Talk:Alzheimer's disease

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Ambiguous statistic

The survival time after diagnosis is approximately 6 years

Is this a mean or a median figure? Presumably that information can be found in one of the seven citations given for it, but it should be in the article. --75.63.50.206 (talk) 23:21, 31 July 2008 (UTC)

The reason it's so non-specific is that diagnosis can be late or early in progress of the disease, because it's so nonspecific.OrangeMarlin Talk• Contributions 23:48, 31 July 2008 (UTC)

FAC. Are we already there?

The article has changed very much in a year and the direction has always been FA. Two months ago it was presented as FAC. It was probably too early since a few sections had not been really revised. The FAC served its pourpouse since we had guides on what to improve. In these two months 3 sections have been fully rewritten, and most of the others improved. I believe content is good enough right now to pass the FA proccess, however there are a few issues that should be solved before the proccess begins. I think they are mainly three, but if anybody believes there are any others just say them.

Prognosis

I'll try to revise this section, since it is the smallest one of the article.

Lead

The lead should be a summary of the content of the article. Therefore I believe it should most likely follow the same order than the article give the same weight to article views and have same references. The lead of the AD article has evolved quite separated from the article, and there are importante differences between both of them. Could anybody with a good English take a look at it and rewritte some of it?

Citing style

Quite a lot of months ago this was alredy discussed. Consensus was reached to writte references vertically and using Diberris tool. Some sections and references do not use this style. Most importantly, I really do not like to put several references inside the same number since it is easy to repeat references without knowing it. Consensus has to be reached on whether to use such style and when (How many consecutive references are needed to combine them inside a single number?). Consensus should also be reached on which parameters from Diberris tool are the ones to be used in the references of the article.

We have almost 300 references in the article. It is really hard to follow them and very easy to repeat them or delete one... My proposal would be to use the full reference with the name parameter every time a reference is used. I know this increases the weight of the article, but it eases citing or deleting refences since you do not need to see if the ref is already used when including a new reference or if it is used in other sentences when deleting a reference. Anyway, if it is decided to only put the full reference the first time it is used there are many references (Probably most of them added by me) used several times with the full ref data.

--Garrondo (talk) 10:02, 1 August 2008 (UTC)

I have revised the prognosis and the lead. I have added info not present in the article from the lead and vice-versa.--Garrondo (talk) 12:45, 4 August 2008 (UTC)
See /Archive_4#Citations re the combining of citations. SandyGeorgia said "three or more single-use citations", which strikes me as a pretty sensible threshold.LeadSongDog (talk) 19:27, 4 August 2008 (UTC)
Is there some reason for providing "convenience" urls to linkinghub etc where the citations already have a permalink (pmid, pmcid, doi, etc)?LeadSongDog (talk) 20:03, 4 August 2008 (UTC)
I'm removing them as I find them, because apparently pmcid is recently linkable within citations. This is going to be a fun cleanup. OrangeMarlin Talk• Contributions 21:51, 4 August 2008 (UTC)
Can somebody exactly specify what should and should not appear in a ref so I can help to format all of them?--Garrondo (talk) 08:01, 5 August 2008 (UTC)
For cite journal, the DOI bot will check for and pare away redundant url and accessdate. The url is not needed where there is a correct pmid, pmcid, or doi provided. Accessdate is not needed for journals at all-they don't change. Every cite must have a title. Date, Journal, Volume, Issue, Pages are all good but not urgent to have. Author should normally list the first three authors and et al. where there are more than four. If a full date isn't available, using Year and Month fields is the alternative. LeadSongDog (talk) 14:33, 6 August 2008 (UTC)
I've been cleaning up the references. The DOI bot is not very efficient. I've tried it, and it gets some stuff and not others, using some database that frequently adds URL's to journal locations that require paid logins. I've been removing them. I set up a macro on my computer to clean them up, which I've been doing. Almost done. So that the style is consistent, please let me finish (which i should do today). Thanks. OrangeMarlin Talk• Contributions 14:40, 6 August 2008 (UTC)
Yeah, it's not without its flaws. Its owner usually responds well to bug reports on User:DOI_bot/bugs, though he may not do so right away. Cases in point would be useful. Thanks.LeadSongDog (talk) 15:33, 6 August 2008 (UTC)
I use diberri's template for citations, and I notice that it pulls from a database that has url's on occasion. I don't think it's a bug, it's just that the database is a bit whacked. OrangeMarlin Talk• Contributions 16:47, 6 August 2008 (UTC)

←I think it's close, but I think there are some style and grammar issues that need to be cleaned up. This is what I've seen in successful FAC's. To make the style clean and readable, one person should take the lead to clean it up. I can do that if I can have a couple of days without distraction. Also, we do have to clean up the citations per LDS' comments above. OrangeMarlin Talk• Contributions 21:54, 4 August 2008 (UTC)

