It starts with little things.

First they can't find their underwear or toothbrushes, then they can't remember where their houses are. Eventually, they don't recognize their spouses or children and may violently attack family members.These are some of the signs that a person has Alzheimer's disease. The condition is caused by the lack of acetycholine in a patient's brain. Acetycholine is a natural alkaloid important in the transition of nerve Impulses.

The lack of acetycholine causes Alzheimer's disease patients to lose their short-term memories, although recollections from long ago may remain intact. Other symptoms of the disease are pacing, loss of appetite and violent attacks on other people.

Efforts to reintroduce the acetycholine to patients' brains have been unsuccessful, according to Vickie Lancaster, supervisor of CareWest-Orem's Alzheimer's program.

"The brain won't let foreign matter pass through," she said. "It is very good at protecting itself."

Of elderly people suffering memory problems, about 13 percent suffer from Alzheimer's disease, Lancaster said.

"And one of the hardest things is Alzheimer's can only be diagnosed in an autopsy," she said. "Tests on live patients can never prove they have Alzheimer's, they can only prove the problems aren't being caused by something else, like a brain tumor."

Lancaster said families often put the patient through three or four batteries of expensive tests.

"They hate to give up if the condition might be something curable. With Alzheimer's, you can never be sure."

Lancaster counsels patients at the nursing home where she works and meets with the Alzheimer's Association support group, which meets monthly in Provo.

One of the hardest things for a family to do is accept that there is a problem, she said.

"Maybe a spouse talks about what has been happening, but the children don't believe it. In the early stages, most Alzheimer's patients can fake it for a while. And even when family members see the signs, they may try to deny the problem as long as they can before asking for help."

After family members have admitted there is a problem, they may feel very angry and have a feeling of loss.

"The person they knew is gone," Lancaster said. "An Alzheimer's patient can ask you something one minute and ask the same question a minute later. It is hard to deal with that behavior from someone who raised you or whom you have lived with for 50 years.

"We tell people the most important thing is to keep the good memories separate from what is happening."

The worst guilt is from putting a family member in a nursing home, she said. "Nothing is harder. It's just awful."

There is no treatment and no cure for Alzheimer's, except for calming drugs, she said.

"By the time patients are identified, they usually are incapable of understanding their disease," she said. "Our counseling is for the family."

Lancaster said that although Alzheimer's disease can traumatize a family, she never has seen it pull a family apart.

"Usually it brings them closer together together."

Alzheimer's Association support group members meet to share information on the disease and discuss how to cope with changes in their patients. They also address guilt they may feel about their situations, whether they care for a patient at home or have placed one in a nursing home.

November is National Alzheimer's Disease Month, Lancaster said. Various health care agencies will sponsor a seminar on Alzheimer's disease on Nov. 15 at the Excelsior Hotel in Provo.

"We want to get information to people with a patient in their family and to the general public. We want a better understanding of