Talk:Alzheimer's disease

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Good article Alzheimer's disease has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do. If it no longer meets these criteria, you can delist it, or ask for a reassessment.
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Information from Alzheimer's disease appeared on Portal:Medicine in the Did you know section on May 30, 2006.
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[edit] ToDo list

See /ToDo. LeadSongDog (talk) 16:39, 12 June 2008 (UTC)

[edit] TNF

I am not enough of an expert to do this kind of editing, but this news story[1] 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 [2]). 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[3], 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 [4] and [5] 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)

[edit] 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)

[edit] 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.[1] 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)

[edit] Some thoughts on the article (size etc)

[edit] 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.

[edit] Some Featured Article sizes

  • 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.

[edit] 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).

[edit] 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.

[edit] 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.

[edit] 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.

  • Well there is actually quite a lot of "semi-academic" knowledge attributed to the study of Alzheimer's disease. In fact, every year thousands of scientific papers are published by neuroscientists, neurologists and psychiatrists, expounding on existing information and claiming new ground. I am not sure I have encountered the validity claims and contention that you allude to, but surely this does not demote the academic status of a very real phenomenon, studied by several scientific disciplines. For example, a lot of misinformation circulates about the study of depression, and there is much conjecture even between experts of the same profession of its pathophysiology and treatment (I refer, of course, to antidepressants), and yet, no one who has read about it would seek to refute it as non-scientific, or unworthy.

[edit] 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: [6] 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)

I just noticed this lengthy discussion, which has some incorrect data and focuses inaccurately on overall size, rather than prose size, as emphasized at WP:SIZE. Size recommends a readable prose cap at 50KB. Most other medical articles have around 30 to 40 KB of readable prose. Here are some other FA stats on article size. This article currently has 31KB of readable prose, which is barely adequate, not long. For comparison, "my" Tourette syndrome has 33KB readable prose, similar to this article, but the reason it is short is that I aggressively employed summary style to spin off daughter articles on Treatment of Tourette syndrome, Causes and origins of Tourette syndrome, Sociological and cultural aspects of Tourette syndrome and History of Tourette syndrome (that I could submit to GA if I ever got around to it, and I could eventually create a featured topic). Those articles all have significant and 100% cited content. Given that this article doesn't have extensive daughter articles using summary style, if anything, it's short on the content side, not at all long. I also worked (with Eubulides and Colin) on Asperger syndrome and autism, and the same can be said for those articles with respect to size and daughter articles (they are around 30KB because significant content is well covered in daughter articles). SandyGeorgia (Talk) 21:21, 23 February 2008 (UTC)

I don't think there is any other incorrect data beyond the 60-100K "rule of thumb" sizes not being article sizes but "readable prose size" (and the section was only clarified as "readable prose" sometime after I quoted it - it appeared to refer to the whole article size when I read it, like the reference to the old the 32K page limit!). I think the way this article compares to the science FA's like Autism would show a similar picture whether you compare the article sizes (as I did, which is pretty easy to do), or compared only the size of the prose (as SandyGeorgia has) - especially now this article has been worked on internally so much (cite styles etc). You mainly just need to take the amount of citations into consideration if you are comparing the article sizes.
My actual point was that we needn't keep the article too compact - and that it will eventually expand via sub-articles. I agree with SandyGeorgia that "daughter articles" are the way to go. --Matt Lewis (talk) 16:12, 29 March 2008 (UTC)

[edit] 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)

[edit] 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)

[edit] 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)

[edit] 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)

[edit] 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)
This [7] suggests that we may want to say that Ginkgo does not work nor is it without risks. --Chrispounds (talk) 17:39, 28 February 2008 (UTC)
Maybe I'm particularly thick today, but "In the secondary analysis, where we controlled the medication adherence level, the GBE group had a lower risk of progression from CDR = 0 to CDR = 0.5 (HR = 0.33, p = 0.02), and a smaller decline in memory scores (p = 0.04)" doesn't exactly strike me as meaning it "does not work".

Of course it is wrong, but that's another matter. <PetPeeve>This sort of laziness drives me round the bend: the "lower risk of progression" should at least have read something like "lower risk of progression within the 42 months studied".</PetPeeve>LeadSongDog (talk) 20:32, 28 February 2008 (UTC)

[edit] 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)

[edit] 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)
  • 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.[2][3][4]

--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 on 2008-01-30.LeadSongDog (talk) 14:51, 30 January 2008 (UTC)
I have red it and this an extract: Different epidemiological studies have shown relationships between certain modifiable factors and a population's likelihood of developing Alzheimer. Many of these potential factors have been identified in observational and animal studies. At present, they are only associated with changes in AD risk. Only further research, including clinical trials, will reveal whether, in fact, these factors can help to prevent AD.(page 7). There are no scientific base to put those factors under prevention, since there are no causal relationships proven and its mostly misleading. I still believe all the information on prevention would better fit in the epidemiology section. We are lying since its implicit in the prevention section that if you follow the measures your risk for alzheimer lowers and there is no proof for that. --Garrondo (talk) 17:48, 22 February 2008 (UTC)

[edit] 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:

[edit] 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)

[edit] 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 [[8]] 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)

[edit] 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)

[edit] 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)

[edit] 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)

A recent study on adult hearing loss in the USA, concluded that 5% of the participants (Spirochetes in otology: are we testing for the right pathogens?) had neurosyphilis, and recovered their hearing after treatment, another 2.5% had detectable levels of Lyme Disease antibodies. AD is a clinical diagnosis and spirochetal diseases, which can cause a nearly identical presentation, are unlikely to be be diagnosed if the patient's age makes AD probable. By suppressing, (and Orangemarlin I can't think of a better word for it)information about antibiotic trials and the discovery that minocycline is effective in animal models in slowing disease progression, you are limiting the ability of wikipedia, to provide timely and useful (potentially life saving) information. —Preceding unsigned comment added by 70.71.251.142 (talk) 00:58, 21 May 2008 (UTC)

You can add it to Alzheimer's disease clinical research as long as the contribution exactly matches information in references or it would be classified as original research. Improvements in animal models are not merit enough to post it in main article, since there are thousands of potential treatments under investigation. --Garrondo (talk) 12:46, 21 May 2008 (UTC)

[edit] 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.

[edit] AD as more than a dementia

I'm a bit uncomfortable going too far with link between AD and dementia. Obviously, AD is a 'form' of dementia - but it otherwise it is entirely its own thing. Some dementia is reversible, some is essentially age-related decline. I think AD always needs to stand on its own feet - partly for awareness and understanding (where the Alzheimer's name is so significant), and partly because so many of the symptoms and treatments are entirely AD-specific. The new Caregiving_and_dementia page will be a useful portal for it, but I don't want to 'blur' the two. I'm going to make the Caregiving and Alzheimers page now to establish it, and avoid crossing. I'll try and find the time to get things in it today, so it doesn't get put up for deletion (isn't that annoying when that happens so quick?).

I've just noticed this page, by the way: Prevention_of_dementia (no comment, just a mention). --Matt Lewis (talk) 17:04, 18 February 2008 (UTC)

I haven't got time to finish the intro right now - so rather than leave just a stub-heading (a guaranteed AfD) I'll look at starting it off again tonight. There's no hurry. Someone else might want a go first. Please bear in mind my argument - if specific AD stuff is to go in, it's surely best on an AD page - dementia is far too broad. --Matt Lewis (talk) 17:21, 18 February 2008 (UTC)

[edit] Review

[edit] From SG

  • WP:LEAD, see autism, Asperger syndrome or Tourette syndrome. The lead should touch on elements in each major section of the article, or the main sections mentioned at [[9]]. If the reader reads no more than the lead, s/he should have a good overview of the most important information about the disease. I would expect about three paragraphs, along the lines of the articles I listed.
  • I'm not sure you should ever use single quotes; pls doublecheck that with WP:MOS.
Per WP:PUNC Double or single: Quotations are enclosed within "double quotes". Quotations within quotations are enclosed within 'single quotes'. LeadSongDog (talk) 20:09, 21 February 2008 (UTC)
  • Should further reading be alphabetical (or is there another reason for the order there)?
  • MEDMOS sections look good.
  • In looking only at the two bottom sections, I found several ref formatting issues:[10]
    • Book sources need page numbers
    • There are random errors in endashes; contact Brighterorange (talk · contribs) to run a script to fix them Made a request now. OrangeMarlin Talk• Contributions 00:02, 19 February 2008 (UTC)
    • There are numerous instances of duplicate punctuation in cite templates; don't add punctuation after author names and article titles, the cite templates adds it.Done, I think.LeadSongDog (talk) 14:39, 20 February 2008 (UTC)
    • Use language icon
      • I'm not sure what this means?OrangeMarlin Talk• Contributions 19:07, 21 February 2008 (UTC)
        • Done.Used language={{de icon}} two places, which generates (in (German)). A bit funky, but should interwiki well.LeadSongDog (talk) 22:51, 21 February 2008 (UTC)
    • Be consistent in formatting of author names. Since most of the citations use Diberri (author field), the other cite templates should follow suit, so you have consistent punctuation.
    • Use the ISBN finder in the userbox on my userpage.
    • Watch for dead links and missing publishers;[11] you can periodically run the dead link checker.
  • See Tony1 (talk · contribs)'s userpage for redundancy-reducing exercises. I found many instances of redundant text in the bottom two sections, and strange use of semi-colons.[12]
  • Be careful with WP:OVERLINKing; common terms known to most English speakers don't need to be linked, other terms don't need to be repeatedly linked.
  • WP:ITALICS on words as words, not quotes Found two instances, and I'm not sure why they were even there. OrangeMarlin Talk• Contributions 22:25, 19 February 2008 (UTC)
  • Take care with WP:MOSNUM
  • I'm finding text redunancy and confusing clauses, suggest a run-through by someone better at prose than I am.
  • In the "Pharmaceutical" section, I'm not sure why trade names are in WP:ITALICS and why Trade is sometimes capped, sometimes not. Please see the note above the footnotes in Tourette syndrome and ask Colin (talk · contribs) or Fvasconcellos (talk · contribs) how to handle drug names; there is currently a debate at the talk page of WP:MEDMOS, and I grew tired of following it due to verbosity there. Done. But I used the current WP:MEDMOS, and also not interested in the tendentious discussion about drug names. OrangeMarlin Talk• Contributions 22:45, 19 February 2008 (UTC)
    • That particularly verbose tendentious discussion seems to have finally reached a rational conclusion, so you may want to revisit the conclusion on trade names on medications. SandyGeorgia (Talk) 14:34, 22 February 2008 (UTC)
      • I think that haranguing over drug names at WP:MEDMOS is finally winding down. The only concern I have with this article is I don't know why manufacturer's are mentioned along with trade names, and I suggest deleting those. SandyGeorgia (Talk) 21:27, 23 February 2008 (UTC)
  • There's also some underlinking, see WP:MOSLINK;[13] the entire article should be reviewed for wikilinking, both underlinking and WP:OVERLINKing. That's all I can do tonight, I'll check in on progress on these items in a few days.

SandyGeorgia (Talk) 00:06, 19 February 2008 (UTC)

  • ACK !! WTH is this in the lead ? Further information: Caregiving and dementia  ?? See WP:GTL, templates always go at the tops of sections, and in all my days, I've never seen a Further added to the bottom of a lead. Ouch. That should be worked into the text somewhere. SandyGeorgia (Talk) 04:07, 22 February 2008 (UTC)
Sorry to cause you so much pain! It doesn't have to all be so anal does it? I don't mind that you removed it - although it didn't look outrageous to me at all (why would it?), and it was put in after a discussion on the subject, at the bottom of the lead, just after the relevant line. It was also introduced with a question mark in the edit note! I suppose the very top of the page is the recommeded place for related articles that people might want to immediately go to - or want to move straight on to, after just reading the lead - ?? -Matt Lewis (talk) 17:45, 22 February 2008 (UTC)
No. If it's so important that it must be mentioned right away, then it should find a place in the WP:LEAD via a wikilink. If it's not so important that it needs to be mentioned and wikilinked in the lead, it belongs in the hatnote template at the head of the appropriate section, per WP:GTL. This article is about the condition, not about caregiving, so I think it's fine where it is. I have literally never encountered at FAC or FAR such a non-standard use of a hatnote in the WP:LEAD (an article that warrants a serious read before ya'll approach FAC). SandyGeorgia (Talk) 21:31, 23 February 2008 (UTC)

[edit] Citations

We need to be consistent in our citations. There are no rules, but we can't have 10 different editors implementing 10 different citation methods. More and more FAC's are making use of this tool to make citations consistent. It makes life really easy, because you use the PubMed number to generate a consistent citation. SG has recommended we use it, and I've seen it used in a lot of medical articles. Over half the citations use the Diberri tool, so unless there's a better one, and I'm all for better since I used to type these citations out by hand, let's stick with it. OrangeMarlin Talk• Contributions 20:40, 20 February 2008 (UTC)

  • I left you a trick for combining unsightly ref tags into one.[14] Citations that are only used once don't need to be named, so if you have places where there are three or more single-use citations, you can put them into one set of ref tags, which leaves a much cleaner looking article. When they are named refs used repeatedly, you can't use that trick. SandyGeorgia (Talk) 21:38, 20 February 2008 (UTC)Done.LeadSongDog (talk) 18:30, 21 February 2008 (UTC)
    • I was using the Diberri tool, and I'm not sure there's a way to shut off the "ref name" feature. I actually don't like it, because it's not very user friendly. I never liked the combining of references from a stylistic point of view, but if it makes it neater, it could be a big improvement to editing and reading. OrangeMarlin Talk• Contributions 23:25, 20 February 2008 (UTC)
It's the Add ref tag checkbox in Diberri's long form LeadSongDog (talk) 23:39, 20 February 2008 (UTC)
Oh that was too freaking easy. LOL. But now I have to type the ref tags. I'm too lazy.  :) OrangeMarlin Talk• Contributions 19:06, 21 February 2008 (UTC)
Just over the wikitext edit box is a toolbar. At the right end of that toolbar is a button mislabled as <ref /ref> that puts the ref tags in for you and puts focus between the new tags. So first you click that button, then paste what you copied from Diberri. Two clicks, its done. :/) LeadSongDog (talk) 20:06, 21 February 2008 (UTC)
You don't have to name refs unless you need to use them more than once; using a named ref for every citation just chunks up the article with unnecessary junk. As LSD says, you can just use plain old ref tags, and then use named refs only if you have a repeated (see WP:FN). SandyGeorgia (Talk) 04:11, 22 February 2008 (UTC)
I'm figuring this out. Remember SG, it was only a couple of months ago, I was writing out the citations by hand, until you told me about the Diberri tool. OrangeMarlin Talk• Contributions 19:16, 22 February 2008 (UTC)

How come each time I come back, I find a goofed up ref?  :-)) This needs an accessdate and a format = PDF:

  • Dementia: Quick reference guide. National Institute for Health and Clinical Excellence (November 2006).

