Advances in clinical research in Alzheimer's disease

There has been an explosion of clinical research on Alzheimer's disease (AD) in recent years, shedding light on many aspects of the disease. These include the differentiation of AD from normal aging, appreciation of genetic aspects of the disease, characterization of its pathology and pathophysiology, and the beginnings of a rational approach to treatment. Alzheimer's disease (AD) is a clinicopathologic diagnosis. In the near future, it may be possible to confirm the clinical diagnosis by examination of spinal fluid or by skin biopsy, but the diagnosis of AD in 1991 is based on history, direct examination of the patient and, ultimately, confirmation by microscopic examination of the brain. In short, we stand very close to where Dr. Alzheimer stood when he reported a hitherto unrecognized form of dementing illness in a 51-year-old woman. Alzheimer's case was cited by the editor of the journal in which it was published as an example of the need to look closely at patients from both clinical and pathologic perspectives so that individual diseases might eventually be separated out from syndromes such as dementia. Since Alzheimer's report, many clinical studies have shed further light on this disease. Two important deterrents to Alzheimer's disease research were the presumption that dementia is either a normal age-related phenomenon or a psychotic disorder of old age. The assumption that dementia is a product of normal aging or a functional psychotic disorder of late life was first challenged by Corsellis, who found a strong correlation between the severity of cerebral degenerative change and clinical diagnosis of patients who died in a psychiatric hospital.(ABSTRACT TRUNCATED AT 250 WORDS)