Wikipedia:Featured article candidates/Alzheimer's disease


 * The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was promoted by User:SandyGeorgia 21:55, 25 August 2008.

Alzheimer's disease

 * Nominator(s):  Orange Marlin, garrondo 
 * previous FAC (03:57, 12 June 2008)

Renominating article. The issues described in the previous previous FAC have been addressed, the article has been copy edited several times, and the references updated. Orange Marlin Talk• Contributions 17:32, 18 August 2008 (UTC)
 * I have to add that several sections have been fully re-written from previous FAC.--Garrondo (talk) 17:54, 18 August 2008 (UTC)
 * I would add that nearly all the sections, including the Lead, have been either rewritten, or copyedited so thoroughly, that we should consider it rewritten! Orange Marlin  Talk• Contributions 18:20, 18 August 2008 (UTC)

Karanacs (talk) 17:59, 18 August 2008 (UTC)
 * Support Comments by karanacs. Overall, I found this a pretty comprehensive and accessible article.  The first section, on Characteristics of the disease, is brilliant.
 * The Causes section is giving me fits. It is written a bit too technically for me. This may be because a lot of the background information that I think is necessary to understand that is located in the next section, Pathophysiology.  Perhaps the sections could be switched?
 * Done: I have changed the order of both sections. It is true that it may be easier to understand --Garrondo (talk) 12:31, 19 August 2008 (UTC)


 * Support for a comprehensive, engaging, well-referenced, well-written and researched article. The Reagan letter will probably have to go because it has an invalid rational, (the letter is illegible in any case, and does not add much, if anything, to the article). All the links checked out okay appart from the Charlton Heston CNN one, which firewalled the toolserver. I deleted one broken DOI link from the article. Graham Colm  Talk 18:16, 18 August 2008 (UTC)


 * Comments - I've made a few minor changes


 * Section: Characteristics, sub section: Predementia: but there is still a debate on whether this term.... Simply took out the "a".


 * Sub section: Moderate dementia: Delinked (if that can be said) activities of daily living and abbreviated it earlier in Predementia.

That's all for today, and I'm sorry if such changes were so minor but I'll be back to edit the whole article and make more major edits.

So far so good,

--Sunsetsunrise (talk) 23:46, 18 August 2008 (UTC)
 * I just want to state that I removed the ADL abbreviations. I did so for a couple of reasons (my humorous edit summary nevertheless):  1) ADL is not a commonly used abbreviation.  I tried to see if it were used in medicine, and it's just not used.  2) It might be confused with the abbreviation for Alzheimer's disease, AD.  I don't think this is important, but I think using abbreviations should be limited in an article of this quality and type.   Orange Marlin  Talk• Contributions 00:24, 19 August 2008 (UTC)


 * Support Comments  aaaaaawwwww, we call it ADLs (Activities of Daily Living) here in Oz (chuckle)..do you seriously call it 'daily living activities'? Listen, I am sitting here next to a psychogeriatrician who has pondered whether there should be a legal/capacity section (power of attornel/consent/wills etc.)? Or how we should link? More later as I have to run... Cheers, Casliber (talk · contribs) 03:09, 19 August 2008 (UTC)


 * From my point of view it could clearly fit inside the article. However the question is if it is absolutely necessary for the comprenhensiveness of the article. I mean, this kind of very long articles could have hundreds of sections which could fit (there are thousands of books and articles on AD), but should all of them appear in wikipedia before it can become a FA?. A FA does not mean the article can not grow and have new sections, it simply means that at the moment is a very good article (one of the best articles of wikipedia :-). Is the the AD article right now one of the best articles of wikipedia?: probably it is. Is it perfect or does it cover every issue of AD? Of course not. Cheers --Garrondo (talk) 08:21, 19 August 2008 (UTC)
 * On musing about it (and given the length of the article), material on capacity could easily og in a parent article on dementia is the issues in dementing processes (vascular etc.) are similar. So..good work. Cheers, Casliber (talk · contribs) 11:39, 19 August 2008 (UTC)