SandyGeorgia (Talk) 04:14, 22 February 2008 (UTC)

Missing accessdate:

  • Alzheimer's Disease Genetics Fact Sheet from the National Institute of Health

SandyGeorgia (Talk) 04:14, 22 February 2008 (UTC) Fixed. LeadSongDog (talk) 04:50, 22 February 2008 (UTC)

[edit] Introduction

Regarding the lead, I think it's probably wise to keep anything remotely arguable out of it. I'm not a huge fan of the "Stages" (not everyone uses them), and although I personally agree that the drugs probably lessen the effects, I'm not sure the intro is the place to say that (they don't work for everyone for example, or seem to work to starkly different degrees, and we don't always know how they work - they could be slowing it down, rather than just 'lessening the effects'). Also, do we need to mention the pharmos and clinical trials here? - they are pretty obvious occurrences, I would have thought.--Matt Lewis (talk) 21:50, 20 February 2008 (UTC)

Reading it again, mentioning the undergoing clinical trials I think gives them kind-of 'undue weight' - simply beacuse they often come up with nothing, so we shouldn't raise peoples hopes (they are an event that hasn't occurred too).--Matt Lewis (talk) 23:31, 20 February 2008 (UTC)

RE Snowmanradio's version of intro: I think words like "acquired" need to go into the following-on 'Classification' section (which is the more technical version of the introduction). Now we have the phrase "acquired progressive illness" - which is creeping towards jargon again. I don't think the current edit is actual easy easier to understand, to be honest - the lead is the part that most clearly falls under the "general reader" guide in WP:MEDMOS. Do we benefit from lines like "The combined outward presentation of the symptoms"? Shorter statements are better, I feel. I'll look at edit-comment on the previous "withdrawn" not covering everyone (not sure at the moment - disinhibited is a good addition, but they are actually kind-of the same thing), and am happy the word "carers" found its way in, but I'm going to put the old one back to work from, as I think it's a more stable base to work from. —Preceding unsigned comment added by Matt Lewis (talk • contribs) 17:32, 21 February 2008 (UTC)

Also, re "four to six years" as a 'general' post-diagnosis longevity - I think that needs more than the one citation. There is varied data on prognosis, so we are best keeping the broader figures in, I feel. —Preceding unsigned comment added by Matt Lewis (talk • contribs) 17:50, 21 February 2008 (UTC)

This was written 1 minute before your edit of 17.33 that substantially reverted my reworded introduction. It seems to me that you did not give anyone time for discussion, but your edit summary "as per talk page" makes it sound like that there has been agreement and discussion. I think that it would be much easier to work from the version as it was when I left it earlier today, which may need some small modifications, and the position of the references fixed. I will be grateful if you would put it back until the discussion here makes it clearer what edits are needed. Snowman (talk) 18:07, 21 February 2008 (UTC)
Your edit had been up for 6 hours, and I wanted the old (un-contentious) one back. Perhaps it is best to introduce such radical changes in Talk first? The 'settled' edit has to take precedent in cases like this (or WP would be chaos!). We can talk now of course... (there's no hurry to put changes in, unless they deal with immediate accuracy).--Matt Lewis (talk) 18:37, 21 February 2008 (UTC)

There are many ways in which the introduction can be improved:

  • "language breakdown": what is this?
  • "terminal disease" most people would think of cancer but not upto 20 year survival
  • "neurodegenerative disease" jargon
  • "most common cause" need an approximate percentage - I could not find this for my edit
  • "afflicting 24 million people worldwide" what severity it this?
  • "as his or her senses decline" blindness or deafness do not make a person demented
  • "loses minor, and then major bodily functions" incomprehensible, vague.
  • "In its early stages" not clear if this is before diagnosis or after diagnosis
  • need to mention that there is not clouding of consciousness
  • need to mention that it is an acquired illness to mark the difference with mental defect
  • need to mention decline in intellect
  • could mention distress to relatives
I think that sometimes simple terms can be more meaningful to the general reader than the more 'explained' sentences: I would keep "language breakdown", "terminal disease" and "senses decline" - sound and vision does have less clarity, colours are less vivid... sufferers do slowly withdraw (and stimulation here helps). "loses minor, and then major bodily functions" is pretty much what happens isn't it? As soon we go into too much detail in the 'lead', the flow and purpose of it gets lost (and problems in citing and of exacting accuracy can occur too - which will can it increase in length to 'cover' more...).
There is no mention of senses in any other part of the article, so where does this come from? Loss of senses may be age related, and this is misleading in the summary. The other vague phrases do not help when they could easily replaced. These vague phrases lead to a block in understanding the introduction. Snowman (talk) 23:27, 21 February 2008 (UTC)
Perhaps we could address this - but it could just be a language thing. The article is still being worked on, remember.
It is about clarity of thought. The stimulation is for brain stimulation. Partially deaf or blind suffers will have special problems. Snowman (talk) 00:05, 22 February 2008 (UTC)
Can you be clearer? The line on the senses gradually declining is fundamental to AD.
Do you mean declining perception? Can you explain what you mean? I think you are saying that declining senses like declining eyesight and declining hearing is fundamental to AD. Snowman (talk) 00:52, 22 February 2008 (UTC)
I do. AD eventually destroys everything, unless death gets in the way. Look at the picture of the two brains. --Matt Lewis (talk) 01:02, 22 February 2008 (UTC)
It is a bit difficult to see the organs of senses, including the eyes and ears on that small scale scan. Dements retain basic reflexes and there is no reason to think that there is a fundamental disease related problem with senses. They have a plantar reflex and will move there head to the side they are gently touched, like a baby would. It is not known what a very demented person thinks about, but it is likely that perception has declined a lot. The scans are difficult to see, but cortical atrophy is a key feature. Snowman (talk) 01:21, 22 February 2008 (UTC)
Don't confuse AD with other forms of dementia! AD is a singular disease. The brain controls and processes everything. Only the heart has a (tiny) control centre outside of the brain. --Matt Lewis (talk) 01:34, 22 February 2008 (UTC)
Reflexes area at a lower brain level, but retained enough to show that senses are intact. Snowman (talk) 01:42, 22 February 2008 (UTC)
This is an only the lead, remember, so doesn't have to explain its points ("most common cause" doesn't need further clarifying, for example). I simply has to be a clear and readable introduction.
Some people only read the lead, so it should mention all the key features. Snowman (talk) 23:27, 21 February 2008 (UTC)
I think it does broadly cover all the key features - it just doesn't list them (which is too hard to do). I agree it's supposed to be (in part) for people who only read the lead.
You removed the affect on relatives. Snowman (talk) 00:05, 22 February 2008 (UTC)
I do agree that it's OK mention the 'care burden' in the lead - problem was the other bits. I'll try and get a line in - but one thing at a time!
You'll have to explain "clouding of consciousness"? Fatigue is certainly common.
This is a key feature, could say that "alertness to surroundings" or just "alertness", or some other suitable easily understood phrase. Snowman (talk) 23:27, 21 February 2008 (UTC)
A key feature? I can't agree with that at all. The senses decline, the sufferer 'withdraws' and it can be hard to get their attention - they can miss things very near to them. They tend to only look in a literal straight line. Are we on 'cross lines' over meaining here?
You misunderstand and you are mistaken, it must not be diagnosed when there is a reason for a decline in the level of consciousness, or it would be diagnosed in a concussed state, toxic confusion, and so on. A preserved level of consciousness is absolutely a prerequisite for the diagnosis to be made. It is in the first paragraph on dementia in textbooks. A withdrawn suffered will be able to be woken up by gentle shaking, and when they wake up that may not known where they are or who they are. Snowman (talk) 00:05, 22 February 2008 (UTC)
Suffers may withdraw as their brain function declines, but it is not because their senses decline. I will ask you to find a reference, and I will put a cn tag on the edit you just reverted, because I think that it is wrong. Snowman (talk) 00:40, 22 February 2008 (UTC)
Sorry, I still don't follow you here (and I'm not sure I agree). Is this introduction stuff, anyway?
Introductions need to be accurate. Snowman (talk) 00:46, 22 February 2008 (UTC)
I agree that "neurodegenerative disease" isn't needed here (it's under Classification anyway). I meant to transfer "acquired" to Classification - I'll do that now. The decline in intellect, and distress to relatives, are kind-of obvious by-products, but there is probably a good way of including the care burden somewhere.
It is very easily introduced - see below. Snowman (talk) 23:27, 21 February 2008 (UTC)
I agree - just a short comment with a citation is needed.
Its is common knowledge, a citation would be nice but it is not an absolute. I do not know why you removed it. Snowman (talk) 00:25, 22 February 2008 (UTC)
You did too many things together - it was too hard to keep.
It is not hard to put back. Snowman (talk) 00:46, 22 February 2008 (UTC)
I've put a line in - what do you think? It refers to the Caregiving and dementia article currently being worked on.
Not properly incorporated in the text. Snowman (talk) 01:42, 22 February 2008 (UTC)
Classification is the more technical introduction - perhaps it is that that needs improving more? (ie covering the details on severity etc) --Matt Lewis (talk) 22:58, 21 February 2008 (UTC)
Classification is a different discussion. Snowman (talk) 23:27, 21 February 2008 (UTC)
The entire Classification section was the Intoduction a couple of weeks ago! It was just moved down. It's very much like a technical intro.
It is in the wiki guidelines on the introduction that readers may only read the introduction and nothing else. Snowman (talk) 00:13, 22 February 2008 (UTC)
I agree the intro is important (which I do often say). That guideline isn't saying that everything has to be covered in the introduction! The Classification section is suggested in the guideline WP:MEDMOS. Medmos is clear on "general reader" understanding too.
This is a suggestion, but it needs some improvements;

Alzheimer's disease (AD), also called Alzheimer disease or simply Alzheimer's, is a neurodegenerative disease that is the most common cause of dementia, afflicting 24 million people worldwide. It is an acquired progressive illness with gradual deterioration until death, which is generally caused by the effects of dementia. There is currently no cure. In its most common form, it occurs in people over 65 years old (although a less-prevalent early onset form also exists).[1]

The disease process can start with years of mild short term memory loss, which is similar that seen in normal aging. The clinical diagnosis is generally made when the characteristic picture of symptoms develops; this includes worsening short-term memory loss, declining intellect, and problems with abstract thinking, all without clouding of consciousness. Symptoms may also include mood swings, social behavioral problems and aggression, which can be distressing to relatives and carers. The combined outward presentation of the symptoms is often unique to an individual and their circumstances.[2] As brain function gradually declines, the symptoms worsen with decreasing ability to perform even the mundane activities of daily living, until death occurs.[3] The duration of the disease can be as long as 20 years,[4][5] but survival is generally between about four and six years after diagnosis.[6][7] -- Snowman (talk) 22:18, 21 February 2008 (UTC)

Can you give the other "four to six year" citation? --Matt Lewis (talk) 23:05, 21 February 2008 (UTC)

For easy reference, this is the existing version: (it had a 'consensus' behind it, as it had 'stuck' (also, see OrangeMarlin, Garrondo above), though it was/is certainly still being worked on...)

Alzheimer's disease (AD), also called Alzheimer disease or simply Alzheimer's, is the most common cause of dementia, afflicting 24 million people worldwide. Alzheimer's is a progressive and terminal disease for which there is currently no cure. In its most common form, it occurs in people over 65 years old (although a less-prevalent early onset form also exists).[1] It usually begins many years before it is eventually diagnosed. In its early stages, short-term memory loss is the clearest symptom:[2] this leads 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 occurs.[3] Although the symptoms are common, people commonly experience them in a unique way.[4] The duration of the disease is estimated as being between 5 and 20 years.[5][6]

(I'd just removed "neurogenerative disease" class from it - it might get put back in.) --Matt Lewis (talk) 23:31, 21 February 2008 (UTC)

[edit] Arbitrary break

I like Matt Lewis' version, except I would add something about the social cost. However, I think most of the differences between the versions can be worked out, so that we can get a good lead.OrangeMarlin Talk• Contributions 19:15, 22 February 2008 (UTC)

IMO, the WP:LEAD needs to be seriously beefed up. Read the leads at Tourette syndrome, autism, Asperger syndrome, Tuberculosis and Schizophrenia as samples. Try to touch on all important summary aspects of the condition, creating a compelling stand-alone summary that conveys everything you want covered if the reader goes no further than the lead. Also, don't overcite the lead; it should be a sumamry, so everything mentioned there should already be cited somewhere else in the article. You only have to cite anything surprising or controversial in the lead and true "hard data". SandyGeorgia (Talk) 21:35, 23 February 2008 (UTC)
Can you give examples of the beef it's missing? I can't immediately see anything. The problem is it auto-'marinates' very quickly when you go into the details! If you give one a go yourself (why don't you?) you'll probably notice this. My own beef regarding 'FA suitability' is to do with the implicitly awkward elements of AD. That's why I'm arguing that it is wise to keep the lead short, concise, and free from anything debatable - or anything that needs too much counter-balance and explanation.
What do you think of Introduction "vs" Classification regarding the more technical details, by the way? (ie the intro is more "general reader", Classification more detailed?). The Classification section was actually (word for word) the old lead - I think the two work pretty well together as things stand (not to say they can't be improved...).--Matt Lewis (talk) 21:59, 23 February 2008 (UTC)
I don't want to wordsmith or suggest text changes; I try to stay focused on WP:MOS, WP:MEDMOS and WP:WIAFA issues so I don't put myself in a position of COI when you come to FAC. Also, when ya'll finish my list and convince Colin (talk · contribs), Eubulides (talk · contribs), Casliber (talk · contribs) and Fvasconcellos (talk · contribs) to look at the article, they are better prose and content persons than I am. I read above the concerns that you have about an FA candidacy, and they aren't really pertinent to WP:WIAFA, which asks that an article be accurate, comprehensive, neutral and stable. I'm sticking to pointing out issues that can be raised at WP:FAC, without getting into content, which others do better than I do anyway. Definitely invite these other editors in for a look once you finish my MOS concerns. SandyGeorgia (Talk) 22:15, 23 February 2008 (UTC)
I sure someone will take your advice on contacting those people, but I'm a bit wary of the 'convincing' element! This is an article on Alzheimer's disease - either someone is in or they are not, surely? Nobody should be on board unless they fully committed to WP:AGF, reading discussions, and generally taking it 100% seriously (however much time they choose to give). I'm sure they are every bit as skilled as you say - but surely it's up to them whether they can and wish to do it properly or not. I wonder if they'd want to lock horns with radical-change makers. Lots of people have their own ideas of AD - it's hard to prove what's right and wrong (my concerns over the FA-status again, I guess). Relatively speaking, there are actually few genuine experts on AD out there, I would guess.--Matt Lewis (talk) 23:13, 23 February 2008 (UTC)
No idea what you're saying, Matt, sorry :-) When you approach FAC, outside editors will be reviewing the article and critiquing it according to WP:WIAFA. I'm suggesting you bring in the knowledgeable editors and featured article writers sooner rather than later to avoid unpleasant surprises when the article is exposed to a broader audience and during a FAC. It's best to have all your ducks in a row beforehand, by having requested a peer review, and posting at WP:MED asking them to peek in. The way you worded your response, it almost sounds like you're projecting a POV here (which you probably didn't intend) by not wanting to expose the article to other medical editors, so I'd best unwatch now. I've probably reached the limit of advice I have to give anyway. Good luck at FAC !! SandyGeorgia (Talk) 23:19, 23 February 2008 (UTC)
I didn't mean that - just wondered why they weren't here already. The article needs all the skilled help it can get! I'm sure you've helped a lot, btw.--Matt Lewis (talk) 23:38, 23 February 2008 (UTC)
I also agree the LEAD needs expansion. Previous ones were better! 3 to 4 paragraphs for an article this size is standard, and the number of topics to cover certainly warrants it. If you don't mind, I'll be BOLD and put some stuff back in from previous versions, and add. You can always go back. SBHarris 02:43, 24 February 2008 (UTC)
Hi - sorry Sb - I'm on the other side of this argument, and am very passionate about it (plase read my arguments on Classification "vs" Lead RE 'techno-talk', and WP:MEDMOS "general reader" guidelines. The searcher needs an Intro that gives a clear and understandable picture. I have just made a search on "declining senses" (as someone wants a citation to prove it) - and found this online forum: Someone basically quotes the old Intro - it shows perfectly why I believe in it (or something along its lines) (it's a slightly older version, without the carer line). It meant something to that person - and she chose Wikipedia to quote, when she had plenty of other options. The only question for me is - have we mislead or short-changed her? Now the carer line is in, I don't think we have. --Matt Lewis (talk) 15:37, 24 February 2008 (UTC)
Actually we have mislead her!!! - it's got that bloody "4-6 years" 'survival' ammendment in it that was only up for 6 hours!!!!!!! I'm going to remember this quote as an example from now on - as how normal people use Wikipedia, and how easily it can mislead them!--Matt Lewis (talk) 15:59, 24 February 2008 (UTC)

<outdent> Actually my argument was mainly that the intro needs to be at least 4 parasgraphs with a total of 20 sentences or so, for an article that is pushing 100 kB. My comment that the previous one was better was in the context that overtechnical stuff in the LEAD is better than nothing. If you don't like tech stuff in the LEAD, or old info there that was wrong or misleading, DO take that out. BUT put something in place of it. A LEAD should summarize the whole article for people who can't read it all or can't or don't want to understand the detail of later (the tech stuff, exactly). Surely there must be 20 sentences worth of accurate, non-tech, true, and useful summary to say about AD!! So help me work on it! SBHarris 17:41, 26 February 2008 (UTC)

