Actress Julianne Moore won a Best Actress Golden Global last night for her portrayal of an early-onset Alzheimer’s patient in the movie Still Alice.
Based on the 2009 novel Still Alice by neuroscientist Lisa Genova, Moore plays Alice Howland, an accomplished Harvard professor, who begins to have difficulty remembering things. As the forgetfulness progresses, Alice receives the devastating diagnosis of early-onset Alzheimer’s Disease. The film shows the realistic struggles of the once fiercely independent woman’s decline and the impact on her family.
Moore spent months in preparation for the role:
“I started by watching every Alzheimer’s documentary I could get my hands on. Then I went to the head of the Alzheimer’s Association, who talked about her own experiences with her mother and grandmother having it. They set me up on Skype calls with women around the country who had early-onset diagnoses. One of them, Sandy, who is now a friend, had been diagnosed at 45, which is just astonishing.”
An underlying theme of Still Alice deals with the concept of how much of a person’s uniqueness remains, even if their memories and cognitive abilities decline:
“I gave that a tremendous amount of thought. I found that this notion that someone is obliterated by the disease is completely untrue. Even in the patients I spoke to who were most declined, a lot of who they were still came through to me. It’s astonishing, but there is something there. I don’t know what it is exactly, but I think we have to appreciate the fact that it is still there.”
In her acceptance speech, Moore thanked Genova, as well as those who helped make the movie possible:
“When Lisa Genova wrote this book, she told me that no one wanted to make it into a movie because no one wanted to see a movie about a middle-aged woman.
“So I wanna thank the people who actually made the movie, James Brown and Lex Lutzus, Sony Classics and my good, good friends at Killer Films and this amazing cast, and our filmmakers [Richard Glatzer and Wash Westmoreland], who, in the middle of their own crisis from a degenerate disease, ALS [Glazer], decided they wanted to make movies.”
Source: National Institute on Aging
Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear after age 65. Estimates vary, but experts suggest that as many as 5 million Americans age 65 and older may have Alzheimer’s disease. In addition, there are approximately 200,000 individuals younger than age 65 who have younger-onset Alzheimer’s.
Alzheimer’s disease is the most common cause of dementia among older people. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities, to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.
|As Alzheimer’s disease progresses, neurofibrillary tangles (shown in blue) and amyloid plaques spread throughout the brain.|
Although we still don’t know how the Alzheimer’s disease process begins, it seems likely that damage to the brain starts a decade or more before problems become evident. During the preclinical stage of Alzheimer’s disease, people are free of symptoms but toxic changes are taking place in the brain. Abnormal deposits of proteins form amyloid plaques and tau tangles throughout the brain, and once-healthy neurons begin to work less efficiently. Over time, neurons lose their ability to function and communicate with each other, and eventually they die.
Before long, the damage spreads to a nearby structure in the brain called the hippocampus, which is essential in forming memories. As more neurons die, affected brain regions begin to shrink. By the final stage of Alzheimer’s, damage is widespread, and brain tissue has shrunk significantly.
Memory problems are typically one of the first warning signs of cognitive loss, possibly due to the development of Alzheimer’s disease. Some people with memory problems have a condition called amnestic mild cognitive impairment (MCI). People with this condition have more memory problems than normal for people their age, but their symptoms are not as severe as those seen in people with Alzheimer’s disease. Other recent studies have found links between some movement difficulties and MCI. Researchers also have seen links between MCI and some problems with the sense of smell. The ability of people with MCI to perform normal daily activities is not significantly impaired. However, more older people with MCI, compared with those without MCI, go on to develop Alzheimer’s.
A decline in other aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimer’s disease. Scientists are looking to see whether brain imaging and biomarker studies, for example, of people with MCI and those with a family history of Alzheimer’s, can detect early changes in the brain like those seen in Alzheimer’s. Initial studies indicate that early detection using biomarkers and imaging may be possible, but findings will need to be confirmed by other studies before these techniques can be used to help with diagnosis in everyday medical practice.
These and other studies offer hope that someday we may have tools that could help detect Alzheimer’s early, track the course of the disease, and monitor response to treatments.
As Alzheimer’s disease progresses, memory loss worsens, and changes in other cognitive abilities are evident. Problems can include, for example, getting lost, trouble handling money and paying bills , repeating questions, taking longer to complete normal daily tasks, using poor judgment, and having some mood and personality changes. People often are diagnosed in this stage.