Comments on images —This is part of a comment by Awadewit  which was interrupted by the following:
 * Image:Portion of Reagan's Alzheimer's letter.png - This image is up for deletion.
 * If you read the comments on the discussion for the image or go to the original source it clearly says that the Ronald Reagans library gives permission for the use of any of its materials. It can clearly be used and the debate on wether it should be deleted has to be ended.--Garrondo (talk) 11:46, 19 August 2008 (UTC)
 * I was just pointing out that the image is up for deletion - sometimes editors are unaware that images are up for deletion. I'm not entering into the debate at this point. Awadewit (talk) 11:26, 19 August 2008 (UTC)
 * I just looked (and voted). I think it will be a speedy keep.  Besides, it looks like it's been there for over 2 months.   Orange Marlin  Talk• Contributions 17:37, 19 August 2008 (UTC)
 * As several reviewers have doubted the usefulness of the image I have finally eliminated it. I believe in the lancet article about Auguste D there are some examples of her writting. They might fit as image. I will take a look. --Garrondo (talk) 07:07, 22 August 2008 (UTC)
 * Striking as this image is no longer in the article. Awadewit (talk) 14:27, 22 August 2008 (UTC)


 * Image:InterlockingPentagons.svg - Anyway to fix the red links here? Can we link to an article or offer a better description of the test? Can we link the user's talk page if s/he has no userpage?
 * I could add the original article of the mini-mental as a reference. No more info can be added on the test or we could inccur in copyright issues.--Garrondo (talk) 11:46, 19 August 2008 (UTC)
 * The original article would be excellent. Awadewit (talk) 11:26, 19 August 2008 (UTC)
 * I have linked the mini mental article of the english wikipedia where the original citation can be found and the english wikipedia user page of the author of the image.--Garrondo (talk) 11:46, 19 August 2008 (UTC)


 * Image:Memantine-3d-sticks.png - We need a source on which this model was based.
 * The structure was probably just sketched in a molecular modeling program, such as Accelrys DS Visualizer, and rendered. The author hasn't edited in over a month, so I'm not sure we'll find out anytime soon. Perhaps we can use the skeletal structure I've just uploaded? Fvasconcellos (t·c) 16:59, 19 August 2008 (UTC)
 * Done by OrangeMarlin.--Garrondo (talk) 10:44, 20 August 2008 (UTC)


 * Image:Auguste D aus Marktbreit.jpg - Did Alois Alzheimer take this photo?
 * Is it really necessary to know it?
 * The license is claiming PD because the author has been dead for over 70 years. We can't claim that unless we know who took the photo. Awadewit (talk) 11:26, 19 August 2008 (UTC)
 * I'll look for it.--Garrondo (talk) 11:46, 19 August 2008 (UTC)
 * I have found several indirect evidences that the picture is PD and the author was Alois Alzheimer: 1: is a cover of the Brain journal with 4 different pictures, it gives credits for two of them, but not for the other 2, so we could assume it is becouse they are PD. 2: Is the website of Alzheimer's house. The image of Augeuste is inside his house, most probably becouse he was the author. I can try to send a mail to the house museum to see if they can tell me if Alzheimer was the author.--Garrondo (talk) 12:07, 19 August 2008 (UTC)
 * In this Lancet article says the picture appeared in the hospital file of Auguste when it was found in 1980 and kept right now in the house museum of Alois Alzheimer. There is no way to know the author, but it does not seem to have an owner since in the article no credit is given for the image.
 * This appears to be an anonymous work, then. Was it first published in Germany in 1906? That would require a different license. Awadewit (talk) 20:22, 20 August 2008 (UTC)
 * Yes: the article says the attibutted date is 1902 and it was taken in Germany. What would be the license? I don't really know much about copyright issues.--Garrondo (talk) 07:26, 21 August 2008 (UTC)
 * I have typed in the license as there is no template. Awadewit (talk) 20:51, 21 August 2008 (UTC)

These should be relatively easy to fix. Awadewit (talk) 10:59, 19 August 2008 (UTC)
 * Image concerns have been met. Awadewit (talk) 14:27, 22 August 2008 (UTC)