  • Wow! Have you been busy or what? Great job! I noted a couple of implicit choices you made (somebody had to choose...) to use the short form journal names and page ranges as per pubmed. I really hate to quibble over this, but for a lay reader this can be rather confusing. I suppose I should raise the subject at MEDMOS talk. If the journal name were linked it might be more palatable, but as it is some are incomprehensible until you follow the permalink. Also noted that the short names were inconsistent about use of periods in the abbreviated words. I assume that's just what the tools did.LeadSongDog (talk) 20:54, 6 August 2008 (UTC)

Problems with outdated references in Prognosis section and a weak Prevention section

Based on my cursory glance over the references, there seems to be a reliance upon outdated primary articles when it comes to survival/prognosis. Ref 5., a 1986 primary article, is cited 5 times; it does not appear all that major, either. Ref 6., another primary article (1995) by the same author. Seems worth it to attempt to replace with up-to-date reviews, preferably freely accessible ones? Maybe I'm wrong; it is possible that those studies are the best, and that they were fairly conclusive on the causes of death/survival among Alzheimer patients. This plays into the prognosis section which you're thinking about revising. Also, it would be interesting to highlight seminal papers, although that might violate summary style. I also get the feeling that at least some of these references are superflous, and the best one should be chosen. A good review can cover a lot of information. "Best" can be decided by looking at how up-to-date the article is, how many citations it has, and how available it is (number of libraries with it, PMC availability, ect).

The article itself seems very well-written. It is hard for a layman to understand, but that's inevitable. The weakest section is, unfortunately, probably the most important section for the lay readers which Wikipedia attracts: prevention. I just read the first review referenced there to Alzheimer's/aluminium. It seems pretty good. The end of the prevention section presents a barrage of references which do not really support the "other studies have not confirmed this link" statement, especially because the two sentences bunch together EMF, solvents, and metals. That section needs work before this becomes a Featured Article. I've posted a review of scientific articles relating aluminium to Alzheimer's above on the talk section, which is widely considered to be the most closely related environmental contaminant. Disaggregating these different contaminants would be the first step. II | (t - c) 23:36, 4 August 2008 (UTC)

I think your points on the prognosis section deserve response (I'm still a holdout on discussing aluminum, because I have seen nothing that gives a biochemical reason for it inducing plaques or tangles, but I'll admit to not knowing everything about aluminum in neurons). The two articles mentioned are truly the best for the prognosis of the disease. I used Pubmed's highly effective references that use references system. One of the more modern articles Larson EB, Shadlen MF, Wang L, et al (April 2004). "Survival after initial diagnosis of Alzheimer disease". Ann. Intern. Med. 140 (7): 501–9. PMID 15068977.  uses a Seattle base population (talk about self-selecting--maybe too much coffee), and its results aren't significantly different than the articles mentioned. Sometimes there are just important studies that stand the test of time. BTW, I don't think PMC availability is a useful indicator of the importance of articles. It may have much more to do with arcane intellectual property ideals of various journals. OrangeMarlin Talk• Contributions 00:05, 5 August 2008 (UTC)
Back to aluminum. The reason I don't buy into aluminum as a causal agent for AD is A) Post hoc ergo procter hoc, which weakens any argument, and B) I've yet to read a proposed mechanism. I'd need convincing to put anything more about aluminum in this article. And, I do not work for ALCOA. In case you're wondering. LOL. OrangeMarlin Talk• Contributions 00:12, 5 August 2008 (UTC)
You're probably right about the prognosis section; it looks like most of the major articles are mentioned on this page, and the most recent review was in 2000. PMC availability is not an indicator of the importance of the article, it is an indicator of the availability to the reader only, which should be considered. I've actually noticed that this article will sometimes put up a real strong review followed by an older primary article available at PMC, which is appreciated. As far as the mechanism: since studies have found that aluminium is present in much higher concentrations in the brains of AD patients, that entirely presupposes a mechanism. The question is not whether there is a mechanism, then, but the consistency of these findings, because if these findings are consistent, then the mechanism question is moot. Sorry, misread what you meant by induce. Yes, how the aluminium translates into brain damage is a question, but plenty of research has gone into the mechanism. The 2007 Journal of Alzheimer's Disease article discusses mechanisms and epidemiological findings, and it concludes that "metals, particularly aluminium, are clearly involved, but it is unclear whether they play a minor or a major role in the etiology of the disease". If you don't have it available I can email it to you. II | (t - c) 00:41, 5 August 2008 (UTC)
There are reviews which conclude there is a relationship and others which conclude the opposite so I believe we maintain a neutral point of view as both views are shown and the same weight is given to both of them. Maybe in the future the role of Aluminium is more clear but for the moment there is no scientific consensus on its function and the only thing clear is that it has appeared related in some epidemiological articles. I do not believe the link needs to be more in depht covered in the main article.--Garrondo (talk) 08:14, 5 August 2008 (UTC)
Giving both sides equal weight because "there is a dispute" seems like rather poor reasoning. A 2007 review by Carpenter in a highly specialized journal says there is clearly a relationship. The papers cited which "dispute this claim" have some problems. The most recent 2007 one takes a scattershot approach and looks at all hypothesized risk factors. Because its approach is so wide, it looked at only 3 aluminium epidemiological studies. It apparently selectively picked out ones which were negative. The 2007 J. Alzheimer's Dis. lists 20 aluminium epidemiological studies in table 1, page 4. Of those 20, 15 are positive. The rest of the studies used against the aluminium link are primary/outdated. Clearly some sloppy work in this section, and it casts some doubt on the other sections, unfortunately. Understandably, it is impossible to read all these papers, but the error here could have been gathered from looking at the most relevant paper (2007 focused review) rather than trying to use outdated/primary studies to contradict it. In addition, the 2007 review discusses the mechanisms, so the information is out there if OrangeMarlin feels like exploring past mistaken conventional wisdom. My proposal is that we cut some of the primary studies. The Santibanez paper appears, prima facie, to be strikingly biased, selectively picking 3/20 studies and managing to pick the 3/5 negative ones. It could maybe be used for inconsistency in other risk factors, but the bias makes it a suspicious source IMO. If someone could send it over I would appreciate it; it would be interesting to see how they justify their selection. II | (t - c) 09:24, 6 August 2008 (UTC)
Well: if there is a dispute between primary sources and no scientific consensus in a matter, wikipedia should only state such debate since reaching a conclussion or giving more weight to a view would be original research. I don't feel that a single recent review means there is scientific consensus. On the other hand most articles on prevention, and not specifically centred in aluminium state that there are not enough facts to clearly propose preventive measures.--Garrondo (talk) 11:50, 6 August 2008 (UTC)
Back to Post hoc ergo procter hoc. Just because it's there, I'm not sure there is a cause. By the way, undue weight doesn't quite work the way as described above. Remember, science rarely tries to prove a negative, hence all the alternative medicine crap out there where someone will say, hey there are no references that dispute it. I think most researchers dispute any relationship, precisely because no one has elucidated a mechanism of action, which means it's ultimately not falsifiable. Aluminum is not quite a fringe theory, but it is nearly so. OrangeMarlin Talk• Contributions 14:45, 6 August 2008 (UTC)
OTOH, Occam leads us to hold that the association indicates causality, albeit not what the cause is. If both the metal and the plaques are present because of a mutual causative process, I haven't seen any suggestions what that common cause might be. If the plaques are causing the metal to concentrate that too would need a mechanism. Hence I continue to hold that we just don't know why they're associated. Time will tell but the article needn't wait on it. We should outright say that they're correlated but we don't know why.LeadSongDog (talk) 15:23, 6 August 2008 (UTC)
That's why I'm not totally dismissive as I might be if someone was pushing "Vitamin C prevents AD". There is enough research to make it seem like there is a link, but not quite enough to say it's verified. It's moved from fringe theory to almost interesting. I'm on the fence, but I don't want to give much weight to it. OrangeMarlin Talk• Contributions 16:50, 6 August 2008 (UTC)