Nobody has stopped working on it! It's all about getting it right There will always be an 'average' Lead size, but there can never be a 'standard' one surely? A 20-sentence Introduction for a 100K article might not be uncommon - but it surely cannot represent a rule of thumb. How does its size reflect how well it's written? Or how easy or hard it is to summerise? We don't have to paint by numbers - WP is all about guidelines, not rules. We certainly shouldn't put things in for the sake of it! Too-much info will be off-putting unless it really aids understanding. I worry a great deal about 'half-detail' with the 'social' aspects of AD. It could be said that a good summarising Intro might arouse people's interest, so they read on - rather than give nuggets of the "too-little knowledge" that can be a dangerous thing.
Why don't we list here what is currently missing? Remember that this article (including the social aspects) is still being written. I'm not against another paragraph (and I'd keep the first two fairly simple, like now) - I just want whatever's in it to be 100% suitable - or not there at all. Why completely re-write something that isn't broken? - another paragraph is the way to go, I feel. I've only reverted a couple of re-writes because they haven't yet been improvements (or even close to improvements, in respect of us working from a new 'base' again). I've become very fussy with the Lead - as I'm sure that is is all that many people read, and they musn't be 'scared-off' or mislead (which unfortunately we have done, before now) - that would be bad for AD-awareness (why I'm here), sufferers, family and carers, and Wikipedia's credibility too. --Matt Lewis (talk) 18:56, 26 February 2008 (UTC)
Look, a lot of things could be said about how to write an AD article. However, there is a style policy for Wikipedia articles of this size, and for the LEADs of these and what they should contain, there is WP:LEAD. You-all can write any kind of article on AD you like, but if you write one on AD HERE ON WIKIPEDIA, and make it as long as this one is, you'll be expected to provide a summary LEAD according to the WP style guidelines for articles of this size, not one according to your personal this-or-that philosophical musings or worries. If you don't like Wikipedia's style, go someplace else to write on this subject! SBHarris 06:54, 27 February 2008 (UTC)
Look pal, I've got up early to finish off a couple more paragraphs I've properly thought out. I'VE TAKEN MY OWN VALUABLE TIME TO DO THIS, and it will be up by 8 (about half an hour, when I've finished citing it). Don't you dare attack me like that, and shout at me about what Wikipeidia is - I know this place well enough. I removed your re-write because it was way too technical per MEDMOS "general reader". You said in your Lead you were not married to it - and if you want to remove mine (and you have a good reason) you can. If you want a long Lead you should have thought about including paragraphs to extend it with, rather than re-writing what we had - WHICH WASN'T BROKE! I have found two new paragraphs worth of new information for the Intro (inspired by your insistence), and you better take them seriously because I'm going to be a zombie for most of today with the 3 hours sleep I've had.--Matt Lewis (talk) 07:41, 27 February 2008 (UTC)
Apologize for being too curt. A lot depends on whether you or somebody else intends to fix it eventually, vs. whether you think it's perfect and not broken. It is actually a bit broken, inasmuch as it contains sentences which don't fit in a single paragraph every well. Many are topical and not related to anything else, and might start other paragraphs just as well. If you'd like to see a nice 4 paragraph LEAD, look at the one on the mainpage of WIkipedia, which tells everybody what Wikipedia is [15]. That's a nearly perfect LEAD, and is something we should try for in long articles. It doesn't need to interfere with your sleep so long as we all know somebody's working on it. Again, sorry. It's not deletion of my writing I'm so concerned about, as the fact that somebody's writing is not being substituted. But I have your word now that this will be fixed. Peace. SBHarris 20:50, 28 February 2008 (UTC)
Ok, well sorry for reacting as I did - looking above I think my comment looks a lot worse than yours! We'll all keep looking at the Lead but remember it has been tweaked and added-to a lot, by all the regular contributors and people passing by. The first parag's strength to me is that it is specifically (and suitably in this case) designed for the "general reader" - who can easily look into the article for more detail. It is not off-puttingly long, and is very easy to digest. It actually says quite a lot for one parag! (most are short lines). Most Introductions to AD try and do the same thing. Reading the whole lead through again I think it flows reasonably well (it's now 3 parags long - the 2nd parag could be easily split in two to make 4, but I don't think it aids readability here). As for the Wikipedia lead - I'm so critical of this place I can't fairly judge it! -Matt Lewis (talk) 21:54, 28 February 2008 (UTC)
I'd actually appreciate it if you'd look at the Classification with your detail. --Matt Lewis (talk) 07:48, 27 February 2008 (UTC)

[edit] Extended Lead

Glad the new paragraphs seem to have stuck to a degree - just a couple of points on the parts that seem to be the debatable ones:

[edit] How much is known about AD?

I personally think it's more honest ot begin by saying how "little" is known about AD, rather than that "a lot" is known "but...". Optimistic though I am, the cup is clearly half-empty to me. Maybe we could look at phrasing this.

[edit] Prevention part

I often seem to read how prevention and treatment blur into each other - we need to get this 'uncertainty' surrounding AD right, imo. How else do they treat "early onset"? I suppose we just need decent citations here.

Can you explain what you mean here? To me, prevention and treatment are completely different (one coming before the disease arises and the latter, after). OrangeMarlin Talk• Contributions 21:44, 28 February 2008 (UTC)
I mean the blur is particular to AD - what is often suggested for treating early-onset is what is also recommended to try and prevent it (and is uncertain ground - will it prevent it, and will it slow it down?). The blur is over the unknown 'undiagnosed' time too (or 'pre-dementia'). It seems to be mid-term where the major drugs come onto play - at least in the UK. I'll look for some example.--Matt Lewis (talk) 22:17, 28 February 2008 (UTC)
Now that's going to be hard to write. Be BOLD, because trying something because this is quite critical. OrangeMarlin Talk• Contributions 00:20, 29 February 2008 (UTC)

[edit] Political element

I do think we need something here - but we must get it right of course, and cover it properly outside of the Lead too. People (actually old people) have marched in UK over Aricept on the NHS being kept from early-onset sufferers. It is held back over a 'costs vs effects' argument. But what is costly, and what is effective?--Matt Lewis (talk) 19:39, 27 February 2008 (UTC)

[edit] Caregiver abuse

I think we need to add a paragraph or two about it somewhere (I just don't know where). I was doing a search of pubmed on another issue, and I found a few dozen references on the study of caregiver's abusing patients out of frustration and the overall burden of caregiving. I think it meets the standards of WP:WEIGHT, so we should add it in. Any thoughts? OrangeMarlin Talk• Contributions 19:10, 22 February 2008 (UTC)

I agree - though it's mostly for the Caregiving and dementia page, it needs a mention in here. The temptation to strike back is huge for spouses in particular. The "caregiving burden", bay the way, is without any doubt worse with AD than it is with most other diseases - partly for this very reason! (I'll find a way of getting the fact it is specifically bad back in, with citations to back it up). Families often quickly 'run off' (making it even harder for the primary caregiver), which is insulting to the sufferer, the spouse his/herself can get beaten black and blue over a bad day - who wouldn't 'strike out' in defence at times? It's often self-protection. It's very emotional. The 'no-win' corners an AD suffer can put someone in, after they've spent hours helping them, can lead to massive frustration in the caregiver too - caring can feel like digging your own grave - the great cruelty with AD "caregiving" is that there is so often no classic "reward" of gratitude, progress or even an improved immediate situation. It's can be like babysitting a brain-damaged hyperactive child - you just have to get through it - in a way, the word "caring" doesn't give the full picture.
If you think of already weak or aggressive people - their reactions to an awkward AD sufferer will be obviously be magnified. It is such an unsettling disease, that some AD sufferers will have been abused, after doing little to "deserve" it - as some people (husbands etc) just can't 'deal' with the symptoms. Poets have described AD as proof of no God, because the inherent cruelty of it is on par with child abuse and crucifixion: "madness" is a poetic fear, and the AD sufferer, in effect, dies slowly while still alive (the terrifying prosepect of endlessly 'rediscovering' this is why people often keep it hidden from the sufferer). AD in the arts will find its way into some future "'Sociological and cultural aspects" sub-article, I'm sure - with the current 'AD in the media' as a section or of it, I would guess.--Matt Lewis (talk) 22:36, 23 February 2008 (UTC)
Well, let's add some more to whatever section deserves it, with a see Caregiving and dementia main article link. Interesting that this is used a proof of no G_d. I'd use any science to do so, but that's why there is faith. Oh, wait a minute, that's philosophy. OrangeMarlin Talk• Contributions 17:02, 24 February 2008 (UTC)

[edit] Diet in prevention

The first part says that the mediteranean diet can affect the risk of alzheimer's. Does it reduce, or increase the risk? --Will James (talk) 02:59, 23 February 2008 (UTC)

Positively reduce (now added). The section is no-doubt lagging behind the rest now. It used to be in list form, which is seen as bad form on Wikipedia nearly all the time now - it harder to justify paragraphs though, as they have an "in-build" weight to them. I think it will be part of another article eventually, as consensus on 'inclusiveness' here is imposible (so it should be brief in here). It's not that weighted at the moment and needs more balance - E, for example, is still widely recommended.
I'll put in a new line, and this link on E now, [16]. I'm also removing the folate warning for the moment - the citation given doesn't have the required rigorous testing standards, and is contested on the same page. --Matt Lewis (talk) 13:57, 23 February 2008 (UTC)
The literature on diet effect on Alzheimer's, of course, is based on epidemiological studies which may or may not be accurate, depending on the number of included individuals. I believe it was the Framingham study on cardiovascular disease that set many of the standards of diet to prevent heart disease. Alzheimer's requires that level of study. So, to answer the question, the literature indicates it lengthens the onset of the disease, but it does not prevent it or even reduce the risk. But until a Framingham-type of study is completed, we're guessing. I cleaned up the section which when I started included a bunch of CAM-cruft. My guess is that it's genetic and unpreventable. Since humans evolved to live about 20-30 years, 60-70 year old afflictions weren't selected against. But that's speculation and my own original research.OrangeMarlin Talk• Contributions 16:59, 24 February 2008 (UTC)

[edit] Prevalence

I'm uncomfortable with the 24 million figure in the lead. It seems to be based on a single meta-analytic study that's not reviewed. When compared to the 4.5 million in the US figure, it suggests a global per capita prevalence that is lower by a factor of 4 than in the US. At the very least, this requires some discussion...LeadSongDog (talk) 14:47, 23 February 2008 (UTC)

I can't imagine it being that much less prevalent globally, than it is for the US, if at all. In some countries I thought it hardly occurs. Mind you, the US doesn't have a high Western life expectancy figure - yet we have to take the third world into account too. This kind of stat needs its own citation, certainly. Do you want to look into finding other data?--Matt Lewis (talk) 15:12, 23 February 2008 (UTC)
The best epidemiology editor on Wiki is Eubulides (talk · contribs); the sooner you bring him on board, the better. SandyGeorgia (Talk) 22:17, 23 February 2008 (UTC)
Requested.LeadSongDog (talk) 23:19, 23 February 2008 (UTC)

I'm not sure where the "4.5 million" came from; I couldn't find it in Alzheimer's disease. The cited source for the 24 million figure (Ferri et al. 2005) is of high quality; it estimated dementia prevalence in the population aged ≥60 years in 2001 to be 24.3 million worldwide, and also estimated 3.4 million in North America. This estimate is based on an estimated dementia prevalence at age ≥60 years of 6.4% in North America, 3.9% worldwide. This is a factor of 1.64, not a factor of 4. Does that help answer the question?


Eubulides (talk) 08:44, 24 February 2008 (UTC)

By the way, a more recent (but less-reliable) study estimated a worldwide prevalence of 26.6 million for Alzheimer's in 2006 (11.4–59.4 million range based on upper and lower 10th percentiles of the distribution of fitted incidence rates). Notice that this estimate is for Alzheimer's directly, not for dementia aged ≥60 years. Notice also the wide uncertainty in the estimate. Alzheimer's disease should note the uncertainty in figures like these. I fear that the current text in Alzheimer's disease#Epidemiology is a bit overconfident about the epidemiology, in this and other matters. Here's a citation for the more-recent study: Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM (2007). "Forecasting the global burden of Alzheimer’s disease". Alzheimers Dement 3 (3): 186–91. doi:10.1016/j.jalz.2007.04.381.  Also, here's a recent review on epidemiology of Alzheimer's that you might find helpful in improving the quality of Alzheimer's disease#Epidemiology: Qiu C, De Ronchi D, Fratiglioni L (2007). "The epidemiology of the dementias: an update". Curr Opin Psychiatry 20 (4): 380–5. PMID 17551353.  Eubulides (talk) 08:44, 24 February 2008 (UTC)

Sorry for the omission. The 4.5 million number for total AD in the US in 2000 came from Hebert L, Scherr P, Bienias J, Bennett D, Evans D (2003). "Alzheimer disease in the U.S. population: prevalence estimates using the 2000 census". Archives of Neurology 60 (8): 1119–1122. PMID 12925369. LeadSongDog (talk) 23:38, 24 February 2008 (UTC)

I am convinced that dietary supplements are helping my mother to cope better with her condition and retarding the disease. She has had Alzheimers for 6 years and lives alone with my help every day. She takes Aricept, Ginko, Vit E and C and B12, cod liver oil. I have just started to give her blueberries because research from Reading University claims to help the condition. She is still independant and doing very well. LK.213.122.17.77 (talk) 22:23, 7 June 2008 (UTC)

[edit] Eggcorn

To the article lead I added "(sometimes oldtimer disease, an eggcorn)" but Orangemarlin reverted it. Would you all care to find a place for this? I feel the information is helpful, and Oldtimer's disease etc redirect to Eggcorn. Maybe a disambiguation-style preface at the top of the article? --Una Smith (talk) 17:53, 24 February 2008 (UTC)

In 30 years of practicing medicine, studying neurology and cardiology, managing the development of pharmaceuticals and medical devices, studying Soviet Politburo health issues, and reading literally thousands of articles on cardiovascular and neurological diseases have I ever heard "old timer disease". OrangeMarlin Talk• Contributions 17:59, 24 February 2008 (UTC)
I've heard it, but does it belong in the lead? Do we mention in our article on uterine fibroids that they are sometimes referred to by the eggcorn "fireballs in the Eucharist"? I hope not. Incidentally, health issues of the Soviet Politburo would make a fascinating article - from cerebrovascular disease (Lenin and Stalin) to alcoholic hepatitis (Zhdanov) to... er... lead intoxication (Kamenev, Zinoviev, Bukharin, Krestinsky, Rykov, Tomsky, Rudzutak, Kirov, Yezhov, etc etc.) to the occasional mountain-climing accident (Trotsky), it would be an interesting article. MastCell Talk 22:00, 24 February 2008 (UTC)
Lead poisoning, mountain-climbing, LOL. Rumor is Erwin Rommel's docs certified him as dying of cerebral hemorrhage. For the record, I've heard of Old Timer's Disease more than once. But I was trained as a geriatrician and my patients told me every joke they'd ever heard on the subject ("AD Benefit: you get to meet new people every day..."). All this should go somewhere; I just don't know where. SBHarris 22:19, 24 February 2008 (UTC)
We said no to "old timers disease" a while back because it was not common usage. Yes, this does sound like lead poisoning. --Chrispounds (talk) 01:05, 25 February 2008 (UTC)
So, this is about as much consensus as I've ever seen. OrangeMarlin Talk• Contributions 01:18, 25 February 2008 (UTC)

[edit] Magnetic fields

This canard has been going around so long that people will grasp at anything they can find to support it. The methodology of this study needs a serious review. The high MF exposure groups (pilots, welders,...) each have large confounding factors not considered (frequent pressure changes, metal fume exposure, e.g.) My bet is that this one won't stand the test of time. LeadSongDog (talk) 22:57, 25 February 2008 (UTC)

Is it in the article? It sounds like woo. OrangeMarlin Talk• Contributions 17:46, 26 February 2008 (UTC)
"..like woo?" It's in Prevention, and cites PMID 1906833. LeadSongDog (talk) 18:16, 26 February 2008 (UTC)
Woo is the word describe fake science or medicine, such as Homeopathy. It's used a lot in Science blogs. Let me look at the cite. One cite does not overcome WP:WEIGHT. OrangeMarlin Talk• Contributions 20:18, 26 February 2008 (UTC)

Leaving in MF exposure but ruthlessly removing any mention of a triple blind study showing that antibiotic treatment delays AD progression, despite supporting evidence in animal models seems strangely selective, in determining the suitability of data inclusion. —Preceding unsigned comment added by 70.71.251.142 (talk) 00:41, 21 May 2008 (UTC)

[edit] Caregiving burden?

Why are we wiki-linking it to another part of the article? Is that proper? OrangeMarlin Talk• Contributions 15:47, 26 February 2008 (UTC)

Probably not. --Matt Lewis (talk) 15:53, 26 February 2008 (UTC)
How about I be bold and remove the wikilink. It doesn't make sense. OrangeMarlin Talk• Contributions 17:45, 26 February 2008 (UTC)
See Wikipedia:Section#Section_linking for discussion on the right way to self-reference.LeadSongDog (talk) 18:32, 26 February 2008 (UTC)
I'm not sure I agree with this edit. The Caregiver and dementia article seems to be a perfect link for this article. I'm certainly not passionate about one way or another. OrangeMarlin Talk• Contributions 19:25, 26 February 2008 (UTC)
The "Caregiving" section linked-to in this edit 'further links' to the Caregiving and dementia article from the top - but it gives more specific AD detail too. Best of both worlds?
One benefit to me of a good link is that helps stop 'half-details' occuring in the lead - sometimes it's better just to straight-link to the fuller picture. --Matt Lewis (talk) 19:34, 26 February 2008 (UTC)
I'm all right with it. Some linked articles require upgrading, such as Caregiving and dementia.OrangeMarlin Talk• Contributions 20:16, 26 February 2008 (UTC)
There is no need for links to page fragments, because the same links are in the TOC box. Snowman (talk) 23:54, 29 February 2008 (UTC)

[edit] Elder abuse

I think the page should have a wikilink to "Elder abuse". Snowman (talk) 22:28, 29 February 2008 (UTC)

Maybe under see also? OrangeMarlin Talk• Contributions 15:45, 1 March 2008 (UTC)

[edit] Keep accuracy when fiddling with prose!

A simple point I know, but when fiddling with the prose, please ask two questions:

  • 1) is it needed?
  • 2) am I retaining the originals accuracy?

There has been a long string of re-wording edits made to the Lead - most of which keep the meaning - but be careful not to lose it!!

Eg. with this re-write: "It usually begins many years before it is diagnosed, because in its early stages the clearest early symptom, short-term memory loss, may not be recognized to be important and thought to be due to advancing age"

- It is illogically constructed, and loses the original 2-sentence accuracy with the unnecessary "because".

The original line was simple: "It usually begins many years before it is eventually diagnosed. In its early stages, short-term memory loss is the *clearest symptom:"--Matt Lewis (talk) 14:16, 1 March 2008 (UTC)

This wasn't may edit, but there's some truth in it (it's not illogical that the disease goes misdiagnosed because an early symptom looks like benign forgetfulness of aging). But this implies that this is the major reason it's not diagnosed earlier, and I'm convinced that's not the case. Worse influences are 1) "covering" by spouses who gradually take over instrumental activities, 2) denial by everybody, and 3) the lessened demands of life after retirement and lessened expectations for seniors. My typical interviews went like this:

"What are your children's names, Mrs. Jones?"

"I don't know."

[Husband who has brought Mrs. Jones in] "Oh, Betty, you remember Jane, Ted and Roger!"

"Oh, yes, Jane, Ted and Roger."

At this point I have to remind Mr. Jones to let his wife answer her own questions, without prompts. Five minutes later Mrs. Jones still can't tell me the names of her three children. She's badly demented, but polite, social, and doing quite well at home so long as everything of a complex nature is done for her. SBHarris 16:23, 1 March 2008 (UTC)

Good points about delayed diagnosis - I would highlight that some people are more inclined to self-deceive as well (as you say, denial by everybody). "Some truth" sums up my point really. When you really look at the sentence above you can make a sense out of it - but when I say "logical", I specifically mean unambiguous. It's particularly easy with AD I think, to forget with how little is certain about it too. --Matt Lewis (talk) 17:10, 1 March 2008 (UTC)
I agree. I keep coming back to the article, and I notice some odd prose thrown in. I don't want to toss around accusations, but some of the writing is unencylopedic at times. Let's be careful. OrangeMarlin Talk• Contributions 15:41, 1 March 2008 (UTC)
SandyGeorgia suggested the following: See Tony1 (talk · contribs)'s userpage for redundancy-reducing exercises. It's very useful in cleaning up the prose for an FA article. The admins that promote articles won't do so until Tony1 and SG do their work, or we do it for them. I got one article to FA by spending hours removing redundancies, and I'll admit that the article reads well. I've been removing some of the redundancies (usually, mostly, sometimes, etc.), but some editors keep using it. Let's stop. OrangeMarlin Talk• Contributions 15:44, 1 March 2008 (UTC)
I removed the "eventually" in the original line above - short line though it was, even that was superfluous to meaning. --Matt Lewis (talk) 17:10, 1 March 2008 (UTC)

[edit] Social Costs

The first parag in Social costs is from a subscription page, so I can't personally look at re-writing it. I find it a bit convoluted - can someone look at it?

"Because the median age of the industrialized world's population is increasing gradually, Alzheimer's is a major public health challenge. Much of the concern about the solvency of governmental social safety nets is founded on estimates of the costs of caring for baby boomers, assuming that they develop Alzheimer's in the same proportions as earlier generations. For this reason, money spent informing the public of available effective prevention methods may yield disproportionate benefits.[134]"

I've a couple of things to put in, but we need a better start I think. --Matt Lewis (talk) 01:53, 3 March 2008 (UTC)

[edit] Questionable source

Could someone take a look at this and see if any of the content is helpful. The site is itself off the mainstream (life extensionist) and so might not meet WP:RS, but it identifies RS references for statements made. They would of course need to be verified individually to a)check they are genuine and b) confirm the say what he asserts. LeadSongDog (talk) 17:07, 5 March 2008 (UTC)

A few interesting hits there are:

[edit] Classification

The classification section was created as a way of reducing the load of techinichal terms in the lead. However the lead has been greatly improved and includes all important information with a good equilibrium between technical and common terms. At this point the classification section is just "the poor sister of the lead" having less information, less citations and globally less quality than the lead, and not adding any extra information. Is it needeed right now? I clearly believe its not. Its elimination will supposse any problem and will be an improvement.--Garrondo (talk) 08:41, 6 March 2008 (UTC)

If word like "Aβ" and "ApoE" are happy lower down - I'm fairly OK with losing it. Classification is suggested in WP:MEDMOS, but it's only a guideline, of course - and it could always come back if needed. My worry is that those technical words might suddenly pop up in the lead! the Classification section could be useful simply to keep good-faith editors from looking to improve the Lead with those handful of ubiquitous technical terms - and in doing so compromising its readability.
Personally, I always think the term "progressive" should be in Classification and not the Lead -it means nothing to many people (simple though it sounds) and is fully covered in the lines on symptoms. We begin the article with a word that people don't really know, as many are obliged to wikilink away from the page before they read it! Maybe Classification just needs a re-write?--Matt Lewis (talk) 13:00, 6 March 2008 (UTC)
I believe that almost anybody understands progressive, and its not a medical term... I believe that if there is a good lead as we have now there is no sense in rewritting classification and the better it gets the more difficult would be to "pop up" technical words in the lead. One thing I have seen in wikipedia is that quality brings quality (and this article is a good example)... don´t worry about going back... :-) (and anyway we will be here to help...) Apart from all classification section should classify it... its not a summary of the article, and this classification has never done that. I'm going to eliminate it and see what happens. --Garrondo (talk) 08:36, 8 March 2008 (UTC)
I assume "Progressive illness" actually is a medical term? (if not it's definitely not the best word!). Alzheimer's is indiscriminate over education and country, remember. The USA is more fond of technical words that anywhere else in the world. You also have to pay for your own healthcare individually - so it is more of a personal concern, and it's a cultural thing too (using technical words that is). In the UK we have our healthcare paid for by the state. I would say possibly less than 50% of us here will provide you with an accurate definition of a "progressive illness"! "Progressive" is just not a household word here - and is a touch too abstract to be an obvious extension of "progress". Many (most) people asked will either define it as "continual", or need to think about it first. I know the UK pretty well! We let our GP's do everything. --Matt Lewis (talk) 16:17, 8 March 2008 (UTC)
Would "Degenerative disease" be more acceptable?LeadSongDog (talk) 16:34, 8 March 2008 (UTC)
It probably would be less ambiguous in the UK - but both these almost-identical aspects of AD (progessive and degenerative) are clearly described by the symptoms - so neither is actually needed in the opening line. The word "progressive" was repeated in Classification for sure - but rather than remove the Classification section, perhaps this word (and any others like it) should be there instead? --Matt Lewis (talk) 10:16, 10 March 2008 (UTC)
I don't really see much difference between both terms, but my mother language is spanish... so I'm not the most indicated to give an opinion. --Garrondo (talk) 17:28, 8 March 2008 (UTC)
I think this article having some level of technical terminology is fine. I dislike assuming the lowest common denominator for the readership. The lead should be easy to read, but the details need to be clear. The CAM woo that one finds on Wikipedia utilizes weak language and "friendly" terms to get convince people that diluting a compound retains a water memory. And Matt, you have a rather harsh assessment of the US and UK health care systems. OrangeMarlin Talk• Contributions 17:46, 8 March 2008 (UTC)
Sure, but we are talking about the Lead - we have the rest of the article for the technical terminology. I don't think you need worry about homeopathy etc appearing in here. We just need to follow medmos. We are moving away from General Practitioner authority in Wales (ie the local GP-run surgeries) - and most of us are looking forward to it, as it would mean a more controlled and specialised service in larger, better surgeries. Not sure how I was harsh on the US!? Unless it wasn't a fair judgement to say it isn't social care! People have to have more knowledge in the US - healthcare is a huge personal part of their lives. People in the UK have traditionally put themselves often unquestioningly in the trust of the NHS and their local GPs - but the service getting worse in many respects (GPs now earn about the equivalent to over 200,000 dollars a year, and are doing less work - and we can't guarantee how broad or uniform their knowledge is - and the NHS has some long waiting lists, which is simply due to its financing and structure as we all happily put a fortune into it). Finally we are looking at GP-level, which can only help the broader picture. I'm not knocking the NHS - it just started to get sectioned-off and over-consulted in the 80's and 90's, and the service has in many ways declined ever since - that's not a controversial statement over here. As for the US, that's up to the US people! --Matt Lewis (talk) 19:27, 8 March 2008 (UTC)
Just for curiosity. What do you mean with CAM woo? I didn´t understand you. --Garrondo (talk) 17:58, 8 March 2008 (UTC)
Yes, what's CAM woo? I got a digicam company on Google!--Matt Lewis (talk) 19:27, 8 March 2008 (UTC)
Funny, I asked the same Q recently. The dab page for CAM lists Complementary and alternative medicine.
Look up woo woo in
Wiktionary, the free dictionary.

Put'em together. LeadSongDog (talk) 03:02, 9 March 2008 (UTC)

CAM is Complementary and alternative medicine. Woo is "non-science or anti-science". Some might define woo as bovine feces.  :) OrangeMarlin Talk• Contributions 16:11, 11 March 2008 (UTC)
I shared my worries with a mental health nurse (in a managerial role) whether "progressive" could easily be understood as "continual", and she agreed - many, if not most, people in the UK won't immediately assume the intended "changing-state" meaning. --Matt Lewis (talk) 10:16, 10 March 2008 (UTC)
I've changed to "Degenerative disease" as suggested by LeadSongDog above. Its article actually refers to the AD page - and seems to fit in well, or better at least. I also replaced "debilitating" with it towards the end of the Lead (as I was searching for something more like "degenerative" at the time).

[edit] AB image

The (German) article has an interesting graphic. Anyone care to offer an opinion on whether it could be helpful if translated?LeadSongDog (talk) 20:19, 11 March 2008 (UTC)

[edit] Images

Last months there has been a clear improvement in the texts of the article, however no new images had been added. I have added seven images trying to create a more friendly-viewing article. I hope everybody likes them... :-) --Garrondo (talk) 18:04, 15 March 2008 (UTC)

Nice. There's also an image of the tangles that we may want in the US Surgeon General's report, presumably PD-USGov:

Satcher David et al. (1999). Alzheimer’s Disease Mental Health: A report of the Surgeon General. LeadSongDog (talk) 14:03, 19 March 2008 (UTC)

[edit] A review

Looking at this version. Be aware that I can't read any of the paid-for journals. I've looked (for now) at just one section (and its counterpart in the lead).

[edit] Epidemiology

This is User:Eubulides expert topic and I recommend asking his opinion prior to FAC.

  • The lead say "24 million people worldwide" are afflicted by AD. The source for this is given two sentences later. While those two sentences may well come from that epidemiological source (they aren't in the abstract) it would be best if they were sourced to a general review rather than a comment in a paper whose main purpose is elsewhere. Anyway... the abstract gives an estimate of 24.3 million and 4.6 million new cases "of dementia". Now, you've just said AD is "the most common cause of dementia", meaning it isn't synonymous with it. The epidemiology section later tells us it is associated with "almost half of all patients with dementia". So what is that paper telling us? The total figure for all dementias or do they mean AD and aren't being precise with their language? In addition, this fact isn't repeated in the body text--a clue is that the source is only used in the lead.

Body:

  • "affects almost half of all patients with dementia" doesn't come from (Gorelick, 2004).
  • "Correspondingly, " redundant word.
  • "Among people aged 65, 2–3% show signs of the disease". But (Gorelick, 2004) says "It is estimated that the prevalence is around 1.5% at age 65 years".
  • "while 25–50% of people aged 85 have symptoms of Alzheimer's and an even greater number have some of the pathological hallmarks of the disease without the characteristic symptoms" doesn't come from (Gorelick, 2004).
  • "Every five years after the age of 65, the probability of having the disease doubles". But (Gorelick, 2004) says "doubles every 4 years to reach about 30% at age 80 years" which is not only a different rate but indicates a peak.
  • "The share of Alzheimer's patients over the age of 85 is the fastest growing segment of the Alzheimer's disease population in the US" is not supported by (Hebert, 2003). That five-year-old paper uses a single study to estimate prevalence of AD in the US through to 2050. The paper speculates that the 85+ group will quadruple by 2050 compared to the 75-84 group merely doubling. However, the chart doesn't show any growth in that group till after 2020. So to say it "is the fastest growing segment" isn't supportable. Better to find a secondary (review) source to comment on this aspect rather than a primary source.
  • "A study in Denmark found that women aged 65 are at significantly higher risk (22 percent) of developing AD by age 95 than their male counterparts (9 percent), while vascular dementias were nearly equal." This is the first and only time vascular dementias are mentioned in this article. It would be useful to indicate earlier that vascular (multi-infarct) dementia is the second most common form of dementia and clarify it is not the same as AD. Although this 1999 study pools four previous studies, it is still original research rather than a review paper. The phrase "A study in Denmark" shouldn't really appear outside of a history section. Either women are at increased risk or they aren't. Find a high quality review, cite that, and state the facts not the history.
    • I've revised my opinion on that article and think it is significant enough to cite directly rather than insist on a secondary source. However, if the abstract's concluding sentence is fair, then you can just say "Compared with men, women have an increased risk for AD." without quoting the study by name/location. Colin°Talk 12:48, 3 June 2008 (UTC)
  • "Some studies have shown a relationship between Alzheimer's Disease and magnetic field exposure, although the mechanism is unknown. Other research does not confirm this link." Selecting (potentially, cherry-picking) primary research studies that support or contradict a controversial "fact" should not be done by WP editors. Find a review that discusses this link and use it to help gauge the weight you should give to each side. If the studies are seminal then link to them as an aid to the inquisitive reader but don't use them to support the statement. One way to do this is to cite the study after the words "some studies" or "other research" but cite the review after the "fact" you wish to state.
  • "The role of metals in the disease is also controversial." This is too vague to be helpful. One assumes the "role" is a negative one but it isn't made clear (e.g., perhaps some metal supplement is supposed to prevent AD). Aluminium is the most commonly suspected metal so should be highlighted. The citation lists three sources. Of these, (Rondeau, 2000) is primary research and probably should be dropped in favour of a more recent review. (Shcherbatykh, 2007) looks good from the abstract but I've no way to judge. I think you need to expand this sentence indicating the lack of causal evidence but noting "elevated levels of these metals in the brain may be linked to the development or progression of AD". (Santibáñez, 2007) also looks interesting from the abstract and covers several risks such as solvents, EMP, pesticides, lead and aluminium. However, its focus is to examine the quality of the research rather than to come to any conclusion. Its value as a source for this article is less certain -- but I haven't read the full text.

Looking at just this one section doesn't fill me with hope that this article is close to FA. There's too much text that deviates from the cited sources. For such a common disease, I'd expect the epidemiology section to be more comprehensive than this. I'd like to know whether the disease affects all ethnic groups equally and all countries equally (e.g, rich vs poor). The gender difference isn't adequately covered. Has the epidemiology of Alzheimer's changed over the years, and if so, is that purely down to age-population changes in society.

The editors of this article (who presumably have better access to the sources than me) need to review every sentence to ensure it is supported by the sources. Do this section by section and finish with the lead (making sure it is based on the body text). Once this is done, the ongoing challenge that all committed WP editors face is to ensure all additions/changes are policed to make sure they still match the sources. Well meaning and expert editors can ruin a potential FA by adding text sourced to their own brains. Alzheimer's is, unfortunately, a topic where everyone thinks they know something whether that is off the news or out of this week's BMJ/NEJM. However, the big advantage such an important topic has is that you should have no problem finding high quality review articles in respected journals. Use them as the foundation of your article, rather than citing primary research. The good news is that once you do reach the quality and comprehensiveness of an FA, people do show some respect and the rubbish edits are easier to handle.

Please check each cited paper to see if a free online version is available. PubMed's link can help but isn't 100% reliable at spotting (or linking to) the free papers. If you Google for the "Paper title", then this can often locate PDF/HTML copies at the publisher's site. Being able to located and read the free full paper makes it much easier for folk like me to look up the facts.

This is a very important disease topic. I urge you to continue working towards FAC. Colin°Talk 00:02, 17 March 2008 (UTC)

I agree that right now the two lowest quality sections are epidemiology and causes, which have to be completely reviewed. I suppose I will get to them at some time, but it won´t be soon... so if anybody wants to rewritte any of these sections it will be very welcomed. --Garrondo (talk) 08:01, 17 March 2008 (UTC)
I am at an Alzheimer's conference and the question came up of what source of prevalence is best. The delphi consensus in the Lancet 2006 is the one that folks were speaking up for. --Chrispounds (talk) 01:37, 28 March 2008 (UTC)
That one is "Global prevalence of dementia: a Delphi consensus study" . PMID 16360788.  but see also "The epidemiology of the dementias: an update" . PMID 17551353.  and "An estimate of the worldwide prevalence and direct costs of dementia in 2003" . PMID 16401889. LeadSongDog (talk) 03:58, 28 March 2008 (UTC)
The "affects almost half of all patients with dimentia" that Colin takes issue with appears in page 2 of Ren Yimin (2008-10-27). "Consequences of the interaction of Amyloid Beta with Amyloid Binding Alcohol Dehydrogenase and the Receptor for Advanced Glycation End products".  which refs Jones JA, Lavallee N, Alman J, Sinclair C, Garcia RI. "Caries incidence in patients with dementia". 76–82 (questionable) and Brookmeyer 2007. Further on worldwide prevalence to 2050 is in: Brookmeyer R et al. "Forecasting the global burden of Alzheimer's disease".  lay summary in Peck Peggy (2007-06-11). "AAICPD: More than 100 Million Alzheimer's Patients Predicted Worldwide by 2050". Psychiatric Times.  It doesn't appear though that we have a clear WP:RS for the statement as it reads at present. LeadSongDog (talk) 15:46, 3 June 2008 (UTC)
This website puts Alzheimer's at 50–60% of all dementia, vascular dementia at 20% and Dementia with Lewy bodies at 20%, with the other causes rare. I don't know much about the subject, but I guess much of what the Alzheimer charities concern themselves with is common to all causes of dementia and it suits them to just quote the bigger "all dementia" figure. Maybe there is no accurate figure for global Alzheimer's and you need to rephrase the lead to just give the figure for dementia, along with the approximate proportion due to Alzheimer's. I don't see where Brookmeyer gets his 2006 data from; looks rather speculative to me. Colin°Talk 19:43, 3 June 2008 (UTC)

[edit] Herpes and Alzheimer's

Hey, I found some really interesting information about a link between Herpes Type 1 and Alzheimer's. I already put it in the herpes page. I thought I'd ask here first how it could be put in here before actually putting it in because I'm afraid of screwing up such a good article. Anyway, here's what I wrote on the herpes page:

Alzheimer's disease

Scientists have discovered a link between Herpes Simplex Type I and Alzheimer’s Disease. In the presence of a certain gene variation (APOE-epsilon4 allele carriers), HSV type 1 appears to be particularly damaging to the nervous system and increases one’s risk of developing Alzheimer’s disease. The virus interacts with lipoproteins, their components, and their receptors in the brain which may lead to the development of the disease.[41] This now makes the virus the pathogen most clearly linked to the establishment of Alzheimer’s.[42] It is important to note, however, that without the presence of the gene allele, HSV type 1 does not appear to cause any neurological damage and thus increase the risk of Alzheimer’s.[43]

I was thinking about using at least part of this (altered if needed) in the CAUSES section. What do you think? --Saritamackita (talk) 01:50, 17 March 2008 (UTC)

Search for pubmed.com to see how many articles the topic has. Observe not only the number but also the credibility (are there reviews on the topic?, what do they say?, all articles agree in the conclussions or there are more disagraing that agreeing?). If after that you are convinced on the importance be bold and edit the article. You should probably reduce it to a setence wich makes clear the importance it has; no more no less. An example would be something like "Some articles have found a relation between HSV and AD, althoug this findings are disputed.(REf).--Garrondo (talk) 13:30, 17 March 2008 (UTC)

Sounds good. I've seen a lot of articles about it. Doesn't seem to be disputed too much. I think I'll put in the sentence.

Saritamackita (talk) 17:25, 17 March 2008 (UTC)

I've done a quick search through articles regarding this link. It appears the link between Herpes simplex and AD genes is being uncovered, but it's not conclusive yet. I would reword any addition to this article to state "may play a role." OrangeMarlin Talk• Contributions 18:48, 17 March 2008 (UTC)
I don't know. What I saw seemed pretty conclusive. Are you sure it's not just scientists putting "and more research is needed..." because that's kind of a scientific tradition around.Saritamackita (talk) 21:57, 19 March 2008 (UTC)

[edit] Clinical Trials - Table?

I have the idea to do a Table showing the various ongoing clinical trials in a possible DMD (not symptomatic-only) for AD - it would basically give the drug candidate name, the class/type (eg gamma secretase modulator, anti-amyloid-beta vaccine, antibody, etc), and a few other details (cite earlier results if published, perhaps the trial size, official start date, intended completion date). I think this will be a big focus in the next few years, and perhaps one will even work. BUT - has this been done already somewhere else? Is it in any of the citations that people here know of ? No use re-inventing the wheel if it exists already....thanks....io-io (talk) 22:59, 17 March 2008 (UTC)

Here's my concern with clinical trial tables--they give the impression that they both work and will be available soon. For example a Phase I drug may not be available for 5-10 years at best. A Phase III drug may fail. And labeling isn't available. I think that in a paragraph, a brief mention of the drugs in trial can be mentioned with appropriate citations. But this is MY opinion only. I just don't think Wikipedia articles should be advertisements for the drug companies. OrangeMarlin Talk• Contributions 23:49, 17 March 2008 (UTC)
How could such clinical trial lists on Wiki be advertisements for the drug companies if the drugs are not available, nor indeed, the trials are not even completed yet ? ...io-io (talk) 23:53, 17 March 2008 (UTC)
Because this article is #1 on Google, and people will read it, and push to get the drug. Again, it's my opinion, but I don't like discussing future drugs, except in context of research. I would suggest we take a look at all other medical articles and see how other articles handle it. Certainly, don't do what I think, I'm just giving you my opinion. OrangeMarlin Talk• Contributions 23:57, 17 March 2008 (UTC)
The clinical trials are designed not by demand, but by design (statistical basis)...the process is first clinical trials, and only if they succeed, apply and (hope to) get approval from FDA or EMEA for approval...until all that is done, no-one but the human guinea-pigs can get the drug. As for future drugs, they specifically target such things that are discussed in the disease pathology, such as A-beta, Tau, etc - that is what fascinates me, have they truly found the answer (or did the little white mice fool them)...io-io (talk) 00:08, 18 March 2008 (UTC)
There is simply no way that WP can do a good job of covering every trial. See Clinical Trials database to see how many are going on. There are 397 for AD alone, 144 of which are interventions at phase III or IV. What might be feasible is a tailored search query against clinicaltrials for inclusion in the article, such as: AD intervention trials at phase III or IV or similar.LeadSongDog (talk) 13:02, 18 March 2008 (UTC)
Most of these are for preventative or symptomatic-only trials - the number of advanced DMD (disease-modyfing) trials for AD is relatively small the Wiki page says just 2, but when I looked over weekend, I found 6 or 7 - of course there are more, but not a lot - its not easy for the drug candidates to advance as DMDs if they dont succeed with in their initial trials.......io-io (talk) 13:51, 18 March 2008 (UTC)
Part of the reason for limiting the discussion regarding drugs in clinical trials here is that so many of them have not successfully completed their trials. In the last 18 months, more than 4000 patients were in (at least 4) Phase 3 trials for AD that did not reach statistical significance in their primary endpoint. Garrondo created a page for Therapies_under_investigation_for_multiple_sclerosis and this might be one way to aggregate the information you want. A summary of late-stage trials from a new broader page would be appropriate for this article. DMD status for any compound in this area is going to be controversial since there are well-informed clinicians who say current therapies change the course of the disease. I think there are only two clinical programs for investigational new drugs seeking an indication for cognitive effects in Alzheimer's patients with active patients in Phase 3. A couple of others may add to this list soon. Medivation's Dimebon has announced Phase 3 but I have seen any indication they have patients enrolled yet. Lilly's LY450139 gamma secretase inhibitor may have enrolled patients and should be added to the section soon. --Chrispounds (talk) 19:31, 18 March 2008 (UTC)
Specifically I was intending to list drugs in clinical trials here that have not completed their trials at all. I am surprised you say that this is relevant: "there are well-informed clinicians who say current therapies change the course of the disease" - because if it were really true, I would think that, especially as these are known safe drugs (half the battle today), the drug companies would rush out to do trials to prove this, and announce it to the world (and make multi-billions, and a place in history). I was not thinking of a whole new section, as the pathology will have to be repeated in discussing the targets, and also it is hard to avoid speculation on what might work or not. Instead was thinking of a table with citations, I think that would be very easy-to-read, nuetral, and very effective in showing what we might hope (although not "expect") to see....io-io (talk) 20:11, 18 March 2008 (UTC)
I'd like to answer this from two different directions: the first as an encyclopedia and second from an ethical standpoint. As an encyclopedia, clinical trials will grow stale in just a few months. Editors come and go, and all of a sudden, no one is paying attention to the clinical studies section. As an example, AIDS is an FA, yet several of us had to spend a few days cleaning up sneaky vandalism, old information, bad information, and bad copyediting. As an encyclopedia, it is important to put the most current information, but it has to be notable and have some value over time. I don't recall the exact statistics, but the percentage of drugs that get launched from phase 3 trials is not 100%. And it could be years from now. From an ethical standpoint, someone might have a friend or relative that is afflicted by Alzheimer's and they read this article, thinking there is a "cure." I just don't think that's the right way to go. I would suggest that as we build this article, we'll come to a consensus, but three editors here are concerned about putting a chart of drugs in the article. I also haven't found any other article that does the same. OrangeMarlin Talk• Contributions 20:34, 18 March 2008 (UTC)
Well it already describes on the page that there are clincial trials ongoing. And is the word "trial" not a bit obvious in it's meaning? As for other articles, my point was that there is no treatment at all for this, the biggest/fastest-growing disease, and right now is when the pace of trials has accelerated to target the pathologies (amyloid-beta cascade, tau) already described on the page...Alz has been around for millenia, but only right now has the clinical work reached this moment.io-io (talk) 22:28, 18 March 2008 (UTC)
Based on previous WP:MED discussions, anything less than a large phase III trial isn't notable (unless it is notable--like major press coverage). We're not a crystal ball, nor a database. In the main AD article, I wouldn't really expect to see (or find room for) anything other than current treatments and broad brush strokes of what is on the horizon. Ask the Project if you want more opinions. Colin°Talk 21:27, 18 March 2008 (UTC)
Yes, I agree, these would have to be Phase III. But even so, I believe there are approx 6 - 8 of them. Well perhaps sooner or later, there will be a Therapies-under-Investigation page. Maybe I will do the table here, and it can be transported later.....io-io (talk) 22:28, 18 March 2008 (UTC)
You can create that page (Therapies under investigation for Alzheimer), as I did in MS (somebody has to do it). I agree with everybody else that a table won´t be approppiate for this article. I believe that it would be a too speccific information for a general article on AD and secondly is the fact of clinical trials continue evolving, so its very hard to maintain them uptodate. I believe that its preferred to simply name some prominent investigation trends in the main page (as in multiple sclerosis or treatment of multiple sclerosis being both featured articles, and leave such specific information for a subarticle. On the other hand right now there are other sections alredy written which requiere a lot of work if this article wants to become any time a FA, such as the epidemiology or causes subsections, so your help could be very welcomed in this other areas. Regards. --Garrondo (talk) 09:28, 19 March 2008 (UTC)
OK, thanks, a new trick I will have to learn, along with the others (apparently am technically a terrible editor, to judge from feedback) - but I will probably start the table on this talk page, where at least it will get some collaborative input before arriving on a Wiki page...in time I will start the Therapies-under-Investigation page too, or perhaps a Late-Stage Clinical Trials for AD page....also I can look at the causes section here, I may be able to contribute, probably only if there are obvious holes....io-io (talk) 13:31, 19 March 2008 (UTC)

[edit] draft table (for an "investigational therapies" page)

Table - Late-Stage Clinical Trials in Disease-Modyfing Candidates for Alzheimer's Disease
Target/Approach Notes (Theoretical) Candidate Name Trial Phase Trial Start Date Expected End Date Planned Enrollment AD population targeted (severity) AD population targeted (genetic) Comments
Selective A-Beta-42 lowering Agent Converts A-Beta-42 to less Toxic analogues MPC-7869[5]. Phase III Feb 2005 May 2008 1,600 Mild n/a 800-patient Trial also underway worldwide[6].
Gamma Secretase Inhibitor Inhibits Gamma Secretase, believed crucial to pathology LY451039[7] Phase III March 2008 March 2012 1,500 Mild-to-Moderate n/a Earlier 45-patient Trial completed early 2007, results not released[8].
Antibody to Amyloid-Beta Mimics Natural Antibody triggered by AN-1792 aab-001[9] Phase III Dec 2007 Dec 2010 800 Mild-to-Moderate Apolipoprotein E4 Carriers only Identical Trial also underway in Europe
Antibody to Amyloid-Beta Mimics Natural Antibody triggered by AN-1792 aab-001[10]. Phase III Dec 2007 Dec 2010 1,250 Mild-to-Moderate Apolipoprotein E4 Non-Carriers only Identical Trial also underway in Europe
Metal-Protein Interaction Attenuation Primary Target is Copper PBT2[11]. Phase II (completed) Dec 2006 Dec 2007 80 early Alzheimer's disease n/a Deemed a Success; Phase III to start
Fibrilization of Amyloid-Beta Prevents/Reverses Fibrilization of A-Beta AZD-103[12]. Phase II Dec 2007 May 2010 340 Mild-to-Moderate n/a Phase I was success
Neuroprotection Neuroprotective Peptide, intra-nasal AL-108[13]. Phase II (completed) Jan 2007 Jan 2008 120 Mild Cognitive Impairment n/a Deemed a Success; Phase III to start
Vaccine to Amyloid-Beta Injects modified A-Beta (active vaccine) acc-001[14]. Phase II Nov 2007 Mar 2012 228 Mild Cognitive Impairment n/a Sequel to famous AN-1792 Vaccine Trial
Notes
  • limited to DMD candidates, late-stage
  • a few more to be added?
  • comment welcome

[edit] article traffic statistics

I've found this - it's a beta, and not I'm sure how accurate it is. It gives the page hits for the last 90 days.