Comments - Sources were fixed at the previous FAC. I spot checked again, and they look good. Links checked out with the link checker tool. Ealdgyth - Talk 12:51, 19 August 2008 (UTC)

Comments: Overall, the number and quality of the references looks very good, and think this article is worthy of passing FA status. But, there are some issues to address first. --Aude (talk) 15:48, 19 August 2008 (UTC)
 * In the "Advanced dementia" section, you might add that not only are Alzheimer's patients unable to feed themselves, they often cannot chew. Thus, they require their food to cut into small pieces and eventually it needs to be pureed.
 * "behavior problems such as wandering" is mentioned later in the article, in the "Psychosocial intervention" section. I suggest wandering behavior also be described in the Characteristics section.  Alzheimer's patients that do this might be searching for something, think they need to do something but forget what or where it is.  Or they may be trying to retrace their old routines, from when they were younger.  There are other reasons as well.  When they wander (especially with more advanced patients), if the doors are not locked, they may wander away and get lost.
 * The "Caregiving" could be a little more informative. The one and two sentence paragraphs don't seem adequate when I know there is more to say about this aspect of the disease.  One basic thing is that the demands of caregiving are overwhelming on relatives, and oftentimes Alzheimer's patients end up in a nursing home.  I know that nursing home care is mentioned in the social costs section, but it really has more to do with caregiving.
 * As I keep reading, I found the "Caregiving burden" section within the "Society and culture" section. It seems awkward to split caregiving up between two sections.  Just a suggestion, but the first paragraph of the "caregiver" section is good. ("The role of the main caregiver is often taken by the spouse or a close relative...")  I think this paragraph would fit in the "Caregiving" section.  Also, briefly mention about "Dementia caregivers are subject to high rates of physical and mental disorders" and perhaps put the rest of the details in the subarticle.  This way, (or some other way you think of) this material is not split between two sections.
 * There are no references for the first paragraph in the "Prognosis" section.
 * The article could use some copyedits. For example, in the "Epidemiology" section, the sentence "United States specific Alzheimer prevalence was estimated to be 1'6 % in the year 2000" is not worded very well.
 * Same section, "Epidemiology", the sentence ending with "increasing almost to 20% in the 75–84 group and to 50% afterwards[176]" lacks a period at the end of the sentence.

Reply to Aude:
 * Fixed Epidemiology section. Needed some copy editing for clarity.   Orange Marlin  Talk• Contributions 16:37, 19 August 2008 (UTC)
 * Added reference to Prognosis section.  Orange Marlin  Talk• Contributions 16:50, 19 August 2008 (UTC)
 * With regards to chewing. Do you have a source?  I've read over a lot of these references, and I've not seen that.  And my own personal original research would be that the AD patient would not be interested in eating rather than losing the motor skills to chew.  But I'm not sure.   Orange Marlin  Talk• Contributions 16:54, 19 August 2008 (UTC)
 * With regards to wandering, most of the references state that the prevalence of it with respect to AD is "difficult to assess." In other words, I don't think that wandering is a key characteristic for a differential diagnosis of AD.  Since there is no known trigger, it's prevalence and relationship to AD is unknown, it really is hard to use in a diagnosis.   Orange Marlin  Talk• Contributions 17:01, 19 August 2008 (UTC)
 * With regards to caregiving, I think the main article Caregiving and dementia has the detail you're requiring. In addition, we are trying to keep this article around the manual of style developed for medical articles at WP:MEDMOS.   Orange Marlin  Talk• Contributions 17:02, 19 August 2008 (UTC)

Responses - I'm not a medical expert, but approach this with several years experience working with Alzheimer's patients. So, that would be original research, but also confident that sources can be found for behaviors and characteristics that I'm describing.

Eating - In my personal experience, we had to puree food for many patients in the advanced stages of the disease. Some previously were able to chew and eat normal food, so it wasn't because of dental health. It was because they forgot how or lost the ability to chew. Before going to the puree food stage, their food would be chopped up and fed to them. And, in the more moderate stage, they can eat normally. Again, this is all personal experience and original research, but I'm quite sure sources can be located.