Review of Causes section

I just copyedited (or at least tried to do so) this section. And I'm still confused. The first paragraph says that there are three hypotheses. Yet it reads like there are four, but then the last hypothesis seems to be a slight revision to #3. I'm confused. Can someone clarify or rewrite. OrangeMarlin Talk• Contributions 23:51, 4 August 2008 (UTC)

And one more issue: there doesn't appear to be any information about what might cause these things to happen. Down's syndrome and a genetic anomaly seem to be it. Which negates writing anything in prevention except maybe, "hey you're either going to get this or not, it's a matter of genes." is that true? Because that's what I would conclude from reading the section. OrangeMarlin Talk• Contributions 23:54, 4 August 2008 (UTC)
I'm not following. Did you look at the genetics section? Certain genes will strongly predispose you to AD, but if you don't have those, it seems less genetically determined. II | (t - c) 00:51, 5 August 2008 (UTC)
We might have a lack of knowledge to review this section and the pathophisiology section (I am sure I have). It is very specific and an important amount of biochemistry is needed. Could it be a good idea to ask at project medicine for some help?--Garrondo (talk) 07:00, 5 August 2008 (UTC)
Probably even better to try to go outside of Wikipedia and try to tap one of the real experts.
I have written to one of the Alzheimer's genetics specialist of the research center I work at. I have asked him if he will consider reviewing the causes and pathophisiology sections. I do not have a strong relationship with him so he may or may not help us. Does anybody know if his name can appear in something like an aknowledgements box or something like that if he does an external review? I seem to remember to have seen it in some other page, but I am not sure. As soon as he answers I will communicate it. --Garrondo (talk) 13:51, 7 August 2008 (UTC)
You're possibly thinking of Template:External peer review, which goes in the top matter of the article talk page and links it in to Wikipedia:External peer review. It is quite distinct from WP:Peer review.LeadSongDog (talk) 19:33, 7 August 2008 (UTC)
He has decided not to review the article since he does not have time.I could maybe ask some of his doctorate biologists but I suppose they will have similar problems and secondly most of them are right now on holidays. A pity. Any ideas? --Garrondo (talk) 07:32, 11 August 2008 (UTC)
Considering the July 2008 results, we need to ask if the beta-amyloid hypothesis is still tenable. First the 19 July Lancet autopsy results on the AN-1792 recipients showed clearing the AB didn't affect the dementia, then the Chicago ICAD methylene blue results showed attacking the tau did. It seems at least to some that the question is pretty much decided.LeadSongDog (talk) 20:33, 13 August 2008 (UTC)
IMO, we should make a statement that it is pretty much decided. But we have to keep in the prior hypotheses, just in case someone is reading this article and says, "hey what about AB." Eventually, if the tau hypothesis becomes the consensus, we reduce the other two hypotheses to mentions per WP:WEIGHT. Remember, in science, it takes repeatability of results to make good science, and I don't think we're quite there yet. The methylene blue results are preliminary, and pharmaceutical companies can make things appear more than they are. OrangeMarlin Talk• Contributions 21:15, 13 August 2008 (UTC)