As full months, Jan shows 68,666, and Feb shows 79,990. Jan being 'slow' perhaps(?), and Feb being a 28 day month - I would guess this gets about 100,000 a month as a yearly average, possibly more - it will be interesting to see what transpires! (we are around 45,000 in March so far) --Matt Lewis (talk) 14:01, 18 March 2008 (UTC)

Yes, that's an interesting tool. Makes you realise how important WP is. This article has >10x more readers than the stuff I normally write about. Mind you, if you're after readership then Simpsons articles and lists of sex positions make this look positively ignored. Colin°Talk 22:55, 18 March 2008 (UTC)
It would be interesting to see how many of these are first-time hits. My guess is that many people are coming back to the article at various times, as they are connected to AD in some way. I did originally think this article would have been read by many many millions - it doesn't quite look like that's the case now - a few million unique visitors perhaps. The search "Alzheimer's disease" is no.1 in Google, and no.13 in Yahoo - I wonder if Wikipedia's bad rep is putting people off - or if it's getting the 'lion's share' of Google's AD searches? I'll see if I can find the Google stats for "Alzheimer's disease". It's not easy to spell either - people might be getting to non-WP websites that way! --Matt Lewis (talk) 23:20, 18 March 2008 (UTC)
I have no proof, so please don't shoot me. But I actually believe for medical articles, as they get better and more informative, more people read them. They get linked to emails to friends and family, blogs, etc. This article is getting better everyday. Also, I don't think Google's ranking is just for visitors, it includes how many links there are, etc. I forget where the description is located, but it's a complex formula. I wanted some information a few weeks ago, and I googled AD. There were a few good articles, but none really informative (and the number that said you can be cured by eating ginkgo and olive oil were amazing). I can't remember where this article was located, but it was down in the 20's, I believe. I couldn't believe that, so when I came here, I did a few things to up the ranking (like wikilinking where appropriate), cleaning up the references with PMID and DOI numbers (which are links). Readership has gone up as we get more and more links. And now that it's #1 on Google, we can expect people to come to read the article. One of my "beliefs" about Wikipedia medical articles is that unlike articles about The Simpsons or Sex positions, people could be helped or hurt by what we write here. That's why I fight the CAM nutjobs so much, because they write articles as if it is true. We write this article, for example, as if it were verified by a lot of strong research. Those of us dedicated to fixing these articles have a responsibility to give the best possible information to someone who comes hear to read about Alzheimer's disease. Honestly, without sounding arrogant or condescending, the medical articles that get the really good editors (such as this one) and follow WP:MEDMOS are some of the best review articles out there. I almost wish Wikipedia split off it's medical articles (without the CAM promoters), because it can really raise the reputation of Wikipedia. A big group of very devoted editors keep these articles clean. But I bet there are only 10-20 medical articles that are really well written. I keep running across articles that either have COI problems (one article was being attacked by one company's promoters) or CAM woo all through them. This article is moving up to one of the better ones. OrangeMarlin Talk• Contributions 17:08, 19 March 2008 (UTC)
I agree that more people come back as articles improve - that might account for the lower than expected hits for this article (for me at least) - ie it hasn't yet built a readership, or reputation to pass on. Unfortunately we can't see the stats going back for longer. There are some very poor and excellent pages out there (we’ve been both imo over different times!), but we can become potentially the best AD ‘page’ bar none, because of the nature of the Wikipedia (all theoretical until achieved though!).
RE Google position,
I think the AD article has been no.1 on Google for a while - the reason I edit Wikipedia (which I originally thought was an insane idea – and still do sometimes!) is because I realised it was no.1 for so many searches I was making. A lot of people are still 'snooty' and ignore it - they foolish to do so though, imo. The reason for the amount of no.1 positions is in Google's page ranking system - which has a complicated algorithm, as you say. The principal factor is not 'page hits', but actually 'Link Popularity' - which means how many sites link to the page. Crucially, Google also looks at the 'link popularity' of the "homepage" or higher-domain: with "Wikipedia" the results are awesome. I doubt that anyone, including Amazon, has a better score. There is another, better, Wiki site called "Citizendium" (which vets articles, and was set up by Jimbo Wales' original partner) - but it just can't get anywhere near Wikipedia's page ranking, and is stuck in a cycle of not been seen, and so not being edited. Because of Wikipedia's massive Link Pop, all of its pages get a high ranking on Google. Yahoo has a different - and probably fairer - formula. The reason Wikipedia has so much high-ranking porn, advertising sites and general junk - is partly due to its preference for link popularity, and those sites notoriously link to each other.
RE Ginkgo etc,
Most sites I see admit AD is incurable, but then ‘sell’ you the plethora of readily available supplements for profit: the exaggeration (and sometimes pure deceit) that we see is simply advertising hype. Ginkgo Biloba always struck me principally as another blood regulator (to whatever effect) - which may give secondary help in that way. I personally suspect a number of "supplements" could help some AD sufferers from possible wider angles - it's all up to the buyers imo. The important thing is that they know the score, and ideally they see the available evidence, so they are not sold 'snake oil'! I actually recommend a number of things, with the usual caveats - ironically (given its constant recommendations) I'm not big on Ginkgo, as the evidence doesn't strike me as all that great apart from blood regulation. Over both Ginkgo and olive oil (?- do you mean the ‘Mediterranean diet’?) I might suggest garlic - as a blood regulator that we know is good for you too (advising to be careful with blood-thinning medications, see the GP etc). In my experience people want other options (I'm always asked) - it's just human nature in the face of a cruel impending death. The lack of options GP’s and other health practitioners have for AD have a lot to do with it too (which is why many do suggest E, etc). And scandalously, we don't get Galanthamine in the UK unless someone decides we have progressed enough to warrant the expense. Many GP’s often just look blank when asked about things like Gingko too, which is increasingly more dangerous imo (specifically in the sense of GPs and patients staying 'in touch'). --Matt Lewis (talk) 19:07, 19 March 2008 (UTC)

[edit] Stages of Alzheimer's

When I read this section, it seemed to me that it was missing the approximate lengths of time that each stage lasts (1 year? 4 years? 5 years? etc). I think that kind of information would be very helpful to a lot of people. Saritamackita (talk) 18:20, 20 March 2008 (UTC)

A quick comment is that it is not easy, because it is hard to define the lines between the stages; even the tests are being continually questioned, and new ones proposed (typically composites of cognitive and functional performances). But I agree with your intent, perhaps there is a great paper somewhere.....io_editor (talk) 21:11, 22 March 2008 (UTC)
The problem is that what you seek does not exist. You wouldn't get an "answer," except with very wide time limits, because the rate of AD disease-progression varies quite a lot from person to person. Going from mild IADL dysfunction to not knowing your kids or wife, can happen in 2 years or 10. SBHarris 02:43, 23 March 2008 (UTC)
ok. I guess that makes sense. If good research is found on it, though, it should definitely be put in. Saritamackita (talk) 08:45, 26 March 2008 (UTC)

[edit] Summary of therapies under investigation and creation of subpage

This section was growing continously with no order or criteria. I have summarised the section trying to name different investigation approaches but not being exhaustive and I have moved all info, and de table created by io io to a new article centered on investigation. I believe in that it will help to mantain stable the main article while increasing all the info in the secondary article. --Garrondo (talk) 11:29, 23 March 2008 (UTC)

Would propose that the new article be limited to investigation in halting disease (far more interesting/focussed) - that was my intention in doing the table?...io_editor (talk) 17:15, 23 March 2008 (UTC)
Deleting so much information from the section made it difficult to understand. For example, I had to revert a big section deleted, because the whole explanation of why vaccinations might work with AD was deleted. I think for massive changes, should post them here. Moreover, I'm going to take the time to review why certain drugs are being highlighted in the section. I know drug trials well enough to know that being in Phase III doesn't mean anything. Approval is still years away. OrangeMarlin Talk•

Contributions 17:17, 23 March 2008 (UTC)

The section must either be very large, or just small. I think the way that Garrondo had it was closer to what is appropriate, as it is indeed disordered; especially as the area is A) broad B) incomplete and C) not yet proven. Much of the stuff about statins and enbrel should not be there at all, as it is extremely speculative, and even obsolete at that. Also, there is already a "Disease mechanism" sub-section describing the A-Beta cascade theory. Perhaps a line could be added to what Garrondo wrote, stating that following earlier AN-1792 work, vaccine that had triggered the antibdy, there are follow-on approaches....io_editor (talk) 19:18, 23 March 2008 (UTC)
My suggestion would be to reduce back and for copyediting, why don't you and Garrando set up a sandbox for this section (it can be done as page off of this talk page). It would be helpful. OrangeMarlin Talk• Contributions 19:23, 23 March 2008 (UTC)


Maybe this time I was too eager to delete info. Sorry. Thankfully anything can be reverted if somebody feels it wasn´t appropiate. Nevertheless I want to explain my reasons and my action may serve to boost this section. First of all I want to say that I was thinking on doing it for some time, and has been an action on my own. I have been rewritting the treatmens section in order for a month. First it was cognitive therapies (which is my speciality), then approved treatments, and finally I wanted to touch the investigation section.

Investigation sections usually get "cracy". With cracy I mean that they just become a compilation of random info, that do not give an accurate overview of a field. The more complex a disease is the more easy this happens. This is what has happened in Alzheimer: only a few products appear, with a lot of weight given to them, while many others are not even named. See for example this lines: In 2002 it was reported that 6% of multi-dosed participants (18 of 300) developed symptoms resembling meningoencephalitis, and the trials were stopped. Participants in the halted trials continued to be followed, and 20% "developed high levels of antibodies to beta-amyloid" and some showed slower progression of the disease, maintaining memory-test levels while placebo-patients worsened. Micro-cererebral hemorrhages during passive immunisation and meningoencephalitis with active immunisation still remain potent threats to this strategy.[141] Does it have sense to have more than five lines for just an investigation that failed when there are 400 ongoing trials?

I believe that a good idea is draw the main tendencies of research of the field and give some examples of each one, going away from detailing every investigation or clinical trial. Respective to why some drugs are highlighted... Well, be sure it was not my intention... What I precisely intended was exactly the opposite, I tried to give examples (and they were presented as such) of a inmense amount of trials. Right now as I show in the lines before is when there are some drugs highlighted. Respective vaccines: Is it really informative to know why a possible future treatment might work? I believe its just giving to much details. Finally I also agree that being in phase III doesn´t mean anything.

Well as I said: sorry to everybody, I´m no expert in pharma and this might have been a too much of an edit, but lets look in positive for the future:

My aim was to give the big picture of AD investigations and center the section in tendencies and not in specific drugs: I named 3:

  • Amyloid beta fight; (which would include vaccines)
  • Neuroprotection
  • Metal-protein interaction attenuation

Can anybody give other examples of main trends in AD treatments investigation?

Bests to everybody. --Garrondo (talk) 11:43, 24 March 2008 (UTC)

  • Agreed - these sections become a mess, as everybody comes along to place some speculative idea they saw in the newspapers, some of it homeopathic, some alternative, etc - and even the better material becomes uncoordinated (in fact even in diseases where there are already treatments - I am thinking of the MS page - these sections can look very poor). In terms of the treatments you mention, in fact almost all the late-stage ones (even the metal attenuation ones target a catalyst) are aimed at what is called the "Amyloid Cascade", it just depends on whether they are aimed at what is considered "upstream" or "downstream" (and even this is not known for sure) in the process. I will come back later with a suggestion....io_editor (talk) 13:50, 24 March 2008 (UTC)

[edit] A new alternative

A possibility to summarize vaccines into first paragraph eliminating info on the last trial failure would be the following. (New additions in black). What does people think?

Many different investigation approaches coexist. Amyloid beta is a common target of clinical trials of compounds which aim to reduce it using different agents such as bapineuzumab, an antibody in Phase III tirals for patients in the mild to moderate stages of AD,[137] and MPC-7869, a selective amyloid beta-42 lowering agent in Phase III trials for mild AD.[138] This is also the case of vaccines or immunotherapy, which would be used to treat diagnosed patients rather than for disease prevention and are based on the idea that, by training the immune system to recognize and attack beta-amyloid , it might reverse deposition of amyloid and thus stop the disease. An example of vaccine under investigation is acc-001. Other approaches to treating AD are neuroprotective agents, such as AL-108, which has just completed its Phase II clinical trial,[139] and metal-protein interaction attenuation agents, such as PBT2, which has also just completed its Phase II trial.[140] There are also many basic investigations attempting to increase the knowledge on the origin and mechanisms of the disease that will lead to new treatments.

I had missed this earlier. I made edits; see if you like them or not. I agree that the trial failure (or partial success) should be out as it was a vague result (it is not surprising that 20% developed antibodies to somtheing they were injected with). The bapineuzumab MaB is an offspring of immunotherapy. Recently statins failed in a huge trial, so that's out. Also the enbrel story on a single patient is a red herring, there are no AD trials in enbrel, so out it goes too....io_editor (talk) 02:03, 25 March 2008 (UTC)
I dont agree with the 2nd-last edit by Garrondo. To say there is just no cure, is of course true, but alone it sounds naive, especially when research has no hope of really reversing the patient back to full health. The hope right now is to to delay or halt. Also for the drugs under trials, many of the established symptomatic drugs - or new drugs in the same class - and also generic competition is on the way, as 1 or 2 of gthem are now very old - are being tried in different doses, different combinations with each other, different stages of disease, and there will be some efficacy. The burning question is not here, but in the area of the disease itself....io_editor (talk) 14:09, 26 March 2008 (UTC)
It's not only said that there is no cure, but that is palliative and sytomatic treatment which from my point of view is saying almost the same as "Does not delay or halt". I think its an important sentence for the pharma section (and it continues there), and finally there is really no much point in saying it again in investigation since it can't be known which will be the results of those investigations... Maybe a combination of approved treatments is the key, or maybe is one of those more risky investigations... maybe the only investigation on a new treatment has more funds that all the others..who knows... In the investigation section I think it does not give a lot of info saying one more time "do not intend to halt or delay". Finally I not only reverted it becose I felt it was unncesary but becouse it was a copy-paste three times of the same exact sentences which does not sound very encyclopedic. Lets see if anybody else gives their opinion or make new edits. --Garrondo (talk) 15:18, 26 March 2008 (UTC)
OK, I think sooner or later someone will change it again though........also think about my second point as well, because there will be more symptomatic drugs....io_editor (talk) 18:31, 26 March 2008 (UTC)

[edit] Public health cost impact of therapies

Reviewing much of what has been discussed about the various rear-guard-action therapies it struck me that we may not be giving them their due. While not cures, any therapies that significantly postpone the time at which a patient must move on to a more intensive stage of care can be seen as (at least potentially) providing a reduction in the social cost of delivering that care or allowing supply-constrained social resources to be marshalled towards other services. Am I missing something here or should this be discussed in the article?LeadSongDog (talk) 21:55, 25 March 2008 (UTC)

I think these therapies modestly rather than significantly postpone such an event. These symptomatic drugs right now have shown only modest benefits over short periods (6-months is the standard)). Remember the course of the disease pathology is believed to be unaltered, drug or no drug. All the reports are that future costs will be enormous to care for the exploding population and that the current drugs are not good enough. Even now there must be a benefit, but the UK body (NICE) did cost-benefit analyses in the last few years and said that no such benefit existed - relative that is, to the price of these drugs themselves...io_editor (talk) 22:20, 25 March 2008 (UTC)
Then lets find a referencer for those economic public health studies, since it seems important enough.--Garrondo (talk) 08:20, 26 March 2008 (UTC)
Perhaps this will serve:Getsios D, Migliaccio-Walle K, Caro JJ (2007). "NICE cost-effectiveness appraisal of cholinesterase inhibitors: was the right question posed? Were the best tools used?". Pharmacoeconomics 25 (12): 997-1006. PMID 18047386.  LeadSongDog (talk) 13:37, 26 March 2008 (UTC)
That is a start. I believe the full NICE assessment should be findable, as it is a government document, and would have been released at one time. The UK authority is called NIH (NICE is their consultant), so that might be a place to search....back later....io_editor (talk) 13:56, 26 March 2008 (UTC)
Got the abstract. Here's the cite:

Green C, Picot J, Loveman E, Takeda A, Kirby J, Clegg A. (2005). "Modelling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer's disease". Pharmacoeconomics 23 (12): 1271-1282. PMID 16336020. 

Cheers, LeadSongDog (talk) 19:06, 26 March 2008 (UTC)
Well it did assess the benefit of the "delay" - my comments in italics.... RESULTS: The clinical benefits on cognition from treatment ....... incremental (= extra) cost per QALY gained ranging from 53,780 pounds sterling to 74,735 pounds sterling... (vs usual care).... the probability of ....incremental cost per QALY of < 30,000 pounds (this seems to have been the benchmark) sterling is < 21%. The key determinants of cost effectiveness were the effectiveness of treatment, the mean treatment cost and the cost savings associated with an expected delay in disease progression (which is how we started)." .......It looks as if the study felt that the delay was worth 30k, but to get there, the drugs spending would be more than double that. However there is something I don't understand, why they appear to average this over 5 years, as I believe that the average usage of these drugs is only 8-9 months due to efficacy wearing off...io_editor (talk) 23:36, 26 March 2008 (UTC)
Both studies disagree in their conclussions. I propose the following:
There is also evidence for the efficacy of these medications in mild to moderate Alzheimer’s disease,[112] and some evidence for their use in the advanced stage. Only donepezil is approved for treatment of AD dementia during this stage.[113] Their cost-effectiveness is disputed.
adding both references after it. Would it be enough?--Garrondo (talk) 15:27, 27 March 2008 (UTC)
That might be just a little too concise. See Matt Lewis' words above re protests (under Political element). How about An NHS sponsored study found insufficient effect to justify funding their cost, but the premises of that study are disputed. (plus the refs)LeadSongDog (talk) 18:42, 27 March 2008 (UTC)
Re the UK protests over Aricept's limited availability - Donepezil (Aricept) does have this against it [17] and [18]. Also this on cholinesterase inhibitors in general [19] (I don't think we are using these Pubmeds).
I have to go out now - but I'll certainly help regarding social aspects. --Matt Lewis (talk) 20:09, 27 March 2008 (UTC)
I'm certainly for covering it all, btw! It's just about getting it right. --Matt Lewis (talk) 20:12, 27 March 2008 (UTC)
I don't think the point is to say if anticonlinestares inhibitors are effective, since it is well proved they are, even if their effects are very mild. If they had the prize of aspirine no government would doubt on its use. I think the other two references are much more interesting, since they try to balance effectiveness and costs both of drugs and cares. --Garrondo (talk) 09:24, 28 March 2008 (UTC)
If we say that "cost-effectiveness" is disputed - and pose this difficult question of what is costly and what is effective in example form - such as the UK criticisms of the decision over Aricept and the subsequent protests (over the 'cost/availability' side), surely we would then need to show the extremes of opinion over anticholinesterase inhibitors? (ie the 'effectiveness' side of the dispute)?

