These days, he doesn’t always remember who she is.
Four years after John Shreve’s diagnosis with Alzheimer’s disease and seven years after his wife, Janice, began realizing he was having memory problems, he sometimes looks at her blankly, trying to place her.
“You’re not supposed to challenge people with Alzheimer’s or question them, but I find that hard,” said Janice Shreve, 73, who lives with her husband of 42 years in Roseville, Calif.
“I’ll sometimes ask if he knows me. And he says, ‘Of course, I know who you are. You’re my precious thing.”’ Promising new developments in the field of Alzheimer’s research hold great potential for people not yet facing the disease. But for the families of those already suffering, the news is bittersweet, hinting of solutions to come rather than answers now.
In the heart-wrenching world of Alzheimer’s, landmark new guidelines for diagnosing the disease — which affects 5.4 million people today and is expected to soar to epidemic proportions with the aging of the baby boomers — have immediate application not to patients, caregivers and families but to the scientific community.
Studies on the biology of Alzheimer’s recently linked the disease with five specific genes whose presence increases the risk of developing it. So far, the research gives tantalizing clues about who gets Alzheimer’s and how it progresses — but no clear path to a cure.
Still, the guidelines recently released by the National Institute on Aging and the Alzheimer’s Association are bringing researchers and clinicians new hope.
The new criteria, the first since 1984, raise the possibility of advances that will lead to a changed Alzheimer’s landscape in the future, one in which pre-symptomatic treatment may prevent damage before it occurs, just as the treatment of high cholesterol can prevent heart disease from developing.
“It will change the way we look at Alzheimer’s,” said Elizabeth Edgerly, Alzheimer’s Association of Northern California program officer. “In the future, there will be people with Alzheimer’s with no symptoms. They’ll have the biological markers for the disease but no memory problems. That’s what the field is shifting toward.”
But not yet, doctors caution.
The new guidelines divide the progression of Alzheimer’s into three stages: pre-clinical, with measurable changes in brain imaging and spinal fluid yet no outward signs of the disease; mild cognitive impairment, in which memory loss is slight and doesn’t compromise daily life; and full-fledged dementia.While the first stage holds great promise for the development of treatment, experts warn that it’s only a research category at this point.
“This is not a green light for everybody to run out and get brain imaging,” said Dr. Charles DeCarli, neurologist and director of the Alzheimer’s Disease Center at the University of California, Davis.
For example, says DeCarli, some people have the pathology of Alzheimer’s but never develop symptoms — and some people develop memory loss and eventual dementia even though they never have Alzheimer’s. In other words, Alzheimer’s is a path to dementia, but not always and not the only one. Dementia can result from a number of conditions, including strokes and severe Vitamin B deficiency. And according to the Alzheimer’s Association, half the people with dementia never receive any diagnosis at all.
Some dementias — those caused by head injury and, many times, brain tumors — are treatable. But dementia from a large category of diseases mainly affecting the elderly, including Alzheimer’s and Parkinson’s, cannot be cured.