Let's do it

I believe its ready now. We should present it as a FAC.--Garrondo (talk) 07:41, 13 August 2008 (UTC)

Image change proposal for FAC

First of all I wanted to remark the hard-wonderful job of OrangeMarlin and LeadSongDog. The article would not be nearly as good without all your editions...

I also wanted to propose an image change. The lead image is anything but friendly, and would not encourage anybody to read the article except pathologists, which are not very common. I think a possible solution is to put the image of the comparison between the two brains as the lead image and put the pathology one in the place left by the first. Texts fit perfectly so nothing would have to be rewritten and I feel the image of the brains is much more attractive. --Garrondo (talk) 13:16, 7 August 2008 (UTC)

I think we need to get someone to do a copyedit--someone who hasn't worked on this article like the three of us. I'll ask a couple of individuals. OrangeMarlin Talk• Contributions 07:45, 13 August 2008 (UTC)
good idea. I will do the same.--Garrondo (talk) 09:53, 13 August 2008 (UTC)

The lead image change is good. Colin°Talk 12:42, 13 August 2008 (UTC)

I've tweaked the first paragraph a bit. Two changes affect the meaning and I want to check with you guys:

  • I've added "often" to the "terminal disease" bit as later the text says AD is "the underlying cause" for 70% of deaths. I'm not sure if this means that some folk can have AD for a very long time (and so die of an unrelated illness -- they lived with AD rather than dying of it) or merely that AD will kill you unless something else gets there first. Any thoughts?
  • I've removed the "although estimates vary greatly" from the lead. The discussion of estimate quality is probably best left out of the lead and if this is our best guess then let's just present as such. Also, the citation for that clause didn't support it as it only had figures up to 2030 rather than 2050.

Colin°Talk 13:38, 13 August 2008 (UTC)

I agree with the second change, but not with the first: from my point of view it is always terminal, which has nothing to do with the fact that for example an old person can die of a heart attack or a car accident before AD kills him. I change it again--Garrondo (talk) 14:42, 13 August 2008 (UTC)

Last minute issues from Casliber

Hang on folks, just going through - these longer articles are a real pain in the neck if issues crop up and the FAC page becomes a morass of text...Cheers, Casliber (talk · contribs) 10:06, 17 August 2008 (UTC)

  • the physician or healthcare specialist.. - do we need 'healthcare specialist' here? Aren't internal medicine specialists and geriatricians physicians?
  • The disease course is divided into four stages, with a progressive pattern of cognitive and functional impairment expressed from one stage to the next and during each stage. -erm, this sentence has 3 'stages' in it...may wanna try and mix it up a little...
I simply eliminated the second part of the sentence leaving it as: The disease course is divided into four stages, with a progressive pattern of cognitive and functional impairment.
  • noncritical - I have never heard this word used in a medical context, and never seen it non-hyphenated (or is that nonhyphenated) either. Could probably replace with normal aging or somesuch.

*Any particular reason under Characteristics section why Advanced doesn't have 'dementia' after it like the others?

Added dementia for the advanced section
  • PS:Any edits you think I screwed up in by losing meaning or just ugliness of prose, please revert
  • ..and the tangles are located in areas of the brain that cause deterioration of mental function - areas of the brain which cause this??
I have said which area is where Ad patients have more tangles and eliminated the part of the sentence of the cause of deteriorioration of mental function (Almost any brain damage supposes deterioration of mental function).

Early onset Alzheimer's

I think the Intro is misleading in the second line. It used to mention the "early-onset form" of AD, but now just mentions Familial Alzheimer disease (in the line "although a less prevalent inherited form strikes earlier") as the 'other form' of AD. But are they strictly the same thing? I can't find any proof that 'early onset' AD is always genetically inherited. Surely we need to mention 'early onset' AD? I'll re-include the term, and will make an article for it too - I'll retain the link in the Intro it to Familial AD (as it was 'piped' before) until it's done.

This line has proved hard to write as we simply can't say how many 'forms' of AD there are. A way around this is to use the word "Alzheimer's" instead of 'form'. I'm trying this:

"Initial onset typically occurs in people over 65 years of age, although the less-prevalent early-onset Alzheimer's can occur much earlier".