"If we say that "cost-effectiveness" is disputed" - I agree that this leads to 2 difficult questions - the "cost" (net) and the "effect" (QoL being hard to define) - and the NIH studies are often seen as politicaly tainted - perhaps we say nothing about "cost-effectiveness", beacuse it would take almost another page to explain what is meant by that. I think it is enough to say that their usefulness is limited, and that they make no difference to the long-term prognosis....io_editor (talk) 14:23, 28 March 2008 (UTC)

The new page could be "Sociological and cultural aspects of Alzheimer's disease" (per the Autism sub article). We would still need a comment here though. We must always remember WP:MEDMOS (and it's always easy to forget) - Wikipedia is not stirictly intended to be a "pharmaceutical resource", so this article is about Alzheimer's disease in the 'broad sense' first and foremost - though it is great that it goes beyond the "general", of course.
"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."
--Matt Lewis (talk) 12:46, 29 March 2008 (UTC) (didn't sign, sorry)
If you really want this new page, then I cannot help much, but Garrondo would almost certainly be at home (unless you are Garrondo?). But I think we agree, it is beyond the scope of the AD page itself.io_editor (talk) 22:40, 28 March 2008 (UTC)
My point is actually that it is within the scope of a broad article on AD - but I feel it needs to be developed under a sub-article too. I misleadingly said it needs "a comment" in here (which does sound dismissive) - actually I meant a couple of nicely-packed well-written sentences - whatever can cover it best, with a "Further information" leading to the sub-article! It's definitely part of the subject of AD. --Matt Lewis (talk) 12:46, 29 March 2008 (UTC)

I note at AmJ Managed Care (page 811) that theres a decent estimate of savings per month admission is deferred. Later stages aside, it ought to be possible to find an estimate of how many months deferral can be obtained with various treatments. LeadSongDog (talk) 01:28, 29 March 2008 (UTC)

Having just attended the 5th IPECAD conference on AD pharmacoeconomics, I would say that current therapies are questioned first on the magnitude of their clinical effect (4 ADAS-cog points being a clinically significant standard that they are not consistently beating) and second on their cost effectiveness. NICE's modeling has been criticized because they made several simplifying assumptions in the AHEAD/Caro model that very much changed the results in terms of value per QALY. Looking at an outcome like nursing home admission is done via population cohort studies that measure healthcare utilization parameters and then linking those back to the clinical variables that were observed in the regulatory submission trials. The AD2000 trial tried to be an effectiveness study, but it perhaps was too small and broad in its entry criteria to give the best picture of effectiveness. Nonetheless, it did recruit a large number of APO E4+ patients (like 60%). Which costs get accounted for in the value of these drugs is a key element in the effectiveness results. Unpaid caregiver time has what benefit? What about healthcare outcomes for the caregiver? What about health system benefits in the long run (which may include long term care)? These are tough questions to answer. --Chrispounds (talk) 04:13, 31 March 2008 (UTC)
This just came in from BMC. Open access. Zhao Yang, Kuo Tzu-Chun, Weir Sharada, Kramer Marilyn S, Ash Arlene S (2008-05-22). "Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's". BMC Health Services Research 8. doi:10.1186/1472-6963-8-108. LeadSongDog (talk) 04:36, 30 May 2008 (UTC)

[edit] PiB-PET imaging

I was bold and added in a new result, now in preprint from Brain. Check out the lay summary's attached image. Stunning.LeadSongDog (talk) 20:19, 26 March 2008 (UTC)

It looks indeed groundbreaking, and the sort of tool needed to help clinical research make progress. When I looked, there was actually anotehr paper by the smae team, this time showing correlation between PiB and MRI (not so exciting I suppose), so I added it too....io_editor (talk) 00:06, 27 March 2008 (UTC)
Sounds impressive, and it also shows one of the most impressive things of wiki: the article was pubblished barely a month ago and we alredy have it in the article. Well done. --Garrondo (talk) 08:27, 27 March 2008 (UTC)
When you say "combined with a tracer" - it is in fact only the tracer that the imaging sees.....I will changeio_editor (talk) 13:38, 27 March 2008 (UTC)
Good job LeadDogSong. Man that was hard to type. Let's try to remember to change the reference to it's actual listing once it's published. OrangeMarlin Talk• Contributions 23:05, 28 March 2008 (UTC)
Thank you.LeadSongDog (talk) 00:44, 29 March 2008 (UTC)

[edit] Neuroleptics for agitation found to be of negligible benefit and substantial risk

A multi-year UK study by the Alzheimer's Research Trust suggested that this and other neuroleptic anti-psychotic drugs commonly given to Alzheimer's patients with mild behavioural problems often make their condition worse. [15] The study concluded that

“ For most patients with AD, withdrawal of neuroleptics had no overall detrimental effect on functional and cognitive status and by some measures improved functional and cognitive status. Neuroleptics may have some value in the maintenance treatment of more severe neuropsychiatric symptoms, but this possibility must be weighed against the unwanted effects of therapy. The current study helps to inform a clinical management strategy for current practice, but the considerable risks of maintenance therapy highlight the urgency of further work to find, develop, and implement safer and more effective treatment approaches for neuropsychiatric symptoms in people with AD.

Ballard C, Lana MM, Theodoulou M, Douglas S, McShane R, et al.. "A Randomised, Blinded, Placebo-Controlled Trial in Dementia Patients Continuing or Stopping Neuroleptics (The DART-AD Trial)". PLOS Medicine 5 (4, e76). doi:10.1371/journal.pmed.0050076. 

 ”

Cochrane database trial registration (not sure how to cite)

So does this not belong in the article?LeadSongDog (talk) 20:40, 1 April 2008 (UTC)

Well, we don't mention it elsewhere in the article. The article could get really long if we list out everything that doesn't work. That was my point.OrangeMarlin Talk• Contributions 20:47, 1 April 2008 (UTC)
This might be worth a mention, because neuroleptics are/were very widely used in patients with Alzheimer's. It's not exactly a garden variety treatment-that-didn't-work; it's more like a widely used treatment that recent evidence suggests may not be beneficial and may even be harmful. MastCell Talk 20:52, 1 April 2008 (UTC)
I did a search and found lots of articles over the past two years that state it doesn't work. I'm wondering why the BBC News article seems to make it appear that one guy figured this out??? Anyways, I'm not opposed to putting it in, but the sentence should say something to the effect of: "Neuroleptics had been widely used with patients with AD, but recent evidence suggests it has limited effect on the course and severity of the disease, and may be harmful to the patient." Use some citations that don't include the BBC News, since it's unpublished, and the interviewed researcher is not alone. OrangeMarlin Talk• Contributions 21:25, 1 April 2008 (UTC)
Sorry, I've gone retroactive and edited my above out-of-sequence to clarify the citation somewhat, make it readable in the talkpage, and add the Cochrane database link. I'll try not to make a habit of it ;/) LeadSongDog (talk) 05:48, 2 April 2008 (UTC)
I have reverted last edition. The editor said it worsens the state of AD patients, when at most in the article says it does not have much effect. Lets get to a consensus and then add it again if we believe it is a good idea. In the read also section there is a 2007 guide from the apa. It has a lot of up-to-date info on articles on neuropsychiatric treatments in dementia. It may serve as an initial revision for a guided search of info. Right now I have a lot of work out of wiki so I won't be able to help much the following weeks.--Garrondo (talk) 12:18, 2 April 2008 (UTC)
Disagree. The ref says
“ Any beneficial effects of neuroleptics in people with AD must be weighed against the short- and long-term adverse effects which, according to meta-analyses, include parkinsonism, sedation, oedema, chest infections, stroke (odds ratio 2.5–3) and mortality (odds ratio 1.5–1.7) [7–11,20–22]. Additional evidence has also highlighted accelerated cognitive decline as an important potential negative consequence of prolonged use of neuroleptics [16,23]. A meta-analysis [17] has confirmed this observation, indicating 0.7 of a Mini Mental State Examination (MMSE) point (95% confidence interval [CI] 0.38 to 1.09) greater decline over 6–12 wk in neuroleptic-treated patients compared to those treated with placebo, which appears modest but represents a doubling in the expected rate of cognitive deterioration over this period.

In the US the Food and Drug Administration [22] has warned about the risk of increased mortality and stroke with neuroleptics in people with dementia, and most practice guidelines recommend nonpharmacological approaches as the first-line treatment for agitation and other neuropsychiatric symptoms (e.g., [24]). However, there is still considerable debate as to the place of neuroleptics in the management of severe and distressing symptoms that are intractable to other treatment approaches, especially when there is potential risk to the patient or to others.

 ”

I think that's pretty unambiguous.LeadSongDog (talk) 14:07, 2 April 2008 (UTC)

I think we're in agreement that it belongs. But let's use the best possible source. And LDS, almost any clinical trial can be referenced with a peer-reviewed article. I'll try to search for one. OrangeMarlin Talk• Contributions 17:08, 2 April 2008 (UTC)
Try a pubmed search on "dementia[ti] AND neuroleptic[ti]" (less quotes)...lots to choose from.LeadSongDog (talk) 19:06, 2 April 2008 (UTC)

[edit] Structure

The article structure needs some rethinking. The Prognosis section is particularly strange, including subsections that really don't belong. Suggestions? LeadSongDog (talk) 17:10, 5 April 2008 (UTC)

I would suggest that the subsections under Prognosis be put into a new section called "Social Impact" or something like that. --Gimme danger (talk) 18:09, 5 April 2008 (UTC)
I agree they look odd, and technically not part of Prognosis, but I am not sure they should be removed off the page. Of the 2 burdens - Caregiving is already staggerring and the Cost is headed that way, as the numbers boom. They are really central issues for society today. Can I suggest though that half (the middle paragraph or most) of Caregiving burden could be removed?io_editor (talk) 18:16, 5 April 2008 (UTC)
The reason why it is under prognosis is becouse its is advised so in MEDMOS, however it might be a good idea to make an exception here and create an indepndent subsection. Nevertheless not to follow the manual of style is an important decision so lets ask everybody else. --Garrondo (talk) 14:28, 6 April 2008 (UTC)
Thanks for directing attention back to WP:MEDMOS. It was very direct:
“ If a disease is incurable, then the Prognosis section can be moved up and a section called Management is more appropriate than Treatment. ”
So, rather than having Treatment followed by Prognosis, we would have Prognosis followed by Management. I don't see anything in MEDMOS that guides the the subsections' form. LeadSongDog (talk) 17:11, 6 April 2008 (UTC)
Very good, as the Prognosis is univerally bad. Within Management I would suggest that the middle paragraph in caregiving burden be substantially dropped/summarized for brevity.io_editor (talk) 18:31, 6 April 2008 (UTC)
I was about to do this, and I suddenly realised that this would mean Management would replace Treatment. While I would agree with this (completely!), it may be controversial as others have seen "treatment" to be mean all drugs....io_editor (talk) 18:48, 6 April 2008 (UTC)
Surely the parag on caregiving your refer to is pretty concise - why lose it? Please give reasons - is any part of it wrong? I'll point to my comments above re "general reader is the audience" and "full topic coverage" (per medmos etc).--Matt Lewis (talk) 22:19, 6 April 2008 (UTC)
I don't see problems with a management section. It would only change the name, not the content of the treatment section, since two sub-sub-sections right now are not pharma treatments and everybody has agreed to it. Neverteless maintaining its actual name is no innacuracy either. However the question was if creating a section of "social impact" was appropiate (I believe there is no such section in MEDMOS).--Garrondo (talk) 14:33, 7 April 2008 (UTC)
MEDMOS suggested section list includes "Prognosis (social impact may also be discussed)", but doesn't speak to whether a distinct subsection should be used for social impact. Presumably we make that call based on size/importance. If sufficiently important that we give it lots of space, then make a separate subsection. In this case we may need to go past that to a separate article, in which case there's little point to a separate subsection. Question: Is the social impact of AD sufficiently distinct from that of other dementias to have a distinct AD impact article? I'd suggest that we should simply cover the topic under Caregiving and dementiaLeadSongDog (talk) 16:07, 7 April 2008 (UTC)
All the main points in a proper "daughter article" needs to be covered in the parent article - it's actually required (I asked someone in FA once). So we will always need these sub-sections, at very least. I want to stress again that these “non-technical” factors of AD as no less worthy of main-article space than the technical factors - far from it, the ethos of Wikipedia is about the whole subject, and the general reader. What will the word "Alzheimer's" mean to a general reader? What will he/she want/expect to know? I can't stress this enough, as most people here are natural to the sciences.
In MEDMOS, the line "(social impact may also be discussed)" does sound a bit like a rather patronising aside (!) - it should be more affirmative: eg. "If "social aspects" are important they need to be addressed here, in sub-sections if necessary". It perhaps shouln't be left as 'obvious' that some articles have highly-relevant "social aspects" (like AD), whereas others obviously do not. I think I'll look at slightly re-wording MEDMOS here. --Matt Lewis (talk) 19:15, 7 April 2008 (UTC)
You are absolutely correct, in a way the social impact the whole point. I had thought earlier that perhaps the Caregiving section was too wordy, and could lose most of middle paragraph without losing meaning.io_editor (talk) 19:27, 7 April 2008 (UTC)
I probably included most of that parag, but if you can make it even more direct than fine. I try and get things as concise as I can without losing any of the points I want to include. AD is a dementia (and very much its own disease too), that causes a few core behavioural symptoms that caregivers will tell you are very common, and I think the parag covers them. Of course a sub-article (its own or the dementia one) could give even more detail, but I think we've covered the main aspects here. Initially it was part bullet-form, then was made converted to a parag.
I've tried a change to MEDMOS by the way - what does anyone think?--Matt Lewis (talk) 19:48, 7 April 2008 (UTC)
(this is the diff - it was removed quickly by someone who believes that each social aspect will have a corresponding section in the article as its home - but I just can't see it. I've stated a discusion here in MEDMOS talk). --Matt Lewis (talk) 20:19, 7 April 2008 (UTC)
Having fought it out at MADMOS (for far too long) I can report that changes have been made to society. Cultural references no longer covers it all, as apparently it was supposed to do. I have made the changes in line. It clearly needs an introduction. --Matt Lewis (talk) 00:42, 15 April 2008 (UTC)
Sometimes I think I should stop asking questions ;/) Thanks for toughing it out Matt.LeadSongDog (talk) 20:14, 15 April 2008 (UTC)

[edit] Blood/brain leakage

Another interesting item has come out here. It indicates that the heritable ALS-linked gene SOD-1 leads to low levels of ZO-1, occludin and claudin-5 (proteins in the barrier) and to early failure of the barrier within the spinal column, before the loss of motor neurons. Note too the final para referring to "In January [2008], Zlokovic reviewed the evidence for involvement of the barrier in diseases like Alzheimer’s, ALS, and multiple sclerosis in a 24-page review in Neuron." Relevant? LeadSongDog (talk) 19:01, 7 April 2008 (UTC)

I feel it is too much specific for main page. Maybe suitable for secondary article on phathology. Only my opinion.--Garrondo (talk) 13:41, 8 April 2008 (UTC)
Sorry, I got lazy with the above. The papers are
  • Zhong Z, Deane R, Ali Z, Parisi M, Shapovalov Y, O'Banion MK, Stojanovic K, Sagare A, Boillee S, Cleveland DW, Zlokovic BV (2008 Apr). "ALS-causing SOD1 mutants generate vascular changes prior to motor neuron degeneration". Nat Neurosci 11 (4): 420-422. PMID 18344992. 
  • Zlokovic BV (2008-01-24). "The blood-brain barrier in health and chronic neurodegenerative disorders". Neuron 57 (2): 178-201. PMID 18215617.  and
  • Deane R, Zlokovic BV (2007 Apr). "Role of the blood-brain barrier in the pathogenesis of Alzheimer's disease". Curr Alzheimer Res 4 (2): 191-197. PMID 17430246.  Review.
It was mainly the reviews that I wanted to draw attention to.LeadSongDog (talk) 16:07, 8 April 2008 (UTC)

