Jane Wirsig first started complaining of persistent fatigue in 1976, but the watershed event in the Princeton, N.J., woman's illness came while she was doing her household accounts the next year. She abruptly stood up, slapped her leg in frustration, and told her husband, Woodrow, "Something's wrong. I've forgotten how to subtract."
Wirsig was one of 4 million Americans who suffer from Alzheimer's disease. By 1986, she couldn't walk, couldn't talk, didn't recognize her husband and choked on her food.
That year, her husband enrolled her in an early experimental trial of a recently approved Alzheimer's drug called tacrine, and her condition immediately improved. "She stopped choking, she could walk again, and best of all . . . she could recognize me and tell me 'I love you, too,' " Woodrow Wirsig said. "The (drug) gave my wife another three years of an acceptable quality of life" before she died in 1989 at age 69.
Jane Wirsig's story, told in Woodrow's book, "I Love You, Too," is one that is likely to be repeated in the future.
In the last two years, researchers have been reporting unprecedented successes in understanding the causes of Alzheimer's disease and developing therapies.
Spurred by the recent discovery of genes that promise to provide an explanation of how Alzheimer's develops, some researchers believe that they are on the verge of producing revolutionary treatments to delay the onset of Alzheimer's disease, and perhaps prevent it.
"I am absolutely convinced that within 10 years we will have a pill that prevents Alzheimer's disease," said Dr. Allen Roses of Duke University, who discovered the genetic link.
Tacrine is still the only approved Alzheimer's drug, but two others, estrogen and an anti-inflammatory called indomethacin, have been shown in recent small studies to delay the onset of the disease and reduce its effects. At least 15 other drugs are in clinical trials. Grafts of fetal cells are also likely to be tried as therapy within the next six months.
Perhaps the greatest excitement revolves around the recent genetic discovery linking Alzheimer's to a protein that carries fats in the blood.
"These are exciting times. Much more has happened just in the last three years than has happened in the last three decades," said Dr. Leonard Berg of the Washington University School of Medicine, chairman of the medical and scientific advisory board of the Alzheimer's Assn. "I have the clear sense that scientists across the country are much more enthusiastic that we will come up with some better answers in the next few years than they were even five years ago."
"For the first time, I feel optimistic that (researchers will be able) to discover effective new drugs," said neuroscientist Richard Wurtman of the Massachusetts Institute of Technology.
The new findings are thought to be so important that researchers and the Alzheimer's Assn. are mobilizing an all-out effort to obtain $100 million in additional research funds from Congress to follow up on them. "It's time to redouble our efforts now that we are seeing a real payoff" in research results, said Joe Roth, association chairman.
Alzheimer's is a disease of aging. It affects perhaps 3% of people ages 65 to 74, 20% of those 74 to 84, and as many as 50% of those over 85. Moreover, the number of people over age 65, and thus at risk, is expected to double within the next 30 years, bringing a strong sense of urgency to the search for new therapies and preventives for Alzheimer's.
The disorder is characterized by a progressive loss of mental function, including loss of memory, language and the ability to deal with numbers. Victims progress further into confusion and a complete inability to handle normal everyday situations, failing to remember even their own names. When the brain finally loses the ability to regulate even elementary body functions, they die of malnutrition, dehydration, infection or heart failure.
The most distinguishing characteristic of the disorder is the presence of rock-hard plaques and tangles in the brain, which are used after death to make a definitive diagnosis of Alzheimer's.
The average time from diagnosis to death is usually seven to 10 years, but it can be as short as two or as long as 20. About 100,000 people die of Alzheimer's each year in the United States.
The effects of Alzheimer's can be devastating not only to the patients but to their families as well.
Barbara Stratford's father, J. Allen Stratford, developed the disorder in 1988 at age 66. An outgoing, enthusiastic man who loved sports and surrounded himself with his seven children and their families, the elder Stratford suddenly became "a grouchy old man, totally unlike himself," his daughter said.
His weight dropped to 98 pounds because he had no appetite. With all his activities reduced, "we thought he was just sitting there waiting to die," Barbara Stratford said.