In this stage, damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought. Memory loss and confusion grow worse, and people begin to have problems recognizing family and friends. They may be unable to learn new things, carry out tasks that involve multiple steps (such as getting dressed), or cope with new situations. They may have hallucinations, delusions, and paranoia, and may behave impulsively.
By the final stage, plaques and tangles have spread throughout the brain, and brain tissue has shrunk significantly. People with severe Alzheimer’s cannot communicate and are completely dependent on others for their care. Near the end, the person may be in bed most or all of the time as the body shuts down.
Scientists don’t yet fully understand what causes Alzheimer’s disease, but it has become increasingly clear that it develops because of a complex series of events that take place in the brain over a long period of time. It is likely that the causes include some mix of genetic, environmental, and lifestyle factors. Because people differ in their genetic make-up and lifestyle, the importance of any one of these factors in increasing or decreasing the risk of developing Alzheimer’s may differ from person to person.
Early-onset Alzheimer’s is a rare form of the disease. It occurs in people age 30 to 60 and represents less than 5 percent of all people who have Alzheimer’s disease. Most cases of early-onset Alzheimer’s are familial Alzheimer’s disease, caused by changes in one of three known genes inherited from a parent.
Most people with Alzheimer’s disease have “late-onset” Alzheimer’s, which usually develops after age 60. Many studies have linked the apolipoprotein E (APOE) gene to late-onset Alzheimer’s. This gene has several forms. One of them, APOE ε4, seems to increase a person’s risk of getting the disease. However, carrying the APOE ε4 form of the gene does not necessarily mean that a person will develop Alzheimer’s disease, and people carrying no APOE ε4 can also develop the disease.
Most experts believe that additional genes may influence the development of late-onset Alzheimer’s. Scientists around the world are searching for these genes, and have identified a number of common genes in addition to APOE ε4 that may increase a person’s risk for late-onset Alzheimer’s.
Research also suggests that a host of factors beyond basic genetics may play a role in the development and course of Alzheimer’s disease. There is a great deal of interest, for example, in associations between cognitive decline and vascular and metabolic conditions such as heart disease, stroke, high blood pressure, diabetes, and obesity. Understanding these relationships and testing them in clinical trials will help us understand whether reducing risk factors for these conditions may help with Alzheimer’s as well.
Further, a nutritious diet, physical activity , social engagement, and mentally stimulating pursuits can all help people stay healthy as they age. New research suggests the possibility that these and other factors also might help to reduce the risk of cognitive decline and Alzheimer’s disease. Clinical trials of specific interventions are underway to test some of these possibilities.
Alzheimer’s disease can be definitively diagnosed only after death, by linking clinical measures with an examination of brain tissue and pathology in an autopsy. But doctors now have several methods and tools to help them determine fairly accurately whether a person who is having memory problems has “possible Alzheimer’s dementia” (dementia may be due to another cause) or “probable Alzheimer’s dementia” (no other cause for dementia can be found).
To diagnose Alzheimer’s, doctors may:
Alzheimer’s disease is complex, and it is unlikely that any one intervention will be found to delay, prevent, or cure it. That’s why current approaches in treatment and research focus on several different aspects, including helping people maintain mental function, managing behavioral symptoms, and slowing or delaying the symptoms of disease.
Four medications are approved by the U.S. Food and Drug Administration to treat Alzheimer’s. Donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Razadyne®) are used to treat mild to moderate Alzheimer’s (donepezil can be used for severe Alzheimer’s as well). Memantine (Namenda®) is used to treat moderate to severe Alzheimer’s. These drugs work by regulating neurotransmitters (the chemicals that transmit messages between neurons). They may help maintain thinking, memory, and speaking skills, and help with certain behavioral problems. However, these drugs don’t change the underlying disease process, are effective for some but not all people, and may help only for a limited time.
Common behavioral symptoms of Alzheimer’s include sleeplessness, agitation, wandering, anxiety, anger, and depression. Scientists are learning why these symptoms occur and are studying new treatments—drug and non-drug—to manage them. Treating behavioral symptoms often makes people with Alzheimer’s more comfortable and makes their care easier for caregivers.
Alzheimer’s disease research has developed to a point where scientists can look beyond treating symptoms to think about addressing underlying disease processes. In ongoing clinical trials, scientists are looking at many possible interventions, such as immunization therapy, cognitive training, physical activity, antioxidants, and the effects of cardiovascular and diabetes treatments.
From the Alzheimer’s Association