The cruelty of Alzheimer's disease is one of the hardest to fathom. It strips people of their normal physical and mental functioning, making them completely dependent on others. It destroys memory, steals the ability to recognize loved ones, and eats away at identity until entire lives have been erased.

Researchers are still unsure of its causes, although they do know that Alzheimer's disease forms abnormal structures in the brain called plaques and tangles and that these structures reduce or block nerve connections, particularly in the area of the brain that controls short-term memory. As the disease progresses, other sections of the brain are also affected. Over several years, Alzheimer's disease results in dementia, loss of coordination, and eventually death. There is no cure for Alzheimer's disease, and only two drugs approved by the Food and Drug Administration (FDA) -- tacrine (Cognex) and donepezil (Aricept) -- are currently being prescribed to slow it down (see sidebar). One unconventional medicine, however, is gaining popularity in treating Alzheimer's: vitamin E (alpha-tocopherol), a supplement normally taken orally for its antioxidant properties and applied topically to improve skin tone and prevent scarring.

Scientists have learned that antioxidants may have a positive effect on patients already suffering from Alzheimer's disease. The New England Journal of Medicine reported on trial studies at 35 hospitals and research centers on the effects of both vitamin E and the Parkinson's-disease drug selegiline, also known for its antioxidant properties. Although both drugs separately and in combination had a beneficial effect, vitamin E, taken at a high therapeutic dosage of 2,000 IU (international units) per day, performed the best, actually slowing the progression of the disease.

Why does vitamin E make a difference? Antioxidants work to counteract the negative effects of "free radicals," or oxygen atoms missing an electron, in the body. In seeking to complete their atomic structure, free radicals attach themselves to healthy atoms, causing a chemical reaction. Many scientists think this chemical reaction can eventually lead to heart disease, cancer, or other illnesses. For Alzheimer's patients, free radicals destroy brain cells, leading to further loss of mental acuity.

Delaying the major milestones in the progression of the disease -- the loss of ability to care for oneself, institutionalization, and death -- could turn many doctors into vitamin E champions. "Vitamin E for Alzheimer's has been advocated to help memory loss by alternative-medicine practitioners for a long time," wrote Norman L. Foster, M.D., an associate professor of neurology at the University of Michigan Medical School who participated in the trial, "but [before now] there has been no evidence to support its use... Now we are going to start routinely recommending vitamin E to our Alzheimer's patients."

Still, vitamin E is not a cure for the disease. Doctors at the Mayo Clinic who also took part in the trial studies noted that while vitamin E and selegiline detoxified free radicals and slowed the progression of the disease, they did not improve the memory, attention span, language skills, or comprehension of patients. But researchers there have not been dissuaded from further study on the issue. Along with more than 65 medical research institutions in the United States and Canada, the Mayo Clinic will soon begin trials on the cognitive benefits of antioxidants.

It is also important to note that a proper dosage of vitamin E for Alzheimer's disease has not yet been determined and that high dosages of vitamin E (2,000 IU is 200 times the recommended daily allowance) can cause gastrointestinal problems and excess bleeding due to the vitamin's anticlotting effects. It is important that Alzheimer's patients talk to their doctor before beginning any new treatment.

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Treating Alzheimer's Disease

Two medications now have approval from the FDA for treatment of Alzheimer's disease, but many new drugs are being studied, both conventional and alternative. A list of the more common treatments being examined is available here; contact your doctor or the Alzheimer's Association chapter in your area for information on how to participate in a study. You can also review the Alzheimer's Association website at http://www.alz.org .

Conventional Treatments

Cholinesterase Inhibitors

These drugs act by preventing the breakdown of acetylcholine, an essential neurotransmitter needed to relay messages in the brain and to form new memories. Only the first two of the following drugs are FDA-approved for the treatment of Alzheimer's disease. The rest are still in trial studies, but participation in the studies may be possible. Ask your doctor for information on access to these new medications.

Cholinergic Agonists

The drug Arecoline is being tested in clinical trials for the treatment of Alzheimer's disease. It acts to stimulate the acetylcholine receptors, which in theory should make more of the essential neurotransmitter available to the body. It has not been approved yet by the FDA as treatment for Alzheimer's disease, but it may be possible to participate in a study. Ask your physician for information on access to this new medication.

Alternative Treatments

Antioxidants

Agents with antioxidant activity, such as vitamin E (alpha-tocopherol) and the Parkinson's- disease drug selegiline (Eldepryl), may slow the progression of Alzheimer's disease by fighting harmful free radicals in the body, which attack and destroy healthy cells. The Alzheimer's Disease Cooperative Study brought together 35 U.S. hospitals and research centers to test the effectiveness of vitamin E and selegiline in Alzheimer's disease patients. Both medications were shown to delay progression of the disease.

Estrogen

Estrogen may do a lot of things to slow down Alzheimer's disease. The hormone may act as a modified anti-inflammatory agent, stimulate the growth of brain neurons and make their connections healthier, promote the natural production of acetylcholine, and convey antioxidant effects. The Woman's Health Initiative Memory Study of Estrogen is an ongoing study of women between the ages of 65 and 79 who are eligible for hormone replacement therapy. Ask your doctor for information on how to participate in this study.

Anti-inflammatories

Noting that rheumatoid arthritis patients have a lower incidence of Alzheimer's disease, researchers have studied the connection between nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and Alzheimer's disease. The research is encouraging but not consistent; the FDA has not approved anti-inflammatory agents for Alzheimer's disease treatment for that reason. Use of NSAIDs for Alzheimer's disease should not be undertaken without a physician's approval due to the risk of excess bleeding and gastrointestinal problems.

Calcium channel blockers

Calcium channel blockers, like nimodipine (Nimotop), are being studied for their ability to prolong the survival of nerve cells, but conclusive results are not yet available. Again, talk to your doctor about the use of these drugs.

Is it Alzheimer's?

This is never an easy question to answer, but early intervention can result in a better outcome for patients and their families. Alzheimer's disease is difficult to diagnose because some early signs may seem like ordinary consequences of aging. Over time, however, Alzheimer's disease results in drastic physiological and personality changes that are specific to the disorder. There is no specific test for the disease; rather there are a series of determinates such as blood tests, brain scans, and mental function and neurological tests that together can indicate Alzheimer's disease. The sooner a diagnosis is made the better, because early treatment may help slow the progression of the disease. Here are some helpful lists of warning signs visible throughout the stages of Alzheimer's disease: http://www.alz.org .

Early signs:

Intermediate signs:

Advanced signs: