Talk:Alzheimer's disease

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Images

I am not sure that the histopathology picture is convincing. Where is the neurofibrilary tangle? It might be useful to show a brain scan or a photograph of a brain with increased sulci and reduced gyri (and perhaps a normal one for comparison). Snowman 23:29, 6 November 2006 (UTC)

I've requested assistance here from a polyglot user who may be able/willing to transwiki the images on the ro: article to Commons. We'll see how it works out.LeadSongDog (talk) 21:29, 29 January 2008 (UTC)

Also asked ro:Discuţie Utilizator:Moby Dick to help out. LeadSongDog (talk) 05:01, 31 January 2008 (UTC)

This is the Romanian AD Featured Article - it has a few pics that could be used here. Interestingly, the 'Treatment' section looks like the one here used to - I wonder how much, if any, of the article is a direct translation. --Matt Lewis (talk) 01:05, 17 February 2008 (UTC)

Fatality

In some parts of the article (for ex. statistics) AD is stated as a cause of death. But on the other hand, no where in the article it's not stated whether AD is fatal or not. It seems like it's fatal, but not clear why, the chances, and reason. It would be nice if there's some kind of info about fatality in the first section. iyigun 23:06, 16 January 2007 (UTC)

Many things are causes of death without being necessarily or immediately fatal to all people, immediately. Any kind of paralysis or coma, for example. These things cause such gigantic care problems for any person that the patient becomes practically impossible to keep alive for the long term. It comes down to a matter of money, ala Terri Schiavo or Christopher Reeve. The more money you have, the better you can do, but it's a losing game, and for people with no effective consciousness, usually one that nobody is willing to play. SBHarris 23:26, 16 January 2007 (UTC)

Since there is no "cure" for AD, everyone who has it will die with it, but not necessarily from it. It can cause death by shutting down brain function. I will get a source and description of that, but of course, "How we Die" by Sherwin Nuland is the classic. --Chrispounds 23:38, 16 January 2007 (UTC)

I do not think you'll find a case of anybody dying of Alheimer's which had progressed to the point of shutting down brain stem function and causing classical brain death. It just doesn't work that way. Nor would anybody allow the process to go on that long, even if it did. SBHarris 23:41, 16 January 2007 (UTC)

Just to make it clear: People who develop Alzheimer's can live from 2 to 20 years with the disease, but Alzheimer's disease is a terminal illness. Due to the deterioration in the brain and body, a person becomes more susceptible to various complications, such as infection, that can cause death. While infection may be the immediate cause of death, the underlying cause is the deterioration brought about by AD. In the brain with Alzheimer's disease neurons continue to die over time and eventually the body will shut down. However, people usually die of secondary infection. It is usually not the actual Alzheimer's that ends a person's life, but rather, any one of a number of side effects of the disease. Such as influenza or pneumonia brought on by compromised immune system. --Igoruha 23:34, 17 January 2007 (UTC)

Yes, and you can say just the same about being a high level quadruplegic. Potato, potahto. Aging itself is a terminal illness. Nobody has died of old age since 1955 when they outlawed it as a cause of death to put on death certificates. Since then, it's been putting down "complications" only. Doesn't change reality. SBHarris 04:41, 17 January 2007 (UTC)

Thanks for your reply Igoruha. I would like to see such an explanation in the article. iyigun 17:04, 20 January 2007 (UTC)

AD is such a problem with memory that the person actually forget or don't take their medication for infections as an example. This is the cause of death in patients. They forget to pee, forget to do every day things. These are the causes secondary to AD. —The preceding unsigned comment was added by 69.43.113.2 (talk) 18:43, 4 April 2007 (UTC).

therefore AD itself is not a killer disease, surely? it makes me wonder when people say, oh he died from AD. not possible! AD makes you forget, etc, but it does not stop the body from functioning, or does it? it's not terminal like MS or MND. 194.221.133.226 (talk) 12:29, 8 January 2008 (UTC)

Alzheimer's disease is a terminal condition that progressivly gets worse over time and is fatal. The first symptom is always deficits in memory followed by aphasia, apraxia, and agnosia after several years. Personality changes, increased irritability, and other behavioral changes can start in the early stages but become most pronounced in the middle stage. In the later stages gait and motor disturbances are common and increase the chance of physical injury because of coordination inabilitys. Also in the later stages individuals can become mute or bedridden. Individuals with Alzheimer's disease may become very vulnerable to physical and mental stressors increasing the risk of Illness and further mental deterioration. The disease severly damages the frontal lobe and associated subcortical pathways. The average amount of time from onset of symptoms to death is 8-10 years... thats quoting the DSM-IV TR.... Id also like to point out that your brain controls the functions that keep you alive. so its reasonable to say that if a disease were to damage parts of the brain that control essential functions your body will shut down. Also the fact that the frontal lobe is being damaged and the patient is loosing there mental abilitys I would think is unbearably stressful on the brain and body and something to that extreme can cause your brain to just give up and quit working. since AD damages the frontal lobe the risk of impaired motor, speech, and comprehension abilitys is almost guarenteed. It also can make patients forgot to preform nessecary things like exreting waste, personal hygene, when and what to eat... that could cause toxicity, sepsus, anemia, etc. and those conditions have high mortallity rates. Basically Individuals with AD will die either from an Illness, A medical condition related to side effects of AD, or simply from AD itself.JonM.D. (talk) 10:35, 10 January 2008 (UTC)

Aluminum

The Alzheimer's Association of the US has issued this fact sheet on aluminum. [1]. Given their scientific board of directors, I think this is enough evidence to remove Aluminum from the risk factor list. The Paquid study results are interesting, but the association's judgment seems to represent the broader opinion on the subject. The AAGP position statement does not mention aluminum. --Chrispounds 15:34, 26 April 2007 (UTC)

Couldn't access the pdf today. There's a comment in this document from Alzheimer's Assoc. This also addresses it as "Myth 4". Without direct access to the article here but only the citation, I'm not inclined to continue including aluminum either, except perhaps as a caveat that it "was once believed" but now most researchers focus on other factors, considering the effects of regular aluminum use for consumable goods containers a non-concern. ZueJay (talk) 02:06, 3 August 2007 (UTC)

Do the objections above remind anyone of the Vatican vs Galileo? When a study showing a link between alzheimer's and aluminum intake has been peer-reviewed and published in the American Journal of Epidemiology, it deserves consideration as a possible risk factor. If the science is sound, it should not matter if Alzhemier's Association has not yet accepted it. The Aluminum industry's obvious objections not withstanding, the real scientists contributing to this article should be willing to consider challenges to the dominant paradigm. --senchang 01:02, 14 November 2007 (UTC)

A special edition of the Journal of Alzheimer's described Aluminum as "especially controversial" [[2]] and thus does not meet the standards we have set with other risk factors as being generally accepted by the scientific community. --Chrispounds 14:34, 14 November 2007 (UTC)

I remeber reading an article at some point saying that aluminum cannot directly cause Alzheimers but that aluminum reaching the brain via blood can cause a build up of chemicals over time resulting in cognitive disfuction... —Preceding unsigned comment added by JonM.D. (talk • contribs) 10:45, 10 January 2008 (UTC)

Sorry, but unless you've got a reference, it's just rumour. LeadSongDog (talk) 04:52, 31 January 2008 (UTC)

Pruning

The target article length for wikipedia is 50,000 characters and we are north of 62,000 as of this writing. I am working toward maintaining the sense of the article whilst trimming it down. One strategy would be to have someone prune and then others come in and copy edit. We also should get a little more tight with our references. Let's shoot for 85% medical references and try to get the primary source rather than a press release from the primary. --Chrispounds 00:46, 15 July 2007 (UTC)

I'd rather not see any material lost. Looks to me like the 'pathology' section is too long, and a lot of that should go into the 'Biology of Alzheimers' main page

peterl 03:02, 7 August 2007 (UTC)

CF Research Links Protein, Stem Cells and Potential Alzheimer’s Treatment

Sugaya is now investigating whether a combination of phenserine and his compound (NBI-18), which increases brain stem cells by 600 percent, could become another way to treat Alzheimer’s. [3] [4] Brian Pearson 02:35, 7 August 2007 (UTC)

The owner of the compound had announced they were not continuing development because of failure in late stage trials. [5] Only late-stage (Phase 3) compounds have been listed to conserve space. --Chrispounds 11:05, 7 August 2007 (UTC)

Cannabis

There is much information on the internet about the use of cannabis to treat this disease, some of it is below

Cannabis lifts Alzheimer appetite - Thursday, 21 August, 2003,

The drug is an artificial version of a cannabis component A cannabis-based drug could help people with Alzheimer's disease by giving them the "munchies", researchers say.

http://news.bbc.co.uk/1/hi/health/3169901.stm

Marijuana may block Alzheimer's - Tuesday, 22 February, 2005,

The compound may protect the brain The active ingredient in marijuana may stall decline from Alzheimer's disease, research suggests.

http://news.bbc.co.uk/2/hi/health/4286435.stm

Cannabis may help prevent Alzheimer's memory loss

Ben Sills in Madrid and Ian Sample - Thursday February 24, 2005

http://www.guardian.co.uk/life/science/sto...1424013,00.html

Hope for cannabis-based drug for Alzheimer's - 18 October 2006

http://www.newscientist.com/channel/health/dn10330-hope-for-cannabisbased-drug-for-alzheimers.html

Science Daily — New evidence in rats suggests that marijuana may contain compounds that slow the memory loss associated with Alzheimer's disease.

October 18, 2006

http://researchnews.osu.edu/

2007-08-03

Marijuana May Slow Alzheimer's

THC, the key compound in marijuana, may also be the key to new drugs for Alzheimer's disease.

http://almost420.blogspot.com/2007/08/mari...-alzheimer.html JHJPDJKDKHI! 03:52, 9 August 2007 (UTC)

Thank you for bringing this information to our attention. The fact that there are a lot of info about cannabis as in relation to AD just says that there are a lot of speculations on this topic, which does not necessarily mean that a credible scientific research has been done on that topic. So in the future, if you want to back up your claim please use scientific peer reviewed sources. That said, you are correct - cannabinoid receptor agonists are in deed effective at preventing amyloid-β toxicity as was reported by Milton in 2002 and 2005 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&dopt=AbstractPlus&list_uids=15709490, http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&dopt=AbstractPlus&list_uids=12384227). As Professor Milton himself notes, "At higher doses, cannabis can have toxic effects themselves, and as a treatment, an effective dosing regimen is essential. A specific agonist without toxic or detrimental behavioral actions would be the ideal candidate; more investment may help develop such a compound.The future for cannabinoid therapy still needs investment to realize its true potential." So, research is being conducted on this topic, but it might be premature to list it as a reliable treatment option in one form or another. Igoruha 21:01, 10 August 2007 (UTC)

Vaccine thwarts the tangles of Alzheimer's

"It's likely that there's a synergism in the pathology," said Dr. Sigurdsson. "Amyloid pathology may cause tau pathology and tau pathology might cause more amyloid pathology. What you have is a vicious cycle. If you can target both of these proteins you'll likely have more efficacious treatment." [6] Brian Pearson 22:40, 21 August 2007 (UTC)

Copper and Alzheimers ?

Copper and Alzheimers ?

Months ago, I listed a discovery of discovered link between copper and Alzheimers. Dr. Rosanna Squitti, today, her listing is being reviewed for deletion, and upon review of Alzheimers, the discovery of her discovery is not there ?

Is there a political agenda to elminate any reference between Alzheimers and heavy metals ?

--Caesar J. B. Squitti  : Son of Maryann Rosso and Arthur Natale Squitti 17:18, 4 September 2007 (UTC)

The issue is scientific and not political. Why are you suggesting this is political? Late stage development of heavy-metal compounds has not shown success in treating Alzheimer's. Animal based models are not sufficient scientific proof for the inclusion on this page. The major US Alzheimer's Association has completely discounted the aluminum theory and does not mention copper. Find a major longitudinal epidemiologic study from recent years that lists copper as a risk factor. --Chrispounds 12:11, 12 September 2007 (UTC)

Alzheimer disease: type of dementia?

"It is the most common type of dementia."

This claim, which occurs several times in the article, is flawed. Dementia is a syndrom and is only one part of the Alzheimer disease. Even more, there are three types of dementia in Alzheimer disease. See http://www.mentalhealth.com/icd/p22-or04.html

--Eleassar ^{my talk} 12:26, 21 September 2007 (UTC)

I note that the change from "most common cause of dementia" to "most common type of dementia" was done by an anon editor who has made no other edits, at 11.17 on 22 Oct 06. Is that really right? PamD 22:57, 23 September 2007 (UTC)

The epidemiological presentations I recall have reported that the of patients with dementia, dementia of the Alzheimer's type is the most common in these patients. I believe that even counting mixed type (Alzheimer's and vascular, or AD and Dementia with Lewy Bodies, or Fronto-temporal dementia) as a pool, the AD population would be the most common. The Alzheimer's Association in the US makes this claim. [see http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp] The ICD-10 classification reflects a European bias. "Dementia of the Alzheimer's type" is how most in the US describe it (see clinicaltrials.gov), although some have talked about relabeling the disease "Alzheimer's dementia" to more closely link the concept that Alzheimer's disease is a dementia. --Chrispounds 23:21, 23 September 2007 (UTC)

Fair enough. The (UK) Alzheimer's Society at [7] says "There are over 100 different types of dementia. The most common are Alzheimer’s disease, vascular dementia and dementia with Lewy bodies.". That's good enough for me! I'd previously thought the dementia was the the effect rather than the disease, but was wrong. Even anon editors with no other edits can be right! PamD 07:24, 24 September 2007 (UTC)

What bothers me here is the distinction between Alzheimer's disease and Alzheimer's dementia (a disease and a syndrom). One cannot define signs and symptoms as a disease per se. There are biochemical and histological changes as well. Even more so as even not counting mixed type dementia there are still two types of clinical presentation/dementia in AD: early onset and late onset. --Eleassar ^{my talk} 09:28, 24 September 2007 (UTC)

I see you believe that you need to see underlying biophysical changes to believe that as disease is present, but practically in Alzheimer's disease this is not how it is being diagnosed. Only about 1/3 of US physicians do imaging before giving the Alzheimer's diagnosis--and this is for rule-out diagnosis rather than rule-in. The new European guidelines from EFNS look for confirmation with biochemical data see PMID: 17222085, but not everyone will practice according to the guidelines. Also from EFNS, a researcher from Antwerpen presented data that showed that CSF biomarkers taken pre-mortem in 50 AD patients did not correlate with post-mortem pathology. Clinical trials of products have also shown changes in biomarkers (hippocampal volume) that give significant results but the clinical signs are not significant. Functional neurological disorders also have the problem of missing underlying pathology, but does this mean they do not exist?

We have presented two sources that state AD as the most common form of dementia. My reading of the WHO/ICD-10 does not dispute this but rather points to some semantical differences. Would you agree? --Chrispounds 15:32, 25 September 2007 (UTC)

Yes, thanks for having pointed this out. So it would be more appropriate to call this entity Alzheimer's dementia and the article should not describe it as a disease but as a syndrome (after all, its etiology is unknown)? --Eleassar ^{my talk} 17:43, 25 September 2007 (UTC)

I think the present belief that the hallmarks of disease on the pathophysiological side (plaques and tangles) are associated with the clinical signs and symptoms (cognitive loss, loss of ADLs) still stands up and that Kraeplin was correct in calling it Alzheimer's disease. The label of Alzheimer's disease is what is commonly used for what may be a syndrome--although the genetics suggest that amyloid is in the cascade of the etiology. But, if you look in the literature for "alzheimer's syndrome," the 13 pubmed articles are not going to justify the 65k article we have. This dispute seems to have been won by the "disease" camp--at least based on usage in the scientific literature. Rebranding a disease (Lou Gehrig to ALS) is a very long row to hoe. --Chrispounds 04:36, 26 September 2007 (UTC)

Perhaps it would be more appropriate and more neutral to define it as a disorder rather than a disease. Anyway, I have removed the disputed tag now. --Eleassar ^{my talk} 10:16, 26 September 2007 (UTC)

I think it is most appropriate to use the language that everyone has been using for the last 90+ years for it: Alzheimer's disease. This is how the medical literature refers to it and this is how the public talks about it. Perhaps semantically it is really something slightly different and does not fit a specific definition. This makes one wonder if the definition of disease is something that needs to be changed and not this name (AD). I will let the editors on that talk page discuss that. --Chrispounds 13:28, 27 September 2007 (UTC)

It's certainly a disease if any disease is a disease. Disorders are things with no recognized pathology, like conduct disorder. Or with no unifying pathology like dementia or schizophrenia. But AD has characteristic histopathology. Early diseases may have no syndrome (set of clinical SYMPTOMS), and AD is no exception. It's like high blood pressure or diabetes in that regard: when starting out, you may not know you have it. But the disease is not the symptoms. Dementia is a syndrome, a set of symptoms, like shortness of breath. It's not itself a disease. If you think of "dementia" as shortness of breath, and AD as being like "emphysema" you'll have a good analogy. AD is only one of a number of dementing illnesses, but early AD does not yet sometimes cause dementia, or may cause it only under stress, just as early emphysema may not cause shortness of breath, or only cause it under stress.

BTW, the term "Alzheimer disease" (no apostrophe or s) is actually more common in the scientific literature of the present day, which you can verify by typing it into medline and looking at paper titles. This probably should be the name of the article, with a redirect from "Alzheimer's disease." SBHarris 20:34, 30 October 2007 (UTC)

I think Neurology has moved to Alzheimer disease, but NEJM, Nature, and Science are not consistent with Alzheimer's. The ICAD meeting which is the largest meeting for AD still calls it Alzheimer's disease. I would keep it for now until the scientific community is consistent. --Chrispounds 14:29, 13 November 2007 (UTC)

Chris, the very fact that there is great inconsistancy out there means it's necessary to keep both terms in the article. I'm willing to compromise on the article name, but I strongly object to removing all mention of Alzheimer disease in the article AT ALL. If you go to PUBMED and read the papers on the subject, (you get the same list of course no matter which term you use to search), then look at the TITLES of the papers, you'll see that Alzheimer disease wins. The scientific community has therefore spoken as well as it can to the issue of concensus. You've got the article titled with a minority term insofar as recent research. SBHarris 17:52, 17 November 2007 (UTC)

Accourding to the DSM-IV-TR Alzheimers disease is a form of dementia. Other kinds of dementia include vascular dementia, dementia due to HIV, Dementia due to head trauma, Dementia due to Parkinson's, Huntington's, Pick's, and Creutzfeldt-jakob disease, substance induced dementia, and dementia due to multiple etiologies. Alzheimers is a type of dementia but demenitia is not a type of alzheimers disease. also many nuerological disorders could be considered a mental disordor and a medical condition... i.e. Somatoform disorders —Preceding unsigned comment added by JonM.D. (talk • contribs) 10:59, 10 January 2008 (UTC)

Article is too long

Although we have a lot of interesting sections, I believe the target length is around 50k for this article and we are around 64k. I would cut down Alzheimer's in the media and perhaps try to prune some of the potential treatments down now that the scene there is changing. Any other places where we could trim and still be coherent. Because the clinical stuff tries to keep to things that are active in the current practice, I would propose cutting out the section on diagnosis via the eyes until that has been validated. We could bring up blood based tests or some of the MCI screens out there in a separate section on testing for Alzheimer's disease. --Chrispounds 14:10, 30 October 2007 (UTC)

I agree the article is too long. At the same time much of the information could be reordered in a beter way. I think there are also some inaccuracies and a lack of citations. Maybe the article and subarticles on Multiple sclerosis could be used as an example to improve it. (Therapies for multiple sclerosis, Pathophysiology of multiple sclerosis...). I´ll try to help but as many of us I have a lack of time and much to do both in wikipedia and real life. --Garrondo 15:23, 5 November 2007 (UTC)

Out of interest, where does it say the target length is 50K? --Matt Lewis (talk) 13:11, 14 January 2008 (UTC)

As I recall, when you finished an edit it would report the length of the article and it would report that the article was longer than 50k and it recommended shortening it. This may have been removed--I have not noticed it. But as an encyclopedia entry, we should be concerned about length of the base article. --Chrispounds (talk) 14:26, 14 January 2008 (UTC)

See Wikipedia:Article size --Chrispounds (talk) 14:54, 14 January 2008 (UTC)

A first and small simplification proposal-Diagnosis

The brain imaging and eye analysis paragraphs in the diagnosis part are superfluous: The first becouse Spect is alredy mentioned before and it talks about brain imaging in general and not related to AD; the second becouse the article mentioned is basic investigation, not applyable yet to clincal practice, also the conclusions given in the EA article are almost original research since they are not even mentioned in the abstract of the article about eye analysis. If not contested in the following days I will procceed to eliminate them. --Garrondo 14:13, 6 November 2007 (UTC)

They aren't superfluous now. SPECT and PET are as good at diagnosis of AD as are mental exams, yet the article only mentions them peripherally as confirmatory and differentiating tests. In the real world of medicine, that's not how they're used at all. In medicine, you can diagnose a probable non-displaced bone facture by the pain, swelling, and history. But if you want to tell exactly how bad it is, you use X-ray. Similarly, dementia is a clinical diagnosis, but if you want to know if it's caused by AD, without doing an autopsy or biopsy, you use PET and/or SPECT. This is far more a clinical standard than many of the treatments and putative risk-reducer for the disease, as mentioned below. And yet the information has been more or less deleted from from previous article versions. SBHarris 05:17, 18 November 2007 (UTC)

One of the standards we tried to set in earlier revisions is that the information and research presented should not be novel nor cutting-edge but rather generally accepted in clinical practice. The treatment and potential treatments were only for approved or Phase 3 compounds, so we may need to do some pruning. Risk reducers should also be supported by large epidemiological evidence or a statistically significant clinical trial in humans. --Chrispounds 15:02, 6 November 2007 (UTC)

The October issue of Alzheimer's and Dementia has some great review articles by Canadian authors that captures a bunch of the latest research thinking. We might want to use some of these articles to sort through some of the Risk factors. --Chrispounds (talk) 22:27, 4 December 2007 (UTC)

From now on

I think this article right now is a good article. Nevertheless I feel much has to be done if it wants to become a Featured article in the future. Right now I feel its worse problem is the lack of proper scientific citations. This complicates a lot the verification of some of the data, and therefore it makes really hard to know what is important enough to stay and what should be moved to secondary pages or even eliminated. My proposal would be that we attacked each section one by one begining from the top to the botton looking for citations in peer-review journals and verifying all the info. In this way by the time we get to the less ordered parts of the article (lasts sections) much of the work would be already done. Garrondo 14:29, 13 November 2007 (UTC)

Okay, I'm going to begin by adding a couple of citations suggesting that functional neuroimaging is as good at diagnosing AD as clinical tests, and better at differentiating it from other types of dementias. SBHarris 08:04, 18 November 2007 (UTC)

I have finished revising the diagnosis section. I have added some new info; but specially I have fully referenced the section (almost 15 new references). All this has made the section a bit longer but I believe the results are worth it. I was thinking of adding a picture. Can anybody get a public domain PET or SPECT image of an Alzheimer patient (I was thinking of somebody working in a hospital...). There aren't any in commons. The next section I will try to improve is the clinical course since it also has an important lack of citations. The Pathology section is fully referenced; however it would be very interesting to try to writte a plain language summary to introduce the section, since the info it gives is from my point of view to much specific and complicated for those who are not familiar with biological terms. Can anybody do it?--Garrondo (talk) 17:07, 9 December 2007 (UTC)

Smoking

It's quite clear from Anstey KJ, von Sanden C, Salim A, O'kearney R (2007). "Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies". Am. J. Epidemiol. 166 (4): 367-78. doi:10.1093/aje/kwm116. PMID 17573335. and http://news.bbc.co.uk/1/hi/health/2994304.stm that smoking itself is not a risk reducer in Alzheimers. For the print document, please quote relevant text here. Please don't revert without discussion. peterl (talk) 03:13, 13 December 2007 (UTC)

Yes. The idea that smoking is protective is from older case-control studies, and has been pretty much overturned by better epidemiology. Interestingly, it's harder to prove that smoking has any effect on APOepsilon4 carriers-- the folk who have the much higher risk of AD anyway. Smoking seems to hurt non-APOε4 carriers worse: PMID 9652667 SBHarris 03:59, 13 December 2007 (UTC)

Conversely, is there anything published on forgetting to have a smoke as a cure for the addiction? LeadSongDog (talk) 04:57, 31 January 2008 (UTC)

TNF

I am not enough of an expert to do this kind of editing, but this news story[8] seems to meet Reliable Sourcing standards and appears to deserve a mention in the article. Any editor want to be bold? SaltyBoatr (talk) 01:47, 10 January 2008 (UTC)

News are not a reliable sourcing but can give you clues on the reliable source that lies behind (in this case a published scientific article: see [9]). The article seems quite promising and in the future these kind of treatments may be useful for the people with the disease. However its only a unique case (only one patient) and therefore we can not be sure that that the effect is related to the treatment. Due to the thousands of studies going on looking for treatments for the disease there is an agreement only to include in the Wikipedia article only those studies that are already in phase III of the clinical trials (the last phase before being used widely). Thanks anyway for providing such an interesting article. --Garrondo (talk) 09:05, 10 January 2008 (UTC)

Is this "phrase III threshold for inclusion" a consensus policy local to this article? I am unfamiliar with that policy in Wikipedia at large. Normally, it appears that the Journal of Neuroinflammation, which is a peer reviewed journal[10], would qualify as a reliable source. SaltyBoatr (talk) 16:59, 10 January 2008 (UTC)

Yes. The Journal of neuroinflamation as a peer reviewed journal is a reliable source as stated in WP:MEDMOS, and the phase 3 threshold is a local policy. The reason for this threshold is not to be overwhelmed by all the investigations that obtain preliminary positive results since only few of them can be finally get to be real treatments. --Garrondo (talk) 18:20, 10 January 2008 (UTC)

Not that I intend to complain very long. But, if I have a vote, I would vote to oppose a Class III local threshold consensus. Specifically in this instance, upon noticing the potentially dubious TNF article in the blogoshpere, I turned here to this Wikipedia article for verification; knowing that I can trust that Wikipedia is typically current and well vetted by dedicated editors. Disappointed, instead, I find that valid WP:V info has been excluded for a seemingly rational, yet none-the-less arbitrary reason, capricious relative to standards elsewhere on Wikipedia. Please do not take this as criticism of your conscience, or your devotion as editors; for that I am grateful. SaltyBoatr (talk) 18:33, 10 January 2008 (UTC)

Before seeing the above, I was bold and added a para on this study. While it needs further work, the interest is not simply in the thereputic result, but also in better understanding the etiology. The action of this drug elsewhere in the body is well understood from extensive psoriasis and other studies. It is not expected to directly address the amyloid plaques, but rather the glial cell transmitter chemistry.LeadSongDog (talk) 17:59, 11 January 2008 (UTC)

One justification for reducing the potential therapies to only those in Phase 3 is that late-stage development in Alzheimer's has been called the least successful of any disease area. Maybe sepsis is worse. Animal models and Phase 2 results have not been predictive of regulatory approval. In the period from October 2006-October 2007 there were 3 compounds across 5 trials that did not show positive results (statistically significant primary endpoints) in Phase 3--leuprolide, tramiprosate, and xaliproden. If we put early stage therapies in as potential treatments in this high-level article, we may be expanding beyond what can be reasonably be expected (but needed) in the clinic. It may be time to create a separate page that catalogs potential treatments in Alzheimer's --much like the page Garrondo has done for MS area. As a research area, etanercept is something new for AD, but it is not ready for a high-level article. If we include everything that has been tested in 15 or more people, the potential treatments would overwhelm the body of the article, and that may not serve the reader in the best way. --Chrispounds (talk) 03:25, 12 January 2008 (UTC)

I just read over the potential treatments and pulled out tramiprosate since it is no longer in Phase 3 and the MEM compound has not made it into Phase 3 yet. AAB-001 has started phase 3 [11] and [12] give more background on this passive immunization strategy if someone has time and the interest to write it up. --Chrispounds (talk) 03:44, 12 January 2008 (UTC)

Assessment

I have upgraded the WPMED importance assessment to High. I don't mean to preclude it being rated Top, if several WPMED participants support that rating. It just seems that "Mid" is obviously too low. WhatamIdoing (talk) 04:56, 12 January 2008 (UTC)

Alzheimer's in the media

The alzheimer`s in the media subsection is getting quite bulky and will continue growing since Alzheimer is such a social problem (There are probably thousands of films protraying the problem and many more where the disease is a secondary topic). I believe it would be a good idea to move the whole subsection to a secondary article with the same name, and only leave a few lines with the link to the sub-article in the main one. Does people agree?--Garrondo (talk) 15:45, 14 January 2008 (UTC) I forgot to say that its also completely unreferenced--Garrondo (talk) 15:48, 14 January 2008 (UTC)

You have my support in reducing this to a few sentences. If you setup an alert in Google for Alzheimer's disease, you will find 8-10 articles each day. --Chrispounds (talk) 19:45, 14 January 2008 (UTC)

I agree in principle to a split if needed, but it's a rather short list at the moment.

6 of the 8 examples in the current list are basically self-referencing - they link to their corresponding Wikipedia articles (the home of the detailed references) - in these kind of listed examples that method is fair enough, I think, and certainly saves on bloat! I suppose to be fully accurate we need to check up on the original articles, to see if they are accurate link-targets/articles. One of the other two (both without their own WP articles) seems to have found a ref (but might need another one, given its content), the other I'll look for a ref for, as I think this section is important. --Matt Lewis (talk) 23:06, 17 January 2008 (UTC)

Lists are discouraged. I propose the following both to eliminate the list format and reduce its size. I would unify the media section and famous section in a "cultural references" section. All the information eliminated would be moved to a secondary article and I promise to find refs outside WP for every person and film in the main article. The text would be the following.:

Being Alzheimer's such a prevalent disease is not rare that many notable people have it. Well known examples are United States ex-president Ronald Reagan or irish writter Iris Murdoch, having both of them even scientific articles centred in how their language deteriorated with the disease. Other cases are Ferenc Puskas, Harold Wilson, Rita Hayworth, or Charlton Heston. The media attention to these and many other cases has helped to make socity even more aware of the problem of the disease.

Alzheimer has also been portrayed in many films such as Iris (2001), The Notebook (2004), Thanmathra (2005) or Memories of tomorrow (2006); documentaries , such as Malcolm and Barbara-A Love Story(1999) and Malcolm and Barbara- Love’s Farewell(2007) both featuring Malcolm Pointon; or TV series, being the disease either the center of the main plot or a secondary issue.

Sorry, I always forget to sign. --Garrondo (talk) 10:23, 18 January 2008 (UTC)

There's a guideline on this topic at Wikipedia:Manual_of_Style_(Medicine-related_articles)#Notable cases. LeadSongDog (talk) 17:31, 18 January 2008 (UTC)

I had red it. However both my approach and what there is right now in the page are suitable, but I think mine is "cleaner". It mantains most of the information, it eliminates list format and it reduces space. What I want is editor to say their opinion. --Garrondo (talk) 10:03, 19 January 2008 (UTC)

Sorry for the late opinion, Garrondo - I've been trying to find the time to work on the media section (as I did say I would - I've just been distracted with my WP time by other topics). Autism has a quite large 'Sociological and cultural aspects of autism' sub article - though the two links to it are rather hidden in paragraphs. Autism actually has around 10 side or sub articles - some long, some quite short. Many are only given as links in parags - they should also be collected as a group at the botton IMO.

I'll look at creating a similar page for AD, basing the media section on the list we have, as it is decent-enough work that people have made the effort to do. We can connect the pages later. Your shortened media edit could still stand, though 'famous people with x disease' headings are pretty standard on WP. I've never seen a sizeable list of famous people with AD - so I'm not sure that 'media' and 'famous people' need be combined - unless we do also have this sub article to link to. The Autism article seems to have quite a bit of crossing between the main article and the 'causes' and 'epidemiology' sub articles - we could follow there lead to a degree perhaps. I accept that there is clear demand here for a tight scientific AD article - so it looks like splitting and deciding upon sub articles is the way to go.

One thing that is better about alphabetical lists, by the way, is that they are less prone to bias than paragraphs. The guideline quoted by LeadSongDog above covers lists becoming separate articles. I am a bit worried the more 'human' elements surrounding AD are slowly being compromised, especially when that 'size factor' comes into play. I do worry about the whole Featured Article thing too - lets get the information in first, and let things take their course. Just looking though it, I personally think it's nowhere near approaching FA status yet. A lot of information has to be dealt with, written, cited and sifted properly, not just curtailed or cut. Decent prose is no easy thing, either. Some more headings may appear yet too. I would guess any sub articles would be judged as part of the whole. --Matt Lewis (talk) 16:31, 22 January 2008 (UTC)

One way of collecting all the boxes at the bottom is with a navigational box; as I did in multiple sclerosis, since "see also sections" are discouraged. The reason why I mixed both sections is that such small sections as the famous people one are not very useful. It´s just a way of simplifying the index of the article while maintaining most information. I know there is still a long, long, long, long way to go to get a FA and maybe we will never get there, but I think that tend to it is the best way of improving the article quality. You will have probably noticed that more or less I´m working from top to bottom improving the different sections and after I finish them they are usually longer than shorter. I don´t mind in having a long article. What I try to eliminate is that information that is not really necessary for the topic. Let´s continue working. I think that the last few months the article has improved a lot. --Garrondo (talk) 08:50, 23 January 2008 (UTC)

Some thoughts on the article (size etc)

Appropriate article size

Obviously, this article (like so many others), could really bloat if allowed to do so – we’ve all typed in ‘Alzheimer’s’ on a search engine and seen the results – sales-hype and inflated search-results aside, the interest is clearly massive. I think the wider interests in AD need to be reflected here, but without the massive excess of information. For me that is what Wikipedia is about. I've been looking through Wikipedia featured articles to see what a realistic size-target for a good Alzheimer’s article could be. The article is currently 79K.

Some Featured Article sizes

• Asthma - 74KB
• Autism - 85KB
• Prostate Cancer – 98KB
• Tourette Syndrome (the uncommon tic disorder) - 66KB
• Boeing 747 - 86KB
• Adam Gilchrist (current Australian cricketer) - 94KB
• Bupropion - 74K
• Dalek (monster from TV programme) - 84KB
• Celine Dion – 81KB
• The Elder Scrolls III: Morrowind (video game) - 76KB (a not untypical size for Featured Article video games).
• White Dwarf (age of star) - 74KB

• I’ll also include ‘Episcopal Church in the United States of America’ from a user-page link above, as it seems like a typical ‘non-featured’ article - it was 81K, though it didn’t seem unreasonably long either. It’s surprising how the space is filled!

Obviously, many that I looked at (mostly all randomly) were smaller than those listed above - I’m highlighting some of the higher sizes to bring home my point.

It should be noted that many biographical, historical, geographical and political ‘Featured Articles’ are even longer than the ones I listed – but I didn’t bother to include historical biogs and places etc, as they are intrinsically broader subjects than Alzheimer’s (broad though AD can be).

I think the highest currently accepted Wikipedia article (non-featured) is around 300KB.

Note on References

There are currently around 150 References in the Alzheimer’s article – these are added to the overall K. It could be argued that for science-based articles this extra length should taken into account, though looking at the Featured Articles, most articles do have at least 100 references, though few as many as 150 (and it could be argued that we need more in places).

What is enough?

Wikipedia has a ‘rule of thumb’ figure for recommended article ‘splitting’ – 60K (‘probably’) to 100K (‘almost certainly’). This seems to be reflected by the Featured Articles, though many important articles are well over 100K in size (biogs, places, histories etc) even after spitting. Little is said by Wikipedia about the ideal size after an article has been split – I suppose it would vary by subject, with the usual emphasis on keeping concise.

Of course, edits should always be first judged on merit, with the article’s length coming into account at some point after this. It seems to me that article length is best viewed from a totally objective ‘whole-article’ perspective, and that undue ‘word counting’ section by section is best avoided. Length should be something of a consideration, of course – but the overall K-factor shouldn’t be an overbearing concern on a typical edit-making basis

Over-emphasis on restricting the article’s size could lead to constricted style and content, and even mask potential bias, as ‘the article is already too big’ could be used as unjust weight to an argument for removal. Problems can arise if certain subjects are not initially allowed enough air. Clearly, each issue should be judged on its own merit, article-size aside.

In my opinion, this Discussion page is the best place for debating suitability or relevance, on the merit-first basis. Discussion often starts after the first alteration/revert that occurs when someone has followed Wikipedia’s ‘be bold’ ethos and has made an unheralded contribution.

Creating side articles (page splitting)

It seems to me that this article is highly likely split in the future, possibly more than once – as it’s the usual Wikipedia way of dealing with growth. An article can be divided simply because it gets too big (obviously here an article has to be first given the space to grow). Often what is ‘split’ is the more ‘important’ information – a particularly detailed or technical area might get an article to itself, but any large area can be re-allocated – and often it’s the ‘least important’ information that is moved.

An alternative to splitting large articles, is for editors to plan and create the off-shoot page(s) in advance, or to split information before it gets large enough to bloat the article.

The obvious alternative to any kind of article-splitting is for dedicated editors to maintain an article within a certain size, keeping paragraphs as concise as possible, and enforcing a high ‘relevance threshold’. One criticism here is that size-problems will eventually occur anyway, if too much ‘undeniable’ new information becomes included. In my opinion, this last method is the least ideal.

Alzheimer’s – a Featured Article?

On the subject, someone previously speculated over whether this article would eventually become a Featured Article. Although the article obviously needs to be the best it can be, I personally feel that FA status is unsuitable for a subject like this. Putting it simply, too little is known and understood about AD as a disease, and many things surrounding it, like contact with heavy metals, and the respective validity and competition within the pharmo/alt health markets, are highly contentious issues to significant groups of people. If the article gets featured, more noise would surely be made here than is at present, and feature-‘marketing’ an ultimately semi-locked article could easily become problematic. So awarding a kind of ‘semi-academic’ status (however good this article might get) would not be all that wise here, in my opinion, for all the reasons given above.

Article for all readers.

Finally, I do think that millions of AD sufferers, families, friends, paid and unpaid carers, and laymen in general (I make the distinction from academics, employees and students), will periodically look at this article. In my opinion, they all deserve to learn things that editors believe, through consensus, is useful to them – and this points to the article getting longer to me. Many of these are the people who on a daily level actually treat the non-sleeping, non-stop disease themselves – with their invention, and with their time.--Matt Lewis (talk) 04:42, 18 January 2008 (UTC)

• ANSWER: May I point out that overlong articles are never supposed to be simply "split." Rather, very long sections are moved off to their own pages and A GOOD SUMMARY is left in their place, with a '''{{main|Subarticle}}''' tag at the head, to show where the material is. Obviously the more technical sections (such as the histopathology section of this article) and anything else of less general interest, should be the first targets for this tactic. But no information should be lost. People who want to read it all can easily click on the main subarticles and and read them, before going back. So, peace. If this is done well, you'll hardly even notice. And again, nothing will be lost. SBHarris 05:19, 18 January 2008 (UTC)

I'm afraid you've completely misunderstood me! I'm not against splitting, and I've not been talking about losing information, but gaining it! This Wikipedia article I quoted called 'Article Size' ( ‘rule of thumb’ ) covers splitting. I agree with it, and can see it happening, as I've said - giving similar details about what it entails to those you have left above! Can you tell me which part you got the impression I was against splitting, so I can look at re-writing it? I want a better AD article (or two), and I don't want to mislead anyone. --Matt Lewis (talk) 06:08, 18 January 2008 (UTC)

I´m sure it can get a FA and I plan to demostrate it (althought it will still take some months). If there are controversial issues they can be shown if well referenced. On leghth article: I agree that the article K is not a good measure. If we think the lenght is appropiate it should be left no matter how many ks it weight (specially with so many references... and there many more to come, since many parts are undereferenced); and speaking of references: We should use diberris tool every time we put a ref from a scientific article: [13] as a way of giving the same format to all of them. —Preceding unsigned comment added by Garrondo (talk • contribs) 09:51, 18 January 2008 (UTC)

Don't you think AD is too 'open' an issue? A main worry I have is that Featured Articles are often locked or semi-locked. This rubs entirely against the most important principle of Wikipedia, to me - the organic principle that keeps it afloat! In fact I am overall against FA's, to be honest. I can understand why they feel they need them, and of course why people want the articles they work on to be celebrated - but the negatives outweigh the positives for me, especially with controversial topics. I would keep topics like politics etc out of the list, if I was them. I think there is starting to be a bit of cache to FA's too, which I'm not sure about either. I've noticed that many people's user pages are starting to look more and more like professional CV's! (although it’s become a WP tradition to list contributions, I know) --Matt Lewis (talk) 18:35, 18 January 2008 (UTC)

I for one will roll over on the length argument. It should be the right length but not be so long that no one wants to dive into it for fear they will drown. Matt points out that Autism is an FA--that seems like a considerably more fluid domain than Alzheimer's, so I can imagine we can tune up the text to get to FA level. One way we can improve on length is on this talk page. I will try to get another Archive page built. --Chrispounds (talk) 20:13, 18 January 2008 (UTC)

Help please

I am brand new to Wikipedia. I would like some help spreading the word about a treatment for Alzheimer’s called Cognitive Retention Therapy that was developed by my Uncle based on my Grandmother Mira Ashby's work for Brain injury rehabilitation. Thanks for any help you can provide. Chris Ashby (talk) 23:03, 18 January 2008 (UTC)

Hi and welcome. I've left a response on your talk page. --Matt Lewis (talk) 01:38, 19 January 2008 (UTC)

Archive

With the agreement of my other editors, I will dump all comments in threads from before July 2007 into a new Archive page. For a couple of very old threads with new comments, I will move the whole thread. --Chrispounds (talk) 14:37, 20 January 2008 (UTC)

No objection. If you want to consider bot archiving, I could help set that up. EdJohnston (talk) 15:11, 20 January 2008 (UTC)

You could maybe leave a date for people to check them over by (next weekend maybe?), then delete any threads not commented on before July, as you said. I'm fine with that.

I don't notice long talk pages on my fast PC - but on a slower one I use they're a pain. You don't have to wait for too many responses - I asked a similar question once and it was ignored for ages, on a longer page than this one - people often don't feel they can make the decision. --Matt Lewis (talk) 00:50, 21 January 2008 (UTC)

At the end of January, I will archive all threads started before July 2007. Point out those that you would like to persist. I am not concerned about loading speed, but more about having to page down to find the newest stuff. This is a once a year thing, so a bot is not necessary. Tx tho. --Chrispounds (talk) 02:10, 21 January 2008 (UTC)

Better format

I see Orangemarlin (talk) was busy over the weekend with a few edits. Thank you for this. I think this was a giant leap forward toward conforming to some of the Wikipedia:MEDMOS standards. One thing we might want to do is to eliminate the trivia section. Any thoughts on that? I also see we need some work on the Pathophysiology section.--Chrispounds (talk) 15:04, 28 January 2008 (UTC)

I have done some more reordering but I have not added new info (don´t have time at the moment to search for it). I agree on simply eliminating the statistics sections. 4 of the comment are on USA, and the only one that it is not talks about dementia in general and not alzheimer. Anybody disagrees? --Garrondo (talk) 17:09, 28 January 2008 (UTC)

I agree. Epidemiology should be what it is, not a listing of numbers. OrangeMarlin ^{Talk• Contributions} 17:35, 28 January 2008 (UTC)

Busy right now, but someone should review this WHO item for a worldwide view.LeadSongDog (talk) 17:44, 28 January 2008 (UTC)

FAC

I appreciate the positive comments, but I just came to the article to clean out alternative medicine cruft. This was a well done article. This article is important and can be made FA. We need to do a lot of work, and here are some thoughts:

1. We need to stick with WP:MEDMOS, which is the manual of style for medical articles. There were some missing sections, which I've added. Also, we had some additional sections which I have combined into places where appropriate. But that's just my idea.

2. We need to review all of the references and stick with the WP:CITET format. It makes for easier linking of various citations, and allows us to read them carefully.

3. Speaking of citations, now we need to confirm that they really say what we think they say and confirm what is written in the article.

4. Etiology section needs an upgrade.

5. Epidemiology sections also needs an upgrade.

6. Don't use bullet points. Though they are wonderful for a business memo, they aren't so good for an encyclopedia, because they imply rank order of importance, and other style issues.

7. Lead needs to be worked on. It's a bit long and very complex. The lead should just review the sections that are in the main article one by one.

8. There is some difficult to follow writing. We need to do some copy editing to get the style and language consistent.

9. More pictures would be useful.

10.Watch for spam links going into the external reading section. They can get bad with an article like this.

11.Attack unsourced statements. There seem to be a few.

12.Make sure you wikilink technical terminology the first time it is written. Too many wikilinks is better than not enough.

Those are my ideas. My suggestion is that we add to this list, and then strike through as they are completed. OrangeMarlin ^{Talk• Contributions} 17:52, 28 January 2008 (UTC)

Regarding more pictures, I think some of the non-English versions of this article have nice pictures--Romanian? German? but I am not yet clever enough to move them into our article. --Chrispounds (talk) 15:32, 29 January 2008 (UTC)

Moved from user talk

Thank you for all the good work overnight. :/) LeadSongDog (talk) 14:55, 28 January 2008 (UTC)

You have given the article a critical quality push. Well done... The only problem I can see is that right now I am a bit jaleous. Just kidding; its great to have more editors doing hard work. Thanks. --Garrondo (talk) 16:29, 28 January 2008 (UTC)

A few comments on your last two edits. I agree on removing the alternative section treatment. However I do not agree on your comment that there are no alternative treatments. Maybe a good approach would be the one taken in "treatments of multiple sclerosis". There "alternative treatment" was used for those treatments that are more or less widely-used by patients (in multiple sclerosis are diets, marijuana...) but have not shown proof enough of their utility. I don´t know if there are any of that kind in alzheimer but I believe is a reasonable approach.

Secondly I know that in MEDMOS it says that social issues should be in the prognosis section, but I feel that "prognosis" in alzheimer sound quite strange, since everybody worsens and its alredy explained in symptoms. I believe it would be a good idea to make an exception here and leave the social issues as title (medmos is only a guide). --Garrondo (talk) 17:51, 28 January 2008 (UTC)

I will stand firm against "alternative treatments". If there are treatments that have verifiable and reliable references, let's go for it. But then it's not an "alternative". We cannot give undue weight to stuff that just isn't right. As for prognosis, I understand what you're saying, but prognosis is a section that describes the course of the disease, and what are the chances of recovery (which is zero). The social issues are part of the prognosis and not a symptom. I'm also thinking that some of the symptoms should be moved to prognosis. I know that it MEDMOS is a guide, but FA articles mostly follow it to a T. Part of it is to have a consistency from medical article to medical article. Let's try it, and if Prognosis needs to be changed to "Progression" or something similar we can do it. But the prognosis for Alzheimer's move from a medical to social and behavioral to death. We can write it that way. BTW, let's keep these discussions on the talk page. I'll move it there.OrangeMarlin ^{Talk• Contributions} 17:56, 28 January 2008 (UTC)

An alternative treatment for me is a treatment that althoug more or less widely spread it has reliable refs on its none or only partial effect... The main point to describing them is that they are commonly used, but it must also be clear that there is no proof of their effectiveness.

I don´t agree on symtoms being moved to prognosis. I think the description of symtoms gives a clear picture of the process of the disease. In the case of alzheimer as a deathly degenerative disease symtoms and prognosis are the same. That´s why I think that social effects should be a separate section of prognosis.

I agree in all your other comment on how to improve the article to FA.--Garrondo (talk) 18:15, 28 January 2008 (UTC)

Re: alternative treatments - if a treatment is unproven or untested, but we can document that a significant number of people utilize it, then it would be worth mentioning (both that the treatment is used, and that it is unproven).

I did not suggest we move symptoms to prognosis. I'm saying some of the symptoms are not symptoms but discuss the progression of the disease. And Social effects just doesn't rate a separate section. Let's keep to MEDMOS for the time being. If it makes sense to break it out, let's do, but excessive sections make for a poor read. OrangeMarlin ^{Talk• Contributions} 20:31, 28 January 2008 (UTC)

We don't need to include every speculative Alzheimer's cure published on someone's Web site - there's enough of that on Wikipedia already - but alternative or unproven treatments documented to be widely used or covered in the mainstream media are probably notable enough to mention. MastCell ^Talk 18:18, 28 January 2008 (UTC)

I would say we set a standard for what can stay on the page. For drugs in clinical trials, we have said Phase 3 in humans. We have a reason for this (in this disease specifically) and that has been the historical failure of compounds in trials. For risk factors, we have used broad epidemiology-based or genetic studies because many things could show in vitro evidence. I would set the bar for the alternative treatments quite high--they need to show broad epidemiology evidence or evidence from large randomized clinical trials. The GEM study should be enough for Ginkgo to either be included or ruled out. --Chrispounds (talk) 20:21, 28 January 2008 (UTC)

Ginkgo stays not because it works (preliminary information from the GEM study confirms that it does squat), but because everyone thinks it does something. It's kind of notable. I agree with the Phase III standard. Usually, there is a lot of stuff published. But let's not use as the citation some marketing stuff from a pharmaceutical company. Every Phase III drug in the world has a huge list of publications in peer-reviewed journals. OrangeMarlin ^{Talk• Contributions} 20:28, 28 January 2008 (UTC)

Citation formats

This is just personal opinion, but I like references completely inline, not spread over several lines. I don't mind the ones that are completely vertical, because it makes it easy to clean up the references. However, the method of placing the references used in this article (and I just reverted them just a minute ago or so), is he absolute worst. The ref tags are on one line, the "{{" is on another line. And I can't tell where the text ends and the reference begins. So, let's stick with completely horizontal or completely vertical. None of this hybrid stuff that is hard to read. IMHO. OrangeMarlin ^{Talk• Contributions} 20:51, 28 January 2008 (UTC)

I've raised the subject at Help talk:Wikitext examples looking for some place to approach concensus on it. The problem I'm trying to solve is that if you do the cite template all inline, it's nearly impossible to follow the wikitext as you edit. If you do it all vertical the edit diffs display often show only part of a single cite. This approach keeps it to a simple, understandable diff like this. If we want editors to generate, improve, and maintain quality cites, we should make it as painless as possible. In an article with dozens of cites, recent changes patrolling can be nauseating if we use inline wikitext formatting. LeadSongDog (talk) 21:13, 28 January 2008 (UTC)

I really can't read the one you're using. As long as I am editing, I'd prefer to use either one I propose above. Once the article is approaching a nearly complete state, we can change them to anything you want. I really think it's a matter of preference. I'm not changing any of the reference formats, but since I'm changing a lot of the citations to more useful ones, I'll probably using my approach. However, I'm all right with the completely vertical ones, which are pretty clear. I really dislike the ones which are hybrids of vertical and horizontal. OrangeMarlin ^{Talk• Contributions} 21:24, 28 January 2008 (UTC)

This article doesn't seem to attract a lot of vandalism, so I can force myself to live with either format here, but I don't like it. You're right that it's preference, and hypothetically a userpref could code for it, but there's none such now. Fighting vandalism gets pretty heavy on some pages and I like the odds stacked in favour of the forces of light. That said, I'm generally unhappy with the inefficiency and lack of robustness for wp citation management tools, although they are improving. I'd much prefer that each citation was a transclusion of a database record for the referenced source, which then gets an individual revision history. Having different articles cite the same source differently is really wasteful and embarrassing. Suggest bots should be able to match up incomplete cites to the more complete ones already in the database. LeadSongDog (talk) 22:00, 28 January 2008 (UTC)