[edit] Treatments in clinical development

Getting close to 3RR guys. Better talk it out instead.LeadSongDog (talk) 01:55, 9 April 2008 (UTC)

If you want, decide with OM - actually even better, I will take AD off my watch-list NOW, this moment - and I will not return, ever, so feel free....io_editor (talk) 01:58, 9 April 2008 (UTC)

[edit] TNF-alpha/inflammation

I think the AD page is great--kudos! There was this wacky story on BBC4 radio this morning about a guy in a private clinic in California who is giving perispinal injections of etanercept (TNF-alpha inhibitor) and turning the poor patients upside down--with remarkable, almost immediate, but somewhat anecdotal amelioration of impairment with some months' or years' duration. My first reaction was an eye-roll... But the more I looked into it, the more it started to make sense... and the more literature I found suggesting that -- while this is a very shaky first start in the Tobinick's non-placebo-controlled trials -- this is definitely consistent with some things other people have been thinking about w/r/to TNF-alpha, inflammatory processes, etc. So I added a couple of sentences to the AD page -- in the neuropathology section and in the pharmaceutical management section. I couldn't decide whether to put the first bit in neuropathology, biochemical, or disease mechanisms, and just went with the first. In hindsight, maybe one of the latter would have been better.Celia Kozlowski (talk) 16:40, 11 April 2008 (UTC)

Although there are often stories about compounds in development for Alzheimer's, we have tried to take the strategy that only products in Phase 3 or later would be listed because of the high failure rate in this disease. Yes, the mechanism is interesting, but the patient population so far has been small. Over the last two years, 4000 patients in 5 different 18-month trials did not find compounds that could change clinical symptoms of the disease (on average). --Chrispounds (talk) 10:06, 13 April 2008 (UTC)

[edit] pressure ulcer picture

The topic of pressure ulcers seems too peripheral to this article to warrant an illustration. I propose we remove that image, the image page of which doesn't even indicate that the person shown has Alzheimer's disease. --Allen (talk) 21:53, 15 April 2008 (UTC)

[edit] Pressure sores

I am a little concerned that pressure sores are considered one of the causes of death for people with Alzheimer's Disease. In my experience (30+ years as a registered nurse) bed sores are the result of bad nursing. There exists in the UK and the majority of other countries technology capable of avoiding the pressure which leads to these sores. The initial development of pressure sores indicates poor assessment of the patient's nursing needs, in this case relief of pressure on certain body points and the subsequent action to ameliorate that pressure. Pressure sores are always avoidable. It is the lack of health resources (i.e. lack of skill of the carers, lack of funds for equipment, lack of awareness of relatives) that leads to their formation. Having cared for over 200 individuals in their final stages of life with AD I believe I am able to offer an informed opinion. In my opinion the commonest cause of death from AD is pneumonia (sometimes leading to septicaemia) caused by the lack of activity of the individual. Not a single patient in my team's care ever developed a pressure sore. with kind regards, Richard Avery (talk) 06:56, 16 April 2008 (UTC)

In light of the above two comments I'm going to delete it for the moment. It's evocative certainly - but there nothing to prove the patient has AD, it's quite extreme, and it should be regarded as generally untypical (surely to this degree), rather than appearing the norm. The text is "Pressure ulcers are a common complication in advanced AD.": Perhaps a more typical pressure ulcer can be found (?), with some surrounding article text too, clarifying the reasons why it could happen. If the picture is a typical sore (when they occur) - the text in the caption and the article needs to better explain why and how often they occur. the question is - is the picture a typical example of how a sore develops when it is allowed to?--Matt Lewis (talk) 11:33, 16 April 2008 (UTC)
I have work with inbedded people (not exactly AD) and the thruth is that altough it is rare to reach this degrees of sores it is possible... and these kind of ulcers are the ones that kill people. Of course thankfully many times prevention or cures evitate reaching this state. On the other hand it does not really matter if the person in picture has alzheimer or not, since pressure ulcers are not disease dependant but due to inmovility.--Garrondo (talk) 13:57, 16 April 2008 (UTC)
Maybe a solution is just to say in caption "a picture of a very advanced pressure ulcer", or something like that. --Garrondo (talk) 13:59, 16 April 2008 (UTC)
Regarding richard avery comment: I suspect (I have not read about it) that being attended by a professional team reduces the posibilites of having such ulcers. Probably those AD patients inbedded at home cared by families and specilly by non sanitary and non family carers may be at greater risk... Nevertheless the picture is not so important.--Garrondo (talk) 14:03, 16 April 2008 (UTC)
I agree that the pic's origins don't matter so much as it's a pressure sore, but I'd like to read the source text that came with the picture (if there was any). How long does it take to get a sore like that? - that might be a useful fact to add in the image comment. - I notice you suggest "advanced" - but I think the nurse had a point about how 'bad' it looks - this is a scary image for people to see. I'm happy with it in the article with the right text to explain it fairly (I don't mind giving it a go) - I do feel I need more information on the pic though. Can someone estimate the time it takes to get a sore like that? --Matt Lewis (talk) 14:17, 16 April 2008 (UTC)
According to the pressure ulcer link in the text, which leads to bedsore this is a 'Stage IV' ulcer - "the deepest, extending into the muscle, tendon or even bone.". The image title is in a foreign language, so I guess it's corresponding source text could be too. Images are hard to find I know, but we could do with a lower stage really. I've got a bit of time so I'll have a search for: Alzheimer's ulcer/sore stage etc to see if any stage is typical. (maybe stage 1 is hard to avoid if someone is static all day). --Matt Lewis (talk) 14:25, 16 April 2008 (UTC)
Found this Guardian link. Someone with AD died of MRSI via a bedsore contracted in a care home. Looks like stage IV can develop "quickly". Spoke to soon - I have to go! (the link looks like it could be a good one if anyone wants to follow this up now). --Matt Lewis (talk) 14:36, 16 April 2008 (UTC)
This discussion of typicality and the details of the picture is good, but what about the relevance of pressure sores to AD in general? Sure, it may be a common complication, but isn't that true of any disease or condition that causes someone to spend a lot of time in bed? Would we want to put this image (or any bedsore image) in the articles for each such condition? --Allen (talk) 14:55, 16 April 2008 (UTC)
Well said Allen, the point I'm making is the development of pressure sores has more to do with inadequate care than the illness of the sufferer. Richard Avery (talk) 17:50, 16 April 2008 (UTC)
I would say in its defence that it highlights probably will happen with late-stage AD sufferers if not attended to, as sufferers become unaware/unable to deal with themselves and any pain they may/may not fully perceive. The seriousness of bed sores with AD needs highlighting and I think the link is good enough - but it doesn't necessarily need a picture (though that is true of most things). They can develop quite quickly with unrelieved pressure apparently, so this would need to be included in the caption for this particular pic if it was included. It's all in the caption I would say. --Matt Lewis (talk) 19:58, 18 April 2008 (UTC)
If there was a vote, I'd say remove it, since it's not a consequence of the disease itself, but as someone said above, from poor care. In fact, there's no way to state that the picture is of an AD patient, it could be someone with a coma. And it's one disgusting picture. I hate reading that section of the article, just because the picture is there. However, that picture probably should be in the ulcer section. OrangeMarlin Talk• Contributions 17:55, 16 April 2008 (UTC)
It's from the ulcer section. I thought you were made of tougher stuff marlin! I'll hold back on my suggested caption then ("Some jam tarts are sticky on the bottom")--Matt Lewis (talk) 19:58, 18 April 2008 (UTC)

[edit] Research directions

I just don't like this section here. I'm not sure how it happened, because I can't find anything in this discussion about it, but it's going to be a great catch-basin for fringe ideas. It belongs in the treatment section, but that's just my opinion. What say you editors? OrangeMarlin Talk• Contributions 17:35, 16 April 2008 (UTC)

It was me. I did not ask simply becouse right now is the place for this kind of info in MEDMOS. I think it has some advantages and disadvantages to former placement. Advantages are that the treatment section keeps more neat since I did not like much putting toguether proved treatments and investigations, since it gave the idea that they "are almost there". It does not have to be in the treatment section, since right now they are not "real treatment options". Worst problem may be what you say about fringe ideas, but right now we are asking for a high level of excelence in citations, and secondly I am not sure that being placed here should attract more than before.

Nevertheless I don't really care much where should it be placed, but if we move it back we have to be aware that we are not following current MEDMOS.--Garrondo (talk) 08:23, 19 April 2008 (UTC)

Yes, the MEDMOS 'sections' section was revised in a couple of places in the end, maybe a day before Garrondo made the change. Regarding fringe stuff: I've been reading about sub-articles lately as I thought some information in MEDMOS would be useful. Wikipedia suggests moving fringe information to a sub-article - or, if it's not notable for a sub-article - deleting it. It's interesting that Wikipedia prefers sub-articles to deleting information - which is frowns upon unless absolutely necessary: I didn't know Wikipedias editing policy advocated 'splitting' quite to that degree. But it's supposed to be the "encyclopaedia of everything", I suppose.--Matt Lewis (talk) 14:15, 19 April 2008 (UTC)

[edit] Regan's letter

On the page it refers to this letter and says "clear signs of the disease can be recognised", but that's never addressed - which clear signs are shown? What other signs are there that aren't shown? Can someone knowledgeable about this add to either here or to the letter's page? peterl (talk) 07:21, 21 April 2008 (UTC)

I'll try to find a reference for that... but that writting is clearly of a person with alzheimer... infant writting, not keeping margins... but as you say there is no reference. --Garrondo (talk) 07:37, 21 April 2008 (UTC)

OK... that might have been original research. I have not found references for it (although I'm sure that Alzheimer signs are clear...). Would it be a solution to say that writing is usually affected in the first stages of the disease? --Garrondo (talk) 07:54, 21 April 2008 (UTC)
Thanks Garrondo. peterl (talk) 10:38, 21 April 2008 (UTC)

[edit] New result we need eyes on

Can somebody have a look into this one: Hébert SS et al. (2008). "Loss of microRNA cluster miR-29a/b-1 in sporadic Alzheimer’s disease correlates with increased BACE1/β-secretase expression". Proceedings of the National Academy of Sciences.  (not yet in Pubmed) From the press release it looks like it might shed some light on etiology.LeadSongDog (talk) 16:43, 23 April 2008 (UTC)


[edit] Phosphorylation of Tau protein

In the section on Biochemical Characteristics, it appears that the action of phosphorylating tau is reversed from what is should be. According to other sources (and wiki articles on Tau protein and Microtubule-associated protein), phosphorylation of tau causes dissociation from (not association with) the microtubules. So it should say something like hyperphosphorylation causes tau to dissociate, resulting in the breakdown of microtubule integrity, which cuases the microtubules to aggregate and cause the formation of neurofibrillary tangles. Can someone (an expert, preferably) confirm and amend this if necessary?

Quartertone (talk) 20:19, 24 April 2008 (UTC)

I reverted the following addition from the article, but other opinions are welcome:LeadSongDog (talk) 21:24, 24 April 2008 (UTC)

No treatment has been proven to stop or reverse the disease although German scientists from the Max Planck Institute of Molecular Cell Biology and Genetics in Dresden believe that they have created a drug that when injected into the brains of mice with AD reversed signs of the disease. The drug is said to effectively block the enzyme responsible for the build up of sticky deposits or plaque in the brain , attaching itself to the spot where toxic activity takes place.[16]
Still it is not known whether current treatments slow the progression, or simply manage the symptoms. Many preventative measures have been suggested for Alzheimer's disease, but their value is unproven in reducing the course and severity of the disease. Mental stimulation, exercise and a balanced diet are often recommended, both as a possible prevention and as a sensible way of managing the disease.

A chimpanzee model has been found:

  • "Tauopathy with paired helical filaments in an aged chimpanzee." (2008-07-20). The Journal of Comparative Neurology 509 (3): 259-270.  Published online May 14, 2008

[edit] ACC-001 trial has been suspended

[edit] Correcting apparent vandalism

I corrected the apparent vandalism of this article by user 69.66.31.204. —Preceding unsigned comment added by Mojomama (talk • contribs) 15:47, 7 May 2008 (UTC)

[edit] Cox-2 Inhibitors

This story describes a negative result (worse than placebo) from a halted large (n=2000) study on celecoxib and on naproxen sodium as prospective AD-protective agents. "The findings were posted online Monday and will appear in July's Archives of Neurology"

[edit] Causes -> "genetic" and "familial" inheritance ambiguity

"Most cases of Alzheimer's disease do not exhibit familial inheritance. At least 80% of sporadic AD cases involve genetic risk factors." There is no complete causal link between genes and alzheimers, but there are genes which increase it's likelyhood. I assume "familial" was used to describe genes which provide a causal link, such as the gene which causes cystic fibrosis, and "genetic risk factor" used to describe genes which only increase the risk. If this is the case wouldn't it be better to scrap the term "familial" in order to reduce ambiguity? I think it would be better to say something along the lines of... "80% of cases involve genetic risk factors suggesting alzheimers is not caused by a particular gene and it's likelyhood increases with certain genes." —Preceding unsigned comment added by Doctor Correct (talk • contribs) 17:14, 6 June 2008 (UTC)

[edit] 24 million

(Following copied from my talk - LeadSongDog) Your change to the lead on Alzheimer's disease may have removed ambiguity about the extent of "affects" but reintroduced the false statement that the 24 million is cases of Alzheimers. It is an estimate for dementia as a whole. Since there doesn't seem to be a reliable estimate for AD worldwide, we need to find a way of saying that the 24 million is for dementia, of which Alzheimer's is a common cause. Colin°Talk 06:22, 9 June 2008 (UTC)

Took another go at it. See what you think.LeadSongDog (talk) 15:33, 9 June 2008 (UTC)
Too much jargon, too much information for the lead and the plural "dementias" doesn't work. Rethinking the "is the most common cause of dementia, which affects an estimated 24 million people worldwide." I think the extent of "affects" isn't really a problem. I don't think anyone's expecting a figure for indirect affect (where would one draw the line anyway). Perhaps we should take this to the talk page? Colin°Talk 16:56, 9 June 2008 (UTC)
Few people would consider that the primary caregiver is less affected than the AD patient, particularly in advanced stages. For familial forms, offspring living with the expectation that they too will develop the disease may have their entire life plan changed. The term "affected" must not be conflated with "patient". It is not a trivial point. If you have another way of saying it, fine, but I believe it needs to be said. LeadSongDog (talk) 20:04, 9 June 2008 (UTC)
I think that shifting the default understanding of "affect" from direct to include indirect is campaign language. Makes you stop and think. But not encyclopaedic. I don't think there's confusion in the reader's mind. The word is used when quoting the prevalence of many diseases including, for example, serious congenital genetic illness, where the carer burden no less than with AD, and often longer. The article should be clear on the distinct and separate direct affect of dementia and the indirect affects on carers, family and society. If someone can think of an alternative word to "affect" then great, but this lead sentence must be simplified. The phrase "A Delphi study formed an expert concensus estimate" is pure jargon. Colin°Talk 22:44, 9 June 2008 (UTC)
That's why I linked Delphi method. See also the cited paper-the freely accessible pdf is linked in the citation. Not everyone will trust Delphi technique results, but they are better than simply pulling one expert's number out of a hat. In any case, remember WP:NOTTRUTH. I'm thinking that the number is perhaps not so critical that it belongs as the second line of the lead. Should we move it down a few lines? LeadSongDog (talk) 14:30, 10 June 2008 (UTC)
How about "afflicts" or is that too emotive? Fainites barley 22:15, 11 June 2008 (UTC)

[edit] Archive 4

I've just moved threads starting before 2008 to archive 4. LeadSongDog (talk) 20:04, 9 June 2008 (UTC)

Also sorted out a misplaced <ref name="xxx"></ref> that was prematurely truncating the talk page rendering.LeadSongDog (talk) 20:10, 9 June 2008 (UTC)

[edit] Featured article

From a non-expert point of view this article is excellent. Editors should list issues that would prevent this article from becoming FA. On my reading, I see essentially none, but I am not an expert on the subject. The FA requirements can be found here: http://en.wikipedia.org/wiki/Wikipedia:Featured_article_criteria . This article is long, but Alzheimer's is a complex topic, so I would prefer the in-depth treatment.

Please respond with your opinions. —Preceding unsigned comment added by Lwnf360 (talk • contribs) 06:10, 12 June 2008 (UTC)