In disclosing that he had developed Alzheimer's disease, former President Ronald Reagan said he wanted to make more Americans aware of the incurable illness, which is characterized by progressive mental and physical deterioration and which affects an estimated 4 million Americans.
Medical researchers applauded Reagan's announcement and said they expected it to lead to greater public awareness about Alz-hei-mer's, as was the case several years ago when he had surgery for colon cancer.The disease becomes increasingly common with advancing years and has become a major public health problem as more people live longer. About one-third of Americans at age 85 have Alzheimer's compared with 5 percent at age 65.
Reagan, who is 83, said in a letter written in a steady hand and released by his office in Los Angeles on Saturday that he was in good health but beginning "the journey that will lead me into the sunset of my life."
In an accompanying statement, five of Reagan's doctors said that the diagnosis had become apparent from annual check-ups over the past year, but particularly from more extensive testing and observation over the past few weeks. They said they expected his health to deteriorate as the years pass.
Alzheimer's disease runs a highly variable course. Some people go downhill quickly, dying within a year. For many others, the disease progresses more slowly and death occurs after a decade or longer and often from some other disease.
Experts interviewed said the medical details released were too sketchy to determine what the doctors meant by "early stages" and how much the disease had progressed.
Because Alzheimer's begins to affect the mind in such a subtle way, the experts said it is often difficult to tell when a person first begins to experience symptoms from the disease.
Experts like Dr. Calvin H. Hirsch of the University of California at Davis said it is theoretically possible that Alzheimer's affected Reagan in the final months before he left the White House in January 1989, nearly six years ago. But they cautioned against overinter-pretation of any anecdotes that might surface now that Reagan's diagnosis is publicly known.
"You will probably hear a slew of anecdotes not told before from people saying, `I knew it all along,' " said Dr. Leon Epstein, a geriatric psychiatrist who is an expert on Alzheimer's disease at the University of California at San Francisco.
But, Epstein said, Reagan was examined every year, and it was a standard part of that test for doctors to listen to answers to various questions for clues to mental deterioration.
Dr. Daniel Ruge, who was the White House physician in Reagan's first term, said in an interview on Sunday that he did not notice any indication of Alz-hei-mer's disease in talking to the president almost daily during those years.
"He was a pretty bright guy, one of the most organized people I know with an ability to say things in the fewest possible words and with a good memory," Ruge said. "You never had to tell him anything twice."
In an interview in 1980, Reagan talked about how his mother, Nellie, was senile "for a few years before she died" of a stroke as a complication of arteriosclerosis at age 80.
Although there is a hereditary component in many cases of Alz-hei-mer's, overall the pattern is not clear. In some families the disease is passed on in an autosomal dominant pattern, meaning that each child born to an affected parent has a 50-50 chance of developing the disease.
In diagnosing Alzheimer's disease, doctors must be careful to rule out other conditions like a thyroid gland disorder, brain tumor, subdural hematoma or depression.
In 1989, Reagan suffered a serious head injury known as a sub-dural hematoma, a blood clot that forms beneath the skull, when he was thrown from a horse.
In early stages, Alzheimer's patients are generally able to feed and dress themselves. Behavioral changes like increasing agitation, restlessness and paranoia can occur. Someone with Alzheimer's may pace aimlessly around a room or remove food from refrigerator and horde it in a closet.
The biggest problem is often for the spouse who may bear the heartache of not being recognized by the partner, being called an imposter, even being hit without apparent provocation by an angry person with Alzheimer's.