I agree. The reference system is arcane and cumbersome. But, it is better than writing each one out (and I was doing that for awhile). Let's see what works best. And I hope the vandals aren't out in force here. Usually, enough smart editors watch an article like this one, so we shouldn't worry too much. OrangeMarlin ^{Talk• Contributions} 23:49, 28 January 2008 (UTC)

I've taken a look at the wikitext of Pneumonia and Down's syndrome, both Featured articles. By and large, they use the fully horizontal form inside paragraphs and the fully vertical form in list sections such as Further reading and See also. I'd live with that.LeadSongDog (talk) 23:37, 29 January 2008 (UTC)

I wish the edit box distinguished between text and references (or other wiki-code). I don't think FA requires that the references be one way or another. I'm actually liking the way you did it, but it takes more time (unless you tell me there's a magical method of doing it). I'm using Wikipedia Template Filling to create my references. I think you and I are the only ones that seem to care. So, Rock, Paper, Scissors?? OrangeMarlin ^{Talk• Contributions} 08:27, 12 February 2008 (UTC)

I'm in go-with-the-flow mode today. Fill your boots!LeadSongDog (talk) 04:34, 13 February 2008 (UTC)

Epidemiology and prevention

Right now a lot of content is or could be in both sections. Right now most of them are in prevention but from my point of view they should be moved. My reasons are the following: To give advise on prevention there has to be a clear proof that the measure you give is effective; similarly to what happens with treatments. To give that kind of advise there has to be some short of causal relationship between the thing that should be avoided or taken and the disease. This kind of causal relationship can be only discovered with a experimental design of a study; there has to be sure proof that if you give that the risk of having the disease decreases. All the references that we have now (and also all I have found) are epidemiological-correlational studies, but there are not any experimental design. Apart from that there are contradictions on the different results. The conclusion of the most important journals is that there is not enough proof to give specific advise on prevention. As example:

• Available data do not permit definitive conclusions regarding diet and AD or specific recommendations on diet modification for the prevention of AD. -PMID: 15380154-Lancet 2004.
• Evidence regarding dietary and supplemental intake of vitamins E, C, and folate, and studies of alcohol and wine intake are also reviewed. At present, there is insufficient evidence to make public health recommendations, but these studies can provide potentially important clues and new avenues for clinical and laboratory research.-PMID: 16917203-Alzheimer Dis Assoc Disord 2006.

Therefore I believe that all these studies should be moved to the epidemiology section but I would appreciate some feedback on this question. --Garrondo (talk) 14:04, 29 January 2008 (UTC)

I think by definition, Epidemiology is the study of the factors that might lead to disease. So, the lack of Folic acid (and I agree the data is kind of debatable) could be an risk factor for disease. However, the addition of folic acid to your diet can be prevention. Epidemiology is a population level discussion. Prevention is at the individual level. Does that make sense? OrangeMarlin ^{Talk• Contributions} 19:12, 29 January 2008 (UTC)

c.f. Epidemiology, Prevention (medical), Etiology#Medicine. LeadSongDog (talk) 20:41, 29 January 2008 (UTC)

my understanding is that a b12 deficiency is part of the rule out criteria for AD diagnosis. If the folate deficiency is present, then they treat that and it is not AD. The Cochrane review in 2003 reported: No evidence that folic acid with or without vitamin B12 improves cognitive function of elderly healthy people or people with dementia. --Chrispounds (talk) 01:00, 30 January 2008 (UTC)

• In all epidemiology, remember that association doesn't prove causation. And even if causation is present, you don't know, when A and B are associated, whether or not A causes B, or B causes A, or A and B are caused by C. So for example: people with dementia have poor diets for a number of reasons. But there's every reason to believe that dementia can cause poor diets, so when vitamin deficiencies are associated with dementia, you really can't infer that the vitamin deficieny caused the dementia. SBHarris 03:47, 30 January 2008 (UTC)

• This is precisely why large longitudinal studies like the Nurses' Health Study are so valuable. Effects never precede their cause in time. One case on the point is this paper LeadSongDog (talk) 05:56, 30 January 2008 (UTC)

• I would say just the opposite. Longitudinal studies can fool you badly. The Nurse's Health Study is a case in point. It found a 40% lower risk of cardiovascular disease risk in women who used post menopausal estrogen. In later randomized prospective trials, however, the actual benefit wasn't nearly so large. Obviously, THEREFORE, the NHS simply found that nurses who take estrogen after menopause are a different group than nurses who don't, and causation wasn't what they thought it was. And nurses who eat their broccoli are probably a different group, too. So what? Effects never precede causes indeed, but also, it's very often the case that what you think are cause and effect, are merely two effects at different times, both proceeding from an even more early root cause that you haven't considered or even suspected. SBHarris 06:28, 30 January 2008 (UTC)

I believe its mostly a difference of strongness of afirmation. When you writte something in prevention you are impliying causation: If you take this there is less risk of having Alzheimer, which seems too much with the evidence at the moment; while if you have it in the epidemiology section you only say that populations that take this tend to have less Alzheimer; not impliying any form of causation. I believe its an important difference since many people can be wrongly led to think that if they eat broccoli for example they have less probability of having alzheimer, which is not true. We have to still think some more on the matter.--Garrondo (talk) 08:46, 30 January 2008 (UTC)

You simply never know. Population studies just study markers for populations. People who smoke cigarettes in the US get murdered more. But this doesn't not mean you can necessarily influence your risk of murder, either by starting to smoke, or by quitting if you do smoke. Smoking is a marker. It's a marker for unwanted teen pregnacy also, but nobody believes cigarettes have anything positive to do with fertility. SBHarris 01:17, 2 February 2008 (UTC)

A proposal: I propose to leave only the following text in the prevention section, and move, check and rewrite the rest of the prevention text to the epidemiology section:

Different epidemiological studies have shown relationships between certain behaviors and a population's likelihood of developing Alzheimer. However the existance of contradictory results and the lack of experimental studies able to prove causal relationships do not support the recommendation of specific measures for the prevention of AD.

--Garrondo (talk) 09:59, 30 January 2008 (UTC)

Might be a little too negative. Have a look at the current NIH recommendations (section 5):"Can AD be Prevented?" (PDF). National Institutes of Health National Institute on Aging. June 2006. Retrieved 2008-01-30.LeadSongDog (talk) 14:51, 30 January 2008 (UTC)

Deep Brain Stimulation

I know it doesn't meet the phase III criteria for inclusion, but the use of Deep Brain Stimulation for AD, discovered accidentally during other work, is certainly interesting:

• Jeremy Laurance (2008-01-30). "Scientists discover way to reverse loss of memory". The Independent. Retrieved 2008-01-30.
• Hamani Clement, McAndrews Mary Pat; et al. (January 2008). "Memory enhancement induced by hypothalamic/fornix deep brain stimulation". Annals of Neurology. 63 (1): 119–123. doi:10.1002/ana.21295. Retrieved 2008-01-30. {{cite journal}}: Explicit use of et al. in: |author= (help)LeadSongDog (talk) 16:07, 30 January 2008 (UTC)

eliminated cite

Butterworth, Brian. The Sunday Times. 1984-11-04 This cite was eliminated. I know its hard to prove that it talks about president Reagan. I talks about how his language in his last speeches was worse than in his first four years. It is named in several neuropsychology articles and one of them is the one on Iris Murdoch. It´s not a very strong ref but I believe its interesting.--Garrondo (talk) 08:18, 31 January 2008 (UTC)

Diagnosis

It is explained that a Diagnosis of AD can only be confirmed by autopsy, doctors do not make a diagnosis of Alzheimer's they make a diagnosis of Dementia of the probable Alzheimer's type. Please work this into the diagnosis section; I do not know how to word it properly to make sense. A diagnosis of "Dementia of the probably Alzheimer's type" needs to be in there under diagnosis. -Chris Ashby | Talk 00:23, 2 February 2008 (UTC)

A February 7, 2008 report in Nature [[14]] reveals that researchers have found a way to photograph plaques in the living brain and compare them over a period of time to chart growth of these amyloid-beta plaques. This is mentioned in the opening paragraph, though not in the diagnosis paragraph. More in depth reading of Nature's article might be required. --JasonSpradlin82 (talk) 00:21, 11 February 2008 (UTC)

Animal studies can be used in some areas of the article, but hardly in a human diagnosis section. That study is a LONG way from human applicability. But it is very interesting nevertheless. OrangeMarlin ^{Talk• Contributions} 00:37, 11 February 2008 (UTC)

Improvements

We still have some things to do:

• We really should be consistent in references. I'm flexible.
• Prognosis section is weak. I've added a great reference that appears to quantify the prognosis. Anyone willing to tackle a summary in this section?
• We need to wikilink better. We're missing a lot of basic medical terms that aren't linked, and I think this is a basic need for any FA medical article.
• Needs a thorough copyediting. It still reads like 10 different people wrote it, so we have to get the tenses, grammar, spelling and everything else somewhat consistent.