I'm a bit worried about the finalisation of the FA process being a bit of a train - we need to get matters like this right, rather than 'edit around' them, which I suspect may have happened here.--Matt Lewis (talk) 18:25, 18 August 2008 (UTC)

I think your rewrite is fine. As for the "train", I'm not sure you should be too worried about it. The FA process seems to be thorough (as opposed to years ago--I read some FA articles that are just plain bad). I agree with not editing around concerns. OrangeMarlin Talk• Contributions 18:35, 18 August 2008 (UTC)

Onset

Incidentally, does the actual "onset" occur after 65? Maybe the start of this line can be addressed too.--Matt Lewis (talk) 18:33, 18 August 2008 (UTC)

I will try "Generally it is diagnosed in people over 65 years of age..." --Matt Lewis (talk) 18:36, 18 August 2008 (UTC)

The problem with words like "commonly" is that they seems to allude the prevalence of the disease across society, rather than over age. --Matt Lewis (talk) 18:46, 18 August 2008 (UTC)
I looked over 3 or 4 articles (I used one to reference the statement), and Alzheimer's appears to almost never happen before 65. The article from Brookmeyer, seems to indicate it's less than 0.05%. I guess in a population of 5 million over that age, that's still a big number. OrangeMarlin Talk• Contributions 18:55, 18 August 2008 (UTC)
BTW, there's really no good articles that make a definitive statement about when it does occur. The 65 number is used because I think the epidemiological studies indicate that it becomes a significant (though very small) number at that point. One day, when we know what actually predisposes someone to Alzheimer's, we can determine the exact onset age. Also, I think there's a delay in diagnosis, which may make the date later than usual.OrangeMarlin Talk• Contributions 18:58, 18 August 2008 (UTC)

Early-onset Alzheimer's disease created

I intitally created the article and introduction, then was 'bold' and merged in the text from Familial Alzheimer's disease below the intro (FAD accounts for about half of early onset AD). It's easy to delete the text I've inserted, and I haven't 'redirected' the FAD article to the new article yet. I've asked for comments in Talk:Early-onset Alzheimer's disease. If it is OK, we can link the second line in the Introduction straight to Early-onset, instead of pipe-linking it to FAD, which is only half the story. --Matt Lewis (talk) 02:17, 19 August 2008 (UTC)

Dementia before age 65

Frontotemporal dementia usually is diagnosed before age 65. Mention of this might be helpful, in a section of the article about differential diagnosis. --Una Smith (talk) 04:57, 27 August 2008 (UTC)

US/UK English

This article is predominantly US English and has been since the start. Despite my personal preference for UK spelling, I attempted to fix the few non-US spellings in this edit according to WP:ENGVAR. Adherence to guidelines is part of the FA criteria. This was undone by Matt Lewis (talk · contribs). I queried this with Matt but we're at a stalemate. All I desire is consistency within the article; the choice of US or UK English is up to the major contributors IMO. Could someone else decide either way. Thanks, Colin°Talk 21:26, 20 August 2008 (UTC)

I addressed the "has been from the start" in response on my talk.. I think the US-lead appraisal is unnecessarily unfair (as it goes..). And AD is not area specific (or not in 'the West' at least - hard to say elsewhere). If FA's demand one type only, how about International English? The American editors have been more than amenable so far. It's not all about Ronald Reagan - its about AD. It's a bugger for us all. I'm happy with both (I don't even notice the variation), but it looks like we must make a choice...--Matt Lewis (talk) 21:55, 20 August 2008 (UTC)
I don't care which one to use (I don't even know the difference between both of them), but WP policies say that one should be chosen.--Garrondo (talk) 09:24, 21 August 2008 (UTC)
I prefer UK English, because it is used by more English speaking countries and in countries (such as India) where English is the second language. I am comfortable with both, but I suggest we use the UK version. Bugger is a bit difficult to understand. LOL. OrangeMarlin Talk• Contributions 14:43, 21 August 2008 (UTC)
It looks we have consensus leaning towards UK English. It would be my pleasure to make the change to consistent UK spelling. I'll have a go later, unless anyone shouts in the meantime. Colin°Talk 15:15, 21 August 2008 (UTC)
No objection either way, but yes, we need consistency. International's fine with me. Go for it.LeadSongDog (talk) 15:19, 21 August 2008 (UTC)

Done. Unfortunately, the templates and categories are US English. Colin°Talk 17:07, 21 August 2008 (UTC)

No flies on you! Bravo.LeadSongDog (talk) 17:42, 21 August 2008 (UTC)

neuroimaging

The text days "SPECT and PET neuroimaging are used to diagnose Alzheimer's in conjunction with methods involving mental status examination." Earlier it said "Alzheimer's disease is usually diagnosed clinically". This paragraph may give the (contradictory) impression that such scans are routine, which I suspect they are not. Can someone clarify the text (insert the word "occasionally", or say "under research for the diagnosis", etc) or whatever is appropriate. What may be available for rich patients in the top US teaching hospitals isn't necessarily so elsewhere. Colin°Talk 12:44, 21 August 2008 (UTC)