I think this ties in with where you say "Complex motor sequences become less coordinated as time passes, reducing the ability to perform most normal daily living activities." People lose the ability or forget how do do functions such as chewing and swallowing. I think apraxia relates to this somehow. Here are some sources I found, but I don't have access to much scientific scholarly medical articles to find even better refs.
 * "choking may occur if the client [patient] forgets to chew food sufficiently before swallowing" pg 360, Nutrition Essentials for Nursing Practice: Fifth Edition Revised
 * "The patient with dementia may forget to chew or swallow. ..." pg 126, Alzheimer's Disease: A Guide to Diagnosis, Treatment, and Management
 * "Clients in the later stages of Alzheimer's disease may be unable to swallow or may not know what to do when food is placed in their mouths", p. 167, Introductory Medical-surgical Nursing
 * Nutritional Needs of the Person with Alzheimer"s DiseasePractical Approaches to Quality Care . Journal of the American Dietetic Association http://linkinghub.elsevier.com/retrieve/pii/S000282239700758X
 * Management of severe Alzheimer's disease and end-of-life issues . Clinics in Geriatric Medicine http://linkinghub.elsevier.com/retrieve/pii/S0749069005700744

Wandering is a significant aspect and common characteristic of Alzheimer's. If difficult to use in diagnosis, you should say that. Many people in moderate-advanced stage don't sit still. They are often wandering around, will go outside and wander (if not restrained), or often moving about.
 * Several thousand scholarly articles talk about wandering in Alzheimer's patients.
 * Also with regards to wandering, other similar and common characteristics include hyperactivity.

Regarding caregiving, how does home care and professional care (e.g. nursing home) not relate to caregiving (or Treatment or Management)? It seems odd to me not to mention it in that section.

Another behavior characteristic possibly worth mentioning is that in moderate/advanced stages, Alzheimer's patients often can't tell the difference between hot and cold. That also means they may scold themselves with hot water. --Aude (talk) 18:04, 19 August 2008 (UTC)

Reply
 * Added information about feeding. Thanks to Aude for good references.   Orange Marlin  Talk• Contributions 18:32, 19 August 2008 (UTC)
 * With regards to Wandering, I still can't find any attribution where it's used in a differential diagnosis for AD, which is the basis of the characteristics section. I'm still looking however.   Orange Marlin  Talk• Contributions 18:34, 19 August 2008 (UTC)
 * I found a few articles that still indicate that it's not a diagnostic criteria, but it is a characteristic. I've added what appears to be the best reference.   Orange Marlin  Talk• Contributions 18:57, 19 August 2008 (UTC)


 * Support My concerns have been addressed - well done! Maralia (talk) 22:06, 23 August 2008 (UTC)


 * Support, having gone trough the article a few times, I could really understand this terrible disease, something i couldn't ever before, not even with my college's books. Cheers for a well writen, really claryfing and complete article! -- MakE  shout! 23:57, 19 August 2008 (UTC)


 * Support. Well done to those who have worked hard on fixing the sourcing issues and polishing the prose. I think this meets the criteria and is the sort of medical article on WP I'd be happy to direct someone towards. I have one criticism: the Pathophysiology and Pharmaceutical sections are on the borderline of being too technically detailed (and the former has a daughter article to satisfy those who want such detail). This is a long article, so expanding it with more explanations for the general reader may tip things too far. It may be worth looking at lay-friendly literature that NINDS and charitable organisations produce to get ideas of how to explain the concepts in a simple way, and (more importantly) identify which points are the vital ones to get across. Colin°Talk 17:35, 21 August 2008 (UTC)

From delldot   talk  : a few comments for now, more to follow: Lead and general
 * while fewer than three percent of patients live more than fourteen years  - I believe while should only be used as a connector when emphasizing contrast.   delldot   talk  05:48, 22 August 2008 (UTC)
 * Done: Simply converted to two separate sentences.--Garrondo (talk) 08:10, 22 August 2008 (UTC)


