AD. At present there are at least 50 million AD patients worldwide, and about 10 million in China. It is estimated that by 2050 the number of AD patients in China will exceed 40 million. Among people aged 85 and above, about one-third have AD.

There is a Chinese saying “old child,” meaning that as people age, their mental faculties gradually regress until they become like children. The “old child” is the typical presentation of Alzheimer's disease: AD patients' memory declines year by year, until in the end they cannot even recognize their closest relatives. A markedly abnormal decline in recent memory is the typical early symptom of Alzheimer's disease. Because elderly people naturally experience some memory decline, AD is often overlooked by family members in its early stages, and is only noticed when more severe symptoms appear—by which time it is too late. Most AD patients are already in the middle or late stages when the disease is discovered. Early-stage patients can be treated, while middle- and late-stage patients are very difficult to treat.

From discovery to the patient's death, Alzheimer's disease usually lasts only about seven years. The early clinical presentation of AD is mainly memory decline: patients often forget what just happened or what they are doing—for example, while cooking they forget that they are cooking, and after finishing they often forget to turn off the gas. They ask the same question repeatedly; a question just minutes old is asked again, and even several times over. This stage lasts about three years.

In the early stage, effective intervention and treatment, together with effective control of the patient's underlying diseases, can slow the progression of Alzheimer's disease and even reverse the condition. However, most patients do not receive scientific diagnosis and treatment in the early stage.

After three years, the patient enters the middle stage. Memory declines further: they cannot remember their own name or the names of relatives, cannot recognize the family members around them, and cannot remember their home address; they frequently get lost and easily go missing when going out. At this stage patients gradually lose basic living skills and cannot wash, dress, or use the toilet by themselves. Their personality also changes markedly: they become sensitive and suspicious, with delusions of reference and delusions of persecution, and sometimes experience hallucinations and aggressive behavior. Patients at this stage can hardly live independently, and the middle stage generally lasts two years. In the middle stage, if patients are not properly cared for, they may easily die from complications such as acute infection or bedsores.

In the late stage, the patient's brain function is severely deteriorated: they can only stay in bed all day, cannot communicate with relatives, are incontinent of urine and stool, have difficulty swallowing, cannot eat properly, and require round-the-clock care. Once AD patients at this stage contract an infection, they very easily die rapidly because of their poor resistance. Most patients die in the late stage, which lasts 1–2 years.

Over the 3–7 years from onset to death, Alzheimer's disease places a heavy economic burden on the entire family. Caring for an AD patient is no easy task: patients are emotionally irritable, prone to depression and anxiety, and aggressive. Caregivers not only bear considerable financial pressure but also great mental stress. This caregiving journey is both long and painful, which is why some describe developing Alzheimer's disease as embarking on a long and painful farewell with one's family.

Which elderly people are more likely to develop Alzheimer's disease? Generally, people with underlying conditions such as hypertension, diabetes, cerebral arteriosclerosis, hyperlipidemia, or depression are more prone to AD in old age. Those without such underlying diseases—who live actively and optimistically, eat a reasonable diet, love exercise, quit smoking and limit alcohol, actively participate in recreational activities, read often, and keep their brains active—are less likely to develop AD.

Alzheimer's disease is a preventable condition. The medical community currently holds that a reasonable diet, scientific mental exercise, emotional relaxation, cultivating multiple hobbies, controlling blood pressure, blood sugar, and blood lipids can lower the risk of developing AD. In addition, supplementing the elderly with vitamin B12, folic acid, deep-sea fish oil, and vitamin E can also reduce their risk of AD.

Alzheimer's disease is the fourth leading cause of death among the elderly, after cancer, heart disease, and cerebrovascular disease. It is a disease more difficult to care for than others; in the United States, annual spending on treating and caring for elderly AD patients exceeds a hundred billion U.S. dollars. Alzheimer's disease has some genetic component, but currently only about 5% of patients show familial clustering, while the remaining 95% are sporadic; AD is more strongly related to environment and lifestyle.

Brain degeneration is gradual, and preventing Alzheimer's disease must begin in youth. If a person in middle age leads a closed and passive life, has little contact with others in work and life, does not like to use the brain or learn, does not exercise, is overweight or obese, and is anxious or depressed, then they are more likely to develop AD in old age. So as not to place a heavy burden on our children, it is necessary for us to take a series of measures and live in a healthier way to prevent Alzheimer's disease.