Alzheimer's Disease

Alzheimer's Disease, a progressive neural disorder that gradually degrades the cognitive system and culminates in death.Once considered a rare disease of middle age, Alzheimer's came to be viewed in the 1970s as a major public‐health problem in the United States, estimated to be the fourth or fifth leading cause of death in those over sixty‐five.

Alois Alzheimer of Munich first described the disease in 1906, after dissecting the brain of a woman who had died in her fifties from a progressive dementia and observing cortical atrophy, cellular plaques, and neurofribrillary “tangles.” Other physicians who verified these lesions in similar patients recognized the disease as a cause of dementia and premature senility. Nevertheless, for decades thereafter, most physicians continued to believe that memory loss and functional deterioration in the elderly were characteristic of the normal aging process. However, electron‐microscopic studies at Albert Einstein College of Medicine, by Robert Terry in the 1960s and Robert Katzman in the 1970s, identified Alzheimer's plaques and tangles in the brains of 50 to 60 percent of all elderly patients suffering from progressive dementia. In a brief but influential editorial in the Archives of Neurology in April 1976, Katzman argued that senility should be recognized not as normal aging, but as an organic disease that would significantly impact American families financially and emotionally as more of the population lived past the age of seventy.

In 1977, Katzman and Terry wrote to Donald Tower, director of the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS), explaining the need for further research on Alzheimer's disease. Tower collaborated with Robert Butler, director of the newly created National Institute on Aging (NIA), collaborated with staff of the National Institute of Mental Health in sponsoring a major Alzheimer's conference, which presented current research findings and encouraged scientists to develop new projects. Establishing a Neurobiology on Aging program within the NIA in 1977, Butler and others successfully promoted the funding and expansion of Alzheimer's research. The Health Research Services Act of 1985 established ten Centers of Excellence across the country to define diagnostic standards for the disease and to coordinate basic, clinical, and social research projects. By 1993, federal grant support for Alzheimer's research had grown from less than $5 million to more than $300 million a year.

Butler, Tower, and Katzman sought grassroots support from lay groups across the country, formed by relatives and caregivers of Alzheimer's patients. Local groups met in Washington, DC, in 1979 to organize the Alzheimer's Disease and Related Disorders Association (ADRDA). In the years that followed, ADRDA lobbied actively for federal research funding and significantly increased public interest in and concern about Alzheimer's disease.

Although the cause of Alzheimer's disease remains unknown, some researchers have hypothesized that chemical changes in certain proteins found in the brain, perhaps the result of genetic mutations or brain injury, may be the keys to its etiology. Despite significant research progress, Alzheimer's disease remains a tragic scourge and public‐health challenge, as families watch beloved relatives deteriorate, while struggling to find the resources for their care.

Bibliography

Patrick Fox , From Senility to Alzheimer's Disease: The Rise of the Alzheimer's Disease Movement, Milbank Quarterly 67 (1989): 58–102.
Robert Katzman , Current Research on Alzheimer's Disease in a Historical Perspective, in Alzheimer's Disease: Causes, Diagnosis, Treatment, and Care, eds. Zaven S. Khachaturian and Teresa Radebaugh, 1996, pp.15–29.

Marcia Meldrum