 * Someone once told me it's weak writing to use as to begin a dependent clause after a comma. Correct me if I'm wrong here.  delldot   talk  05:48, 22 August 2008 (UTC)
 * the less-prevalent early-onset Alzheimer's  - Are you sure the less-prevalent  takes a hyphen here? It looks weird to me but I don't know.   delldot   talk  05:48, 22 August 2008 (UTC)
 * for an indeterminate period of time - do you need of time here, or could you reduce redundancy by removing it? delldot   talk  05:48, 22 August 2008 (UTC)
 * I'm not sure if common, well-known terms like physician and Diagnosis need to be linked.  delldot   talk  05:48, 22 August 2008 (UTC)
 * From my point of view in such a long and complicated article it is better to overlink than infralink. It is better to link the same word in different sections since doubtly anbybody will read it from beginning to end. Regarding physician or diagnosis: they are common words, but may have a slightly different meaning in daily speech than in a medical article so it may be useful to link them. At the same time many non-english people might read this article and might find helpful those links (to an spanish speaking person the word phisician would lead him to think about physics and not medicine as we always use the word doctor).--Garrondo (talk) 08:07, 22 August 2008 (UTC)


 * Some words, such as Stress (biological), are linked more times than necessary throughout the article.  delldot   talk  05:48, 22 August 2008 (UTC)
 * See above.--Garrondo (talk) 08:07, 22 August 2008 (UTC)


 * >50 uses of the word patient. Even if you're not concerned about the MEDMOS thing about writing for professionals, that's a little repetitive.  There are some cases where it's used three times in two sentences.  delldot   talk  05:48, 22 August 2008 (UTC)
 * I have tried to reduce the number of times it appears.--Garrondo (talk) 07:41, 22 August 2008 (UTC)

Early dementia
 * It's not clear why we need an image of the Reagan letter. Is there something about the writing there that indicates or is characteristic of AD?  If so, could it be pointed out better?  delldot   talk  05:48, 22 August 2008 (UTC)
 * Finally eliminated: I'm sure there are signs of AD (for example the fact that every line goes bit more to the right, but I have not been able to find any references for it, so it would be OR).--Garrondo (talk) 07:41, 22 August 2008 (UTC)


 * may need assistance or supervision with the most complicated activities - the most seems a little over the top. Are these things measured objectively, or could you just say more?  delldot   talk  05:48, 22 August 2008 (UTC)
 * I have changed it for "cognitive demanding activities" which is the non technical way of saying activities with a high memory and executive functions demands. --Garrondo (talk) 07:41, 22 August 2008 (UTC)
 * I changed it to "cognitively demanding activities". delldot   talk  21:11, 23 August 2008 (UTC)

Moderate dementia
 * I think the sentence about violence and the one about disruptive behavior should be moved next to each other for flow. Alternately you might be able to remove the parts of the list in the disruptive behavior sentence and cover them in the other one. delldot   talk  05:48, 22 August 2008 (UTC)
 * Done:Rewritten to combine both sentences.--Garrondo (talk) 07:58, 22 August 2008 (UTC)

Advanced dementia
 * There's a switch to and from the future tense here. I'd remove all the future tense to reduce wordiness and keep it consistent.  delldot   talk  05:48, 22 August 2008 (UTC)
 * Macroscopically, Alzheimer's disease is characterised by loss of neurons and synapses in the cerebral cortex and certain subcortical regions.  - This sentence is a little weird because neurons and synapses are microscopic. Maybe tissue?  delldot   talk  05:48, 22 August 2008 (UTC)
 * Simply eliminated. Did not add anything.--Garrondo (talk) 07:41, 22 August 2008 (UTC)

Great work so far, more to follow from me no doubt. delldot  talk  05:48, 22 August 2008 (UTC)

More comments from delldot   talk  : Biochemistry
 * As I mentioned in an edit summary, 'or' is not great for synonyms because it's ambiguous. One example of a sentence in which this creates confusion is One of these fragments is beta-amyloid, or amyloid fibrils, which form clumps that deposit outside neurons in dense formations known as senile plaques.  Is this a synonym? 'Fibrils' is linked further down, not at first mention.  delldot   talk  22:29, 23 August 2008 (UTC)
 * Eliminated every "or" for synonyms. --Garrondo (talk) 07:19, 25 August 2008 (UTC)