I believe that SPECT and PET are used for confirmatory diagnosis, but the initial diagnosis does not require it. Let me reread and add some appropriate words. I'm not sure what happened, but this came up in the first FAC, and we added some language about availability of procedures. OrangeMarlin Talk• Contributions 14:40, 21 August 2008 (UTC)
At least in Spain they are very rarely used in public health (which comprises 99 per cent of medical care). Only in private hospitals as the hospital I work at it is clinically used routinously. It is probably the same over the world: A pet is expensive but a spect is VERY expensive.--Garrondo (talk) 06:47, 22 August 2008 (UTC)
Here in America, I think it's more common than elsewhere, but not a standard medical tool. I would say that most major medical centers have one. And of course, there are independent for-profit institutions that have them.OrangeMarlin Talk• Contributions 18:45, 22 August 2008 (UTC)

Kraepelin

Text mentions 8th edition, ISBN is broken. I only find seventh. I suspect that the content is in volume 4: Dementia praecox and paraphrenia but someone should verify this.LeadSongDog (talk) 16:36, 22 August 2008 (UTC)

You are right: I copy the following text from an article (PMID 9447568):
Secondly, a new nosological entity relevant to and accepted by clinical practitioners can only be developed in relation to a diagnostic and therapeutic system. This step was taken by Emil Kraepelin in the 8th edition of his famous textbook published in 1909. He, but not Aloys Alzheimer, really created Alzheimer's disease. In the 7th chapter of the 2nd volume on senile and presenile psychiatric disorders Kraepetin mentions Alzheimer at least three times and then goes on to define an "Alzheimer's disease" that is characterized by a severe dementia, beginning at about the age of 50 with its typical neuropathological alterations, especially tangles of fibrils, but without signs of cerebral arteriosclerosis. Then Kraepelin discussed the clinical and nosological meaning of Alzheimer's disease:
... The clinical interpretation of this Alzheimer's disease is still confused. While the anatomic findings suggest that we are dealing with a particularly serious fon~a of senile dementia, the fact that this disease sometimes starts already around the age of 50 does not allow this supposition. In such cases we should at least assume a "senium praecox'" if not perhaps a more or less age-independent unique disease process...(Kraepelin, 1909, p. 627)
The citation for his 1909 book is: Kraepelin, E. (1909). Psychiatric. Ein Lehrbuch far Studierende und °rzte. 8. Auft., Band II/l. Leipzig: Barth. (Engl. trans. (1987): Senile and pre-senile dementias). In K. L. Bick, L. Amaducci & G. Pepeu (Eds) The Early Story of Alzheimer's Disease (pp. 32-81). Padova: Liviana Editrice].
I do not have time right now to look for the isbn and correct citation but I will do it tomorrow or at last on monday if nobody does it before.
--Garrondo (talk) 17:53, 22 August 2008 (UTC)
I'm a bit confused. The isbn # works, and I can even buy the reprint on Amazon.com. I'm not sure if there's any reason to use the original reference, since it might be difficult to find. Since the reprint is exactly the same, and is available to find at a library or for purchase, that's the reference we should use. OrangeMarlin Talk• Contributions 18:43, 22 August 2008 (UTC)
The question comes down to which edition introduced the pioneering content. It's a rather fine point, but if we're putting it in, we should try to get it right.LeadSongDog (talk) 19:39, 22 August 2008 (UTC)
I see now that the isbn works on A9 and on Google Shopping, but not WorldCat, Ottobib, or Google Books. Very strange. Presumably the reprint of 2007 just hasn't percolated through the indices yet, but it may be the book hasn't actually been reprinted pending sufficient orders.LeadSongDog (talk) 19:50, 22 August 2008 (UTC)
Ok, this is just too funny. I hate to think what Babelfish would do...LeadSongDog (talk) 20:14, 22 August 2008 (UTC)
The truth comes out in the end. It's a print-on-demand book. LeadSongDog (talk) 20:32, 22 August 2008 (UTC)
You can't handle the truth. Oh. Sorry. I digress.  :) OrangeMarlin Talk• Contributions 22:31, 25 August 2008 (UTC)
"Now that I do know it I shall do my best to forget it." - Doyle AC. A Study in Scarlet: The science of deduction LeadSongDog (talk) 16:16, 26 August 2008 (UTC)

Alzheimer's disease for main page

The article has reached the FA status after very hard work. Right now it has been nominated to appear in the main page of wikipedia the 21 of september (Alzheimer's international day). Anybody which thinks it is the best date for the article can vote here. That day many media do specials on the disease and being in the main wikipedia page can attract a lot of attention to the article and wikipedia, and also provide reliable information to all those searching for it that day. --Garrondo (talk) 14:29, 26 August 2008 (UTC)