It's getting there.OrangeMarlin ^{Talk• Contributions} 09:01, 12 February 2008 (UTC)

I've added a bunch of wikilinks. Does anyone know if that has something to do with Google ranking? Yesterday the google rank was way down the list. Today, I was googling the disease to find a couple of sources, and the article was at #2. I don't know how Google ranks articles, so it could be just random. OrangeMarlin ^{Talk• Contributions} 20:49, 12 February 2008 (UTC)

Google ranks pages based on relevence and by judging how many other pages on the web link to that page or site as well as what the rank of those other sites are. If they have higher ranks, it will pull up your page's rank. see Google's Page Rank Explained as listed on Google's website. -JasonSpradlin82 (talk) 21:34, 12 February 2008 (UTC)

New 'Classification' section (or something similar)?

I notice that a few of the FA's under the WikiProject Neuroscience start with 'Classification', and 'Characteristics' headings, straight after the intro.

By no means should articles have to follow each others style (and I still not sure of FA for Alz), but what made me look again at existing FA's like Autism and Asperger's syndrome was that I feel the introduction here gets a bit too technical. It poses the question of what Wikipedia actually is to me.

I'm sure there has been debate on WP, on whether a topic like this should be 'hard science' (so to speak), or more for the layman. I expect the consensus is usually 'both', but that can clearly be hard to do sometimes. The best way could be to have an easier to understand intro, and lead into a section like 'Classification' (which could offer a more technical intro).

I think a new intro could cover the progression of AD in a brief way. The 'stages' in the Symptoms section have got a bit technical, language-wise, I feel, for easy reference. I've never been 100% happy with 'stages of AD' anyway - there is kind of general consensus with them, mainly, I think, because there needs to be for practicality. I notice that www.alzheimers.org.uk here doesn’t use them in its general explanation of AD (but does refer to them under Treatments towards the end).

No website has 'ranking power' like Wikipedia: type in a word and very often the WP article comes up top. On Google.com this article is second to www.alzheimers.org.uk (for me anyway) - so I think we've got a duty to make the introduction a widely-readable appraisal of AD.

Could the whole intro as it stands go into the second section (with a briefer first line)?, with a new intro along he lines of (writing off the cuff):

Alzheimer's disease (AD), also called Alzheimer disease or simply Alzheimer's, is the most common cause of dementia, afflicting 24 million people worldwide. Alzhiemrs in a progressive and terminal disease for which there is currenly no cure. In its most common form, it occurs in people over 65 years old (although a less-prevalent 'early onset' form occurs too). It usually begins many years before it is eventually diagnosed. In it's early stages, short-term memory loss is the clearest symptom: this leads on to confusion, anger, 'mood swings', language breakdown, long-term memory loss, and the general 'withdrawal' of the sufferer as his or her senses decline. Gradually the sufferer loses minor, and then major bodily functions, until death eventually occurs. Although the symptoms are common, people commonly experience them in a unique way. The duration of the disease has been know to last from x up to x years. (cite www.alzheimers.org.uk for 2nd to last statement).

Some symptoms, like depression, aren't guaranteed (some people can get more agressive for example) - so the intro should stick to the symptoms that are common to all. It gives someone an appraisal - the quick fix that people often need when they are ignorant of something they suddenly need to know. --Matt Lewis (talk) 23:36, 12 February 2008 (UTC)

I need to read more about what you are writing. However, I believe that WP:MEDMOS takes precedence as the manual of style for this article, over the Wikiprojects. OrangeMarlin ^{Talk• Contributions} 01:02, 13 February 2008 (UTC)

It fits in with MEDMOS fine.

MEDMOS actually says (which is always worth noting):

"Wikipedia is written for the general reader. It is an encyclopaedia, not a comprehensive medical or pharmaceutical resource, nor a first-aid (how-to) manual. Although healthcare professionals and patients may find much of interest, they are not the target audience."

I'm keen on improving the intro, but would rather we discussed it first, especially as a new section could be involved. --Matt Lewis (talk) 01:56, 13 February 2008 (UTC)

I'm going to make an edit now - please read through and comment. It is directly in line with WP:MEDMOS (including the two recommended headings of Classification and Characteristics (which can also be "Signs and symptoms"...). I'm sure it can be improved and have more/better(?) citations. If this article does achieve to FA status (like Autism etc), it will need at very least a "general reader" intro, imo. —Preceding unsigned comment added by Matt Lewis (talk • contribs) 18:47, 14 February 2008 (UTC)

Beautiful. I added some wikilinks, because I'm better at that than writing out the lead!!!! good job. OrangeMarlin ^{Talk• Contributions} 19:21, 14 February 2008 (UTC)

Cheers. There are limits to my understanding of the technical stuff, but I can always add decent-enough prose, and some first-hand 'carer' experience.--Matt Lewis (talk) 19:44, 14 February 2008 (UTC)

Good job: Lead was actually horrible. I´ve been a week on holidays and there have been a lot of improvents in the article. WELL DONE TO EVERYBODY. I love all this movement in this article.--Garrondo (talk) 19:39, 16 February 2008 (UTC)

Current Treatments

We have a couple of statements that seem contradictory. In the lead to the treatment section, we say "some medications do slow disease progression." with a reference. But, in the next paragraph we say, "AChE-inhibitors seem to modestly moderate symptoms but do not alter the course of the underlying dementing process." If a medication does not alter the course of the dementing process, then how can it slow disease progression? The FDA label for Aricept is one source that uses the "do not alter" language. I think we had "do slow disease symptom progression" in an earlier version, and that might be a reasonable middle ground. I believe the Cochrane review uses "delay" instead of slow in judging the effects of current treatments. --Chrispounds (talk) 15:11, 14 February 2008 (UTC)

I think we should be consistent. The medications do not slow disease progression, because they cannot treat the underlying disease. I think it just moderates the symptoms, thereby delaying the progression of the disease. Does that make sense? OrangeMarlin ^{Talk• Contributions} 18:17, 14 February 2008 (UTC)

If it's actually not known which is which, we should say that. I must say I always thought it could be 'slowed', as people who address it head-on with the drugs, diet and lifestyle etc, do live longer, with a better quality life. If the symptoms in themselves progress the disease (and are treatable), then they are 'one and the same' in a sense. Maybe that is what can't be proven?--Matt Lewis (talk) 18:59, 14 February 2008 (UTC)

Caregivers

Is it only me that thinks the article needs more on the caregivers, respite care, etc.? It says 24 million afflicted, but we all know that the family members charged with giving care often suffer more than the patient...LeadSongDog (talk) 22:15, 16 February 2008 (UTC)

I think an equivalent article to Sociological and cultural aspects of autism is needed. It could link to the 'AD in the Media' page, and could go some more into caregiving too. As an example, thousands of elderly people marched in the UK last year over Donepezil, and the general feeling they are being ignored. The Autism FA actually has around 10 direct sub-articles, btw (though some are buried in the text).

Another specific sub-article like Caregiving and Alzheimers might be needed. When not specifically drug-related, it's outside of pubmed of course - but lots of stuff to quote is certainly out there. It's one of those areas that both is and isn't 'original research', as the final result will be fully weighted and credibly cited etc. A benefit is that it can be linked to at top, for people who are looking just for this.

The main AD article could mention a few more of these factors - for instance, some families choose not to tell the sufferer - a big decision: it can make for a much happier time, but is it apt, ethical, and fair? Doctors etc, when informed of this, keep up the 'secret'.

I think an equivalent to Autism therapies is needed too (therapies, tracking, dogs etc). Two other sub-articles should really cover all the speculation of causes, and the 'alternative' treatments too (which would be useful as so much is out there, and doctors give conflicting advice). AD is no small subject, and all these articles will occur eventually, I'm sure (as they have with Autism, and, in general, everything else).

The Autism article isn't great on caregiving either, despite being 'FA' - I have a friend who has brought up a son with autism, and she would just laugh - she and her son did all the work. At 81 she is still contacted for her knowledge. Caring->knowledge->skills/ideas->treatment. --Matt Lewis (talk) 03:42, 17 February 2008 (UTC)

Respite care has some good stuff, but is barely start-class if that. Rather than Caregiving and Alzheimers a more general Caregiving and dementia article might be better for now.LeadSongDog (talk) 05:39, 18 February 2008 (UTC)

The Harris poll along with the Alzheimer's Foundation has done a few surveys on Caregiving that might be good sources for caregiver concerns, needs, etc. Mary Mittleman has done some work on caregiver strategies to keep folks at home. --Chrispounds (talk) 14:52, 18 February 2008 (UTC)

Just tried a Google scholar query on "dementia caregiving" OR "dementia caregiver" and got 2080 hits! Something tells me this is an overdue article.LeadSongDog (talk) 15:50, 18 February 2008 (UTC)

Created article at Caregiving and dementia and pasted above discussion into Talk:Caregiving and dementia. Please continue discussion there.