Disease mechanism
 * This process may also lead to the formation of damaging reactive oxygen species, calcium influx, and apoptosis. - Calcium homeostasis disruption is already mentioned above. delldot   talk  22:29, 23 August 2008 (UTC)
 * Simplified the paragraph eliminated redundancies.--Garrondo (talk) 07:32, 25 August 2008 (UTC)


 * These inflammations are general markers of tissue damage - perhaps These types of inflammation, or Inflammation is a general marker''? delldot   talk  22:29, 23 August 2008 (UTC)
 * Done.--Garrondo (talk) 07:32, 25 August 2008 (UTC)

Genetics
 * It would be better if you could find a review (or reviews) to cover this whole sentence: These mutations have been discovered in three different genes: amyloid precursor protein or APP,[64] and presenilins 1[65] and 2.[66] I believe there's a general consensus among WP:MED participants that secondary sources are better than primary.  And if you're citing primary sources, how do you know it's just three?  As an added bonus, you get rid of the distracting mid-sentence ref clutter.   delldot   talk  22:29, 23 August 2008 (UTC)
 * Done.--Garrondo (talk) 07:37, 25 August 2008 (UTC)


 * Most cases of Alzheimer's disease do not exhibit familial inheritance. In this case genes may act as risk factors.  - In what case? Maybe In this majority of cases?  delldot   talk  22:29, 23 August 2008 (UTC)
 * Done. --Garrondo (talk) 07:37, 25 August 2008 (UTC)


 * there are other risk and protective factor genes - awkward. Maybe other genes act as risk factors or have protective effects?  delldot   talk  22:29, 23 August 2008 (UTC)
 * Done. --Garrondo (talk) 07:37, 25 August 2008 (UTC)

Causes
 * Avoid 'In a recent study' per WP:DATED. delldot   talk  22:29, 23 August 2008 (UTC)
 * Done.--Garrondo (talk) 07:43, 25 August 2008 (UTC)


 * I think you could transition better into the third paragraph about the tao hypothesis. It currently reads, Research has focused on tau protein abnormalities that initiate the disease cascade.[74] The tau hypothesis is supported by the longstanding observation that deposition of amyloid plaques does not correlate well with neuron loss. The last sentence of the second paragraph discusses amyloid plaques not correlating, so you could start out the third, deposition of amyloid plaques does not correlate well with neuron loss; this long-standing observation supports the tau hypothesis, the idea that tau protein abnormalities initiate the disease cascade. As an added benefit, you get rid of the awkward passive voice and introduce the name of the hypothesis in the lead sentence, in keeping with the earlier para.  But is it accurate to cast this as the definition of the tao hypothesis?  If not, can you provide the definition?  delldot   talk  22:29, 23 August 2008 (UTC)
 * Sounds perfect. Done. --Garrondo (talk) 07:50, 25 August 2008 (UTC)


 * Avoid useless, bulk-adding phrases like "It should be noted". delldot   talk  22:29, 23 August 2008 (UTC)
 * Eliminated. Feel free to eliminate any other you find or comment here.--Garrondo (talk) 07:43, 25 August 2008 (UTC)


 * It seems to me that the fourth para would be better broken up and integrated into earlier sections that have already covered the material--namely, the amyloid hypothesis and APOE para under Genetics. delldot   talk  22:29, 23 August 2008 (UTC)
 * I have simplified the par and combined it with the second par of causes, since they are reasons why the amyloid hipothesis is interesting.--Garrondo (talk) 08:03, 25 August 2008 (UTC)


 * There's some repetition between causes, genetics, and biochemistry, but I don't know if it can be avoided. delldot   talk  22:29, 23 August 2008 (UTC)
 * Frankly, neither do I.--Garrondo (talk) 07:43, 25 August 2008 (UTC)

More to follow. delldot  talk  22:29, 23 August 2008 (UTC)
 * The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.