Seems like a fine idea to me. Congratulations to all contributors. It has been a long trek to a little gold star.LeadSongDog (talk) 16:09, 26 August 2008 (UTC)
Great job, editors! --Chrispounds (talk) 19:23, 26 August 2008 (UTC)
On my computer, it always looks like a brown star. Either I'm going color blind, or I need a new monitor. Humph. OrangeMarlin Talk• Contributions 06:04, 28 August 2008 (UTC)
As usual, you're (mostly) right. It's bronze.19:45, 28 August 2008 (UTC)

Social cost of AD due to wandering

In this edit with edit summary Social costs: Eliminated SAR: Not peer-review reference and only a minor cost for society when compared with others named", Garrondo deleted this text:

People with Alzheimer's disease are prone to "wandering", leaving home and becoming disoriented and lost, and often requiring expensive public emergency response services such as search and rescue.[1]

Garrondo's edit summary gives two reasons: quality of reference and notability of cost. The ref is not peer-reviewed but it is by an authority and it is free full text. There may be a peer-reviewed article available, in the public safety literature. Rather than summarily delete the reference, it may be more appropriate to tag it. The social cost of wandering by AD patients is not minor. A SAR mission lasting more than a few hours is likely to expend many hundreds to thousands to tens of thousands of skilled man hours. So, rather than dismiss this contribution, how about looking into it farther and expanding the article to mention non-custodial social costs? --Una Smith (talk) 21:35, 27 August 2008 (UTC)

The quality of reference was poor, and the rest of your edit, therefore, seemed like WP:SYNTH. And wandering is not a major social cost, although when it does occur to the family, it may have one. OrangeMarlin Talk• Contributions 22:02, 27 August 2008 (UTC)
OM, what do you have in mind when you write "major social cost"? --Una Smith (talk) 04:08, 28 August 2008 (UTC)

e/c I haven't looked at this section for a while and I won't read it this minute (I'm busy elsewhere and I've been afraid of what I'll find!), but I'm afraid this is probably part of the Featured Article process. I'm not fan of FA's myself - they lead to controlled information if you ask me. I know very well what wandering is all about. Regarding the deleted line, it only doesn't need to clarify "such as search and rescue" (sounds like a US term, and it's obvious without it). Garondo's done a great amount of work on this article, but sometimes he doesn't fully see AD as all-round bad news as it actually is. People are often found dead if they have been out too long - hypothermia, traffic (eg when the pavements one side only, and corners are tight) - tunnel vision is particular symptom of AD. Sometimes they can't see something inches from their line of vision. I've seen a score of normal working and retired people looking for one person - police excluded! Sometimes complete strangers give the crucial lift home. The section might need to specify that the costs/burden etc to society can be varied. AD is cheap when the governments won't spend on it (the UK is almost ignoring AD in some respects - especially over the right to not tell the sufferer, which clearly doesn't fit into their 'risk assessment' rules) - but somewhere down the line AD simply has to be dealt with. It's hard to factor in police time too. Our 'mountain rescue' is a volunteer service, but it's still a cost. --Matt Lewis (talk) 22:13, 27 August 2008 (UTC)

SAR is mountain rescue, volunteer fire department, etc. In much of the world searches for missing persons are either a police function, or informal. In much of the US, they are an organized volunteer function. Volunteer or paid, the costs of searching for an eloping AD patient can be very high. As in, the monetary value of the manhours spent (in terms of pay not received) frequently exceeds the direct cost of a nursing home for one year. --Una Smith (talk) 04:18, 28 August 2008 (UTC)
Matt Lewis: What has this disccussion to do with FA? Taking AD to FA has done nothing but taking what was a really innacurate and messy article to something that anybody can understand, and the first people who get benefits of it are AD patients families. As for your accusations of not seeing it as "all-around": Do not think that you are the only one that has worked as a carer of people with dementia: I have for four years, so I now the burden it is, which has nothing to do with the search of reliable sources, accuracy and balance in an Encyclopedia.--Garrondo (talk) 07:23, 28 August 2008 (UTC)
Una Smith: Of course the cost of a rescue mission is high, but how common they are? Even a search in a city is costly, but what is the prevalence of AD people going out of their home and a search being organized? Once a year per patient? Probably much less. the cost of that seems VERY LOW, when compared to the lost productivity of a family caring for a person for a whole year or the cost of taking him to a hospital. Lets put it other way: If you were talking about children caring costs it would seem rather simplistic to say that searching for lost children is one major cost for society, when compared to the cost of public education. I believe that for the SAR fact to be included you would have to find a peer-review reference which clearly states the median cost of rescues and searches per person with the disease and year to see if it is really as high as your not-very-reliable reference says. If there is none it may probably be because it is not so important. --Garrondo (talk) 07:23, 28 August 2008 (UTC)
This might be helpful: Volcher Ladislav, Nelson Audrey(ed), Algase Donna L(ed) (2007). Evidence-based protocols for managing wandering behaviors. Springer Publishing, 53-64, 181-191. ISBN 0826163653. LeadSongDog (talk) 15:48, 28 August 2008 (UTC)

