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Alzheimer Disease

Jeffrey L. Cummings, MD; Greg Cole, PhD
JAMA. 2002;287(18):2335-2338. doi:10.1001/jama.287.18.2335.
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Alzheimer disease (AD), the most common cause of dementia in the elderly, is a progressive neurodegenerative disorder that gradually robs the patient of cognitive function and eventually causes death. We review the epidemiology, clinical features, pathophysiology, and treatment of AD.

Brookmeyer R, Gray S, Kawas C.Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset. Am J Public Health.1998;88:1337-1342.
Von Strauss EM, Viitanen D, De Ronchi D.  et al. Aging and the occurrence of dementia. Arch Neurol.1999;56:587-592.
Gao S, Hendrie HC, Hall KS, Hui S.The relationships between age, sex, and the incidence of dementia and Alzheimer disease. Arch Gen Psychiatry.1998;55:809-815.
Ernst RL, Hay JW.The US economic and social costs of Alzheimer's disease revisited. Am J Public Health.1994;84:1261-1264.
Max W.The economic impact of Alzheimer's disease. Neurology.1993;43:S6-S10.
Seshadri S, Drachman DA, Lippa CF.Apolipoprotein E4 allele and the lifetime risk of Alzheimer's disease. Arch Neurol.1995;52:1074-1079.
Statement on use of apolipoprotein E testing for Alzheimer disease. American College of Medical Genetics/American Society of Human Genetics Working Group on ApoE and Alzheimer disease. JAMA.1995;274:1627-1629.
Clarke R, Smith AD, Jobst KA.  et al. Folate, vitamin B12, and serum total homocysteine levels in confirmed Alzheimer disease. Arch Neurol.1998;55:1449-1455.
Evans DA, Hebert LE, Beckett LA.  et al. Education and other measures of socioeconomic status and risk of incident Alzheimer disease in a defined population of older persons. Arch Neurol.1997;54:1399-1405.
Fratiglioni L, Ahlbom A, Viitanen M, Winblad B.Risk factors for late-onset Alzheimer's disease. Ann Neurol.1993;33:258-266.
Guo A, Cupples LA, Kurz A.  et al. Head injury and the risk of AD in the MIRAGE study. Neurology.2000;54:1316-1323.
Launer LJ, Andersen K, Dewey ME.  et al. Rates and risk factors for dementia and Alzheimer's disease. Neurology.1999;52:78-84.
Kalmijn S, Launer LJ, Ott A.  et al. Dietary fat intake and the risk of incident dementia in the Rotterdam study. Ann Neurol.1997;42:776-782.
Orgogozo J-M, Dartigues J-F, Lafont S.  et al. Wine consumption and dementia in the elderly. Rev Neurol (Paris).1997;153:185-192.
Hendrie HC, Ogunniyi A, Hall KS.  et al. Incidence of dementia and Alzheimer disease in 2 communities. JAMA.2001;285:739-747.
Callahan CM, Hendrie HC, Tierney WM.Documentation and evaluation of cognitive impairment in elderly primary care patients. Ann Intern Med.1995;122:422-429.
Folstein MF, Folstein SE, McHugh PR.Mini-mental state. J Psychiatr Res.1975;12:189-198.
Petersen RC, Stevens JC, Ganguli M.  et al. Practice parameter: early detection of dementia. Neurology.2001;56:1133-1142.
Costa PT, Williams TF, Albert MS.  et al. Recognition and Initial Assessment of Alzheimer's Disease and Related Dementias.Rockville, Md: US Dept of Health and Human Services, Agency for Health Care Policy and Research; 1996.
Cummings JL, Benson DF.Dementia: A Clinical Approach.2nd ed. Boston, Mass: Butterworth-Heinemann; 1992.
Mega M, Masterman DM, O'Connor SM.  et al. The spectrum of behavioral responses in cholinesterase inhibitor therapy in Alzheimer disease. Arch Neurol.1999;56:1388-1393.
McKhann G, Drachman D, Folstein M.  et al. Clinical diagnosis of Alzheimer's disease. Neurology.1984;34:939-944.
Bracco L, Gallato R, Grigoletto F.  et al. Factors affecting course and survival in Alzheimer disease. Arch Neurol.1994;51:1213-1219.
Beard CM, Kokmen E, Sigler CA.  et al. Cause of death in Alzheimer's disease. Ann Epidemiol.1996;6:195-200.
Knopman DS, DeKosky ST, Cummings JL.  et al. Practice parameter: diagnosis of dementia (an evidence-based review). Neurology.2001;56:1143-1153.
The National Institute on Aging and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer's Disease. Consensus recommendations for the postmortem diagnosis of Alzheimer's disease. Neurobiol Aging.1997;18:S1-S2.
Arnold SE, Hyman BT, Flory J.  et al. The topographical and neuroanatomical distribution of neurofibrillary tangles and neuritic plaques in the cerebral cortex of patients with Alzheimer's disease. Cerebral Cortex.1991;1:103-116.
Cummings JL, Vinters HV, Cole GM, Khachaturian ZS.Alzheimer's disease. Neurology.1998;51:S2-S17.
