As a geriatrician, I am always interested in the latest literature and theories on Alzheimer's disease, one of the scourges of modern times.
With more and more people living to older ages, the number of people suffering from dementia is estimated to be more than 5 million in the United States alone. This fact was published in the latest "2009 Alzheimer's Disease Facts and Figures" report recently released by the Alzheimer's Association (www.alz.org).
The economic toll for taking care of these victims is estimated in the same report to be $148 billion, and the emotional toll of patient and family suffering is incalculable. But two new books challenge the conventional wisdom on Alzheimer's, one even going so far as to claim Alzheimer's is a "myth" and shouldn't really be thought of as a "disease." The other book claims to have "The Answer to Alzheimer's."
Something in the Name
Are these authors on to something new?
Dr. Peter J. Whitehouse of the prestigious Cleveland Clinic, a respected Alzheimer's researcher for many years, suggests a new viewpoint in his controversial book, The Myth of Alzheimer's, now in paperback.
Whitehouse suggests, not that senility and dementia do not exist and are not problems, but that they are difficult to distinguish from normal aging and other brain diseases.
Many different brain conditions cause memory and behavioral problems, and Whitehouse proposes that we should avoid stigmatizing patients and families by calling them the victims of Alzheimer's disease, a diagnosis that isn't always technically possible to prove.
Additionally, Whitehouse suggests that political and economic resources should be devoted more to care-giving than to an unrealistic search for a cure. Although there has been much negative reaction to the book, when expressed this way, it seems like a reasonable point.
It's true that as bad as what we call Alzheimer's is, such a high percentage of people develop it if they live long enough that one might almost reasonably call it statistically "normal" — and thus not a "disease."
I'll leave this argument to philosophers; however, Whitehouse makes the profound point that words and stories are important, and that what we call things makes a difference in people's perceptions, feelings and behavior.
In this respect, I'm reminded of another provocative book I read many years ago in college.
The Myth of Mental Illness, by Dr. Thomas Szasz, similarly claimed that mental illnesses, problems in living, and negative emotions and behaviors could not necessarily always be called a "disease."
There are no identifiable brain lesions or chemical abnormalities in most patients with mental and emotional problems, and what we call abnormal behavior is determined as much by social consensus as by medical science.
Calling negative emotions and behaviors "diseases" can lead to mixed consequences regarding self-image, blame, responsibility and culpability for one's actions.
Szasz received much criticism for his viewpoints, as has Whitehouse. But Alzheimer's is different from, say, depression, because in most cases of Alzheimer's, there is an identifiable abnormality in the brain called "plaques and tangles."
Though these findings vary and don't totally explain every case, usually one or more abnormalities can be seen in the brain of dementia victims; thus, I believe it is truly a "disease," and not a myth.
But as our current methods of treatment are unsatisfactory, a new approach is needed. An approach of identifying and minimizing risk factors for dementia would be ideal in order to prevent or delay as many cases as possible.
This is the approach offered by another excellent recent book, The Alzheimer's Answer: Reduce Your Risk and Keep Your Brain Healthy by Arizona neurologist Dr. Marwan Sabbagh.
While Whitehouse makes many of the same points, Sabbagh is more optimistic and less provocative, offering hope of a "world without Alzheimer's."
Sabbagh stresses that all the well-known cardiovascular risk factors (diabetes, obesity, high blood pressure) are also Alzheimer's risk factors, since many cases involve strokes and hardening of the arteries, along with nerve degeneration.
So it seems that the best answer for Alzheimer's disease is not to wait until it happens, treat it with drugs and hope for a cure someday, but to try to prevent it by doing everything we can to protect and preserve our brain, and reduce cardiovascular risk factors earlier in life.
Dr. Todd Goldberg is associate professor and director of the Geriatrics Fellowship Program at West Virginia University's Robert C. Byrd Health Sciences Center and Charleston Area Medical Center, Charleston, W.Va.