The cost of wondering has 2 parts. Above, we discuss the cost after the person elopes. Consider also the cost of keeping the person from eloping or otherwise coming to harm due to unattended wandering. That includes 24hr surveillance, and physical security measures. --Una Smith (talk) 16:24, 31 August 2008 (UTC)

Any work in this area is much appreciated by me. I'll certainly find some time soon to focus solely on this subject (certainly before September 21st, when this becomes an 'article of the day'). I personally find it hard to dip in sometimes as I see AD almost every day, and I have a number other involved interests on Wikpiedia too. Certainly we have more work to do in the 'social' area before the 21st, current FA status or no. --Matt Lewis (talk) 23:13, 31 August 2008 (UTC)
But this second cost is alredy included in the article: The cost of living at home is also very high,[17] specially when informal costs for the family, such as caregiving time and caregiver's lost earnings, are taken into account. When it is calculated how much money costs caring for an AD person and how much money is lost is already taken into account that a person with dementia and specifically with AD has to be closely followed. The thing is that it is not only because of wandering. It is also because he may endanger himself in the kitchen or bathroom, he is not able to take his meds adequately, etc. So I do not really see the point of specifically talking about wandering when the costs wandering brings can not be separated from the costs brought by other symptoms of dementia. --Garrondo (talk) 08:34, 1 September 2008 (UTC)
The point I'm trying to make, that seems not to be getting across, is that the financial cost to society of wandering out of bounds (elopement) is not already taken into account. Concerning those costs, the state of the art, albeit a rough state, is in the web page I cited. --Una Smith (talk) 19:38, 1 September 2008 (UTC)

I now see I gave this section a misleading title; a better one would be Additional costs to society due to elopement. --Una Smith (talk) 19:38, 1 September 2008 (UTC)

That annoying 'caregiving burden' again

This section once had a couple of lines that explained that the 'family carer' sees their loved-one lose any idea who their once-loved carer is. Consequently, the carer has virtually none of the traditional caring 'rewards' (such as thanks, or a feeling of progress, as caring for an AD sufferer can be like babysitting someone with hyperactivity - yet it is day after day for so many carers). Tempers fray from both sides. All this is AD related, very specifically - it can't be pushed onto 'general dementia' (and it hasn't even been moved over, either). Where is it all? It's pure deletionism - which is against the rules without good reason.

The section now almost verbatim repeats the sentence from the lead ("Alzheimer's disease is known for placing a great burden on caregivers which includes social, psychological, physical or economic aspects."). Surely that's not even great by MOS is it? I expect it 'passed' their current structure (which all they want to do as MEDMOS) but it's not exactly impressive is it?

Now the sections says "Caregiving can also have positive benefits such as lessened postloss depression and grief in some cases". Sorry, but is this talking the piss or what? I mean FFS? FFS? I nearly hit the hit the roof when I saw what was missing and then read that. Is it sadism, a phonecall from the UK gov, was is it? I've seen someone turn into a shell of himself after his wife finally died - he had nothing left. He visited her every day until the final hour too. Shall I tell him he should be feeling less grief? Wikipedia says it so it must be true. Something in him has died after his endless ordeal. He may never have bawled in tears as soon as she died (I don't know), but I wish you could see the set of his face - and the wet gloss over his eyes from time to time. He was lucky she died in hospital and not by an accident - but he was always there for her, wasn't he? Do you people think AD suffers would ever make it to a hospital death if it wasn't for the constant care that they've had? Really - think about it. And she was once a senoir in the health service too - he told me he has all this money and nothing to do with it. I hope no one here is feeling too smug. One thing MEDMOS don't give a damn about is inner-article balance and WP:WEIGHT. That is up to us - where is it here? They are rubbish references too.--Matt Lewis (talk) 00:52, 31 August 2008 (UTC)

It is true that some people feel praise of their job as carers and this can have positive psychological effects, and it was well referenced, but it may also be unbalanced, no problem with the elimination (But relax PLEASE).--Garrondo (talk) 07:38, 1 September 2008 (UTC)

Corrections to prevalence estimates for U.S.

Alzheimer's disease #Epidemiology said "In the United States, Alzheimer prevalence was estimated to be 1.6% in the year 2000. In the 65–74 age group, approximately 5% of the U.S. population has AD, with the rate increasing to nearly 20% in the 75–84 group and to 50% in the greater than 84 group." But the cited source (Hebert et al. 2003, PMID 12925369) doesn't give percentage figures; it gives absolute numbers of 0.3, 2.4, 1.8, and 4.5 million for people aged 65–74, 75–84, 85–, and total, respectively. The Census Bureau gives counts of 18,390,986, 12,361,180, 4,239,587, and 281,421,906, respectively, for these groups, and these work out to 1.6%, 19%, 42%, and 1.6% respectively, not the 5%, nearly 20%, 50%, 1.6% reported in Alzheimer's disease #Epidemiology. I guess somebody's calculator messed up? I made this edit to cite the Census Bureau for the totals, so that the reader can see where these numbers are coming from, and to correct the numbers. Eubulides (talk) 22:25, 27 August 2008 (UTC)

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