Lantos P, Cairns N.The neuropathology of Alzheimer's disease.In: O'Brien J, Ames D, Burns A, eds. Dementia. 2nd ed. London, England: Arnold; 2000:443-459.
Hardy J.Amyloid, the presenilins and Alzheimer's disease. Trends Neurosci.1997;20:154-159.
St George-Hyslop PH.Molecular genetics of Alzheimer's disease. Biol Psychiatry.2000;47:183-199.
Selkoe DJ.Presenilins, β-amyloid precursor protein and the molecular basis of Alzheimer's disease. Clin Neurosci Res.2001;1:91-103.
Gotz J, Chen F, Van Dorpe J, Nitsch RM.Formation of neurofibrillary tangles in P301l transgenic mice induced by Abeta 42 fribrils. Science.2001;293:1446-1447.
Doody RS, Stevens JC, Beck C.  et al. Practice parameter: management of dementia (an evidence-based review). Neurology.2001;56:1154-1166.
Rogers SL, Farlow MR, Doody RS.  et al. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Neurology.1998;50:136-145.
Corey-Bloom J, Anand R, Veach J.  et al. A randomized trial evaluating the efficacy and safety of ENA 713 (rivastigmine tartrate), a new acetylcholinesterase inhibitor, in patients with mild to moderately severe Alzheimer's disease. Int J Geriatr Psychopharmacol.1998;1:55-65.
Tariot PN, Solomon PR, Morris JC.  et al. A 5-month, randomized, placebo-controlled trial of galantamine in AD. Neurology.2000;54:2269-2276.
Cummings JL.Cholinesterase inhibitors: a new class of psychotropic agents. Am J Psychiatry.2000;157:4-15.
Sano M, Ernesto C, Thomas RG.  et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. N Engl J Med.1997;336:1216-1222.
Mulnard RA, Cotman CW, Kawas C.  et al. Estrogen replacement therapy for treatment of mild to moderate Alzheimer disease. JAMA.2000;283:1007-1015.
Henderson VW, Paganini-Hill A, Miller BL.  et al. Estrogen for Alzheimer's disease in women. Neurology.2000;54:295-301.
Launer JJ, Jama JW, Ott A.  et al. Histamine H2 blocking drugs and the risk for Alzheimer's disease. Neurobiol Aging.1997;18:257-259.
Stewart WF, Kawas C, Corrada M, Metter EJ.Risk of Alzheimer's disease and duration of NSAID use. Neurology.1997;48:626-632.
Wolozin B, Kellman W, Rousseau P.  et al. Decreased prevalence of Alzheimer disease associated with 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors. Arch Neurol.2000;57:1439-1443.
Katz IR, Jeste DV, Mintzer JE.  et al. Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia. J Clin Psychiatry.1999;60:107-115.
Street J, Clark WS, Gannon KS.  et al. Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer's disease in nursing care facilities. Arch Gen Psychiatry.2000;57:968-976.
Tariot PN, Erb R, Podgorski CA.  et al. Efficacy and tolerability of carbamazepine for agitation and aggression in dementia. Am J Psychiatry.1998;155:54-61.
Lyketsos CG, Sheppard J-ME, Steele CD.  et al. Randomized, placebo-controlled, double-blind clinical trial of sertraline in the treatment of depression complicating Alzheimer's disease. Am J Psychiatry.2000;157:1686-1689.
Taragano FE, Lyketsos CG, Mangone CA.  et al. A double-blind, randomized, fixed-dose trial of fluoxetine vs amitriptyline in the treatment of major depression complicating Alzheimer's disease. Psychosomatics.1997;38:246-252.
Alzheimer's Association. Available at:http://www.alz.org.Accessibility verified March 28, 2002.
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Figures

Figure 1. Morphology and Distribution of Neuritic Plaques and Neurofibrillary Tangles
Graphic Jump Location
A, Neuritic plaque (labeled with a monoclonal antibody for human amyloid peptide using diaminobenzidine combined with hematoxylin counterstain, × 2500 magnification). B, Distribution of neuritic plaques in the cerebral cortex. C, Neurofibrillary tangle (Gallyas silver stain; × 2500 magnification). D, Distribution of neurofibrillary tangles in the cerebral cortex.
Figure 2. Cascade of Events Associated With β-Amyloid Generation and Cell Death
Graphic Jump Location
Oligomerization of the β-amyloid peptide initiates oxidative injury, plaque formation (following β-amyloid aggregation), and possibly tangle formation (dashed line). Oxidative injury and inflammation contribute to membrane disruption, degeneration of the neuronal axon, and loss of synapses. Neurodegeneration ensues leading to cell death and neurotransmitter deficits. Apolipoprotein E, α-1-antichymotrypsin, and possibly α-2-macroglobulin contribute to plaque formation.

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