Lauren Smith crashed her car three times last year; she was sixty-two years old and she thought her eyesight was failing. As a mother of three, a doctor's wife, an amateur actress and a keen bridge player, Lauren never had time for illness. Yet even her bridge friends had started to notice changes in her behaviour.

Lauren Smith crashed her car three times last year; she was sixty-two years old and she thought her eyesight was failing. As a mother of three, a doctor's wife, an amateur actress and a keen bridge player, Lauren never had time for illness. Yet even her bridge friends had started to notice changes in her behaviour.

The symptoms of Alzheimer's disease differ for each individual and vary with the progress of the disease. In Lauren's case, Alzheimer's disease was affecting her spatial perception - there were frequent spills when she misjudged the edge of tables and sent cups of tea flying. Her bridge partner May also found her more than once sitting on a couch, utterly lost, trying to find her way to the toilet at the bridge club where she'd been a member for fifteen years. Then there were the afternoons she couldn't stay awake and nodded off in the middle of a hand.

Worldwide Problem

Alzheimer's disease is the most common cause of dementia - a broad term for a set of symptoms affecting people who suffer from a brain disease. These dementing illnesses have existed since antiquity but it was originally thought that Alzheimer's affected younger people and everyone else had a tendency to what was then called "senile dementia" with age. We now know that's not true. "Dementing illness is not a normal part of ageing and only a quarter of all people develop it," says Lewis Kaplan, chief executive of the Alzheimer's Association of NSW.

Worldwide there has been a massive growth in the number of Alzheimer's sufferers. Nationally, there are 160,000 Australians with moderate to severe dementia and according to Lewis Kaplan probably the same number again with undiagnosed early-stage dementia.

Dementia and particularly Alzheimer's disease are age-related - the older you are the more likely you are to develop a dementing illness. Currently twenty-five percent of all eighty-five year olds suffer some sort of dementia and one in fifteen over sixty-five year olds. And with demographic modelling confirming that the eighty-plus population in Australia is growing three times as fast as the general population, the sixty-plus group twice as fast, and the baby boomers set to burst into the older persons arena, there is a crisis looming for dementia carers and government services.

Although there is still no prevention or cure for Alzheimer's disease, the ageing world population has become a key driver for funding extensive research across the globe. In Melbourne today there is a group of researchers working on a vaccine for Alzheimer's; and there is another team in St Paul Minnesota ready to start clinical trials of a vaccine.

Dementing illnesses usually have an insidious onset, with most people developing symptoms gradually over a period of years. Apart from age, the known risk factors are gender - females are more likely to contract Alzheimer's disease. Genetics - if you have a number of relatives with the disease, particularly if you have a relative who developed the disease in his or her 20's or 30's, your risk of developing Alzheimer's disease increases sharply.

Lauren's father died of Alzheimer's disease when he was in his 70's. "But," says Kaplan, "the benefits of paying attention to risk factors are marginal. Even people who don't smoke, drink moderately, exercise their minds, brains and bodies regularly, as well as taking vitamins that possibly make a difference, can still develop the disease."

Genetics

There has been a great deal of genetic research carried out to find the cause/s of Alzheimer's disease. In the 1970's scientists discovered that levels of the neurotransmitter called acetylcholine fell sharply in people with Alzheimer's disease. Acetylcholine is a critical neurotransmitter in the process of forming memories and moreover, it is the neurotransmitter used commonly by neurons in the hippocampus and cerebral cortex - the brain regions devastated by Alzheimer's disease.

Today, drugs such as Exelon, which prevents the breakdown of acetylcholine in the brain and Aricept which works by increasing the levels of acetylcholine, are commonly prescribed to help slow down the mental decline experienced in Alzheimer's sufferers and improve their ability to cope with everyday activities.

More recently researchers have identified the protein fragment called beta amyloid in the brain plaques of Alzheimer's patients. Alois Alzheimer was the first to identify these plaques (dense deposits) outside and around the nerve cells of an Alzheimer sufferer's brain, and tangles (twisted strands of neurofibrillary fibre) inside the nerve cells, now recognised as the hallmarks of the disease.

And lately, research teams have identified gene mutations in people with Alzheimer's disease, but to extrapolate that to the general population may take years.

Friends, You Can Make a Difference

Lewis Kaplan is keen to encourage more research into the caring of Alzheimer's disease, "It is less exciting research because it won't lead to any huge breakthrough, but given that we have such a large population of people with dementia we need to ensure the high quality of their care and delay institutionalisation as long as possible."

In Australia, currently half of all dementia sufferers are cared for informally in the community and the other half in the formal carer system. Dementia Awareness Week, starting September 17th, focuses on both the carer and the sufferer.

Typically everybody just fades away and leaves the primary carer - husband, wife, daughter, son etc. - to take all the responsibility for the Alzheimer's sufferer. "It's difficult looking after someone with dementia," says Lewis Kaplan. "They are unpredictable, some of the time they don't make sense, they can be frustrating because they ask the same question over and over. If you don't understand the disease you may think they are just being difficult. In fact they are desperately trying in their own way not to be difficult or a burden, but eventually as the disease progresses they become completely dependant on others for everything.

"Alzheimer's is a very frightening disease, it's like losing your self. It changes your life; it changes the life of the people around you. But if those people around someone with dementia can understand what is happening and can provide support, then that really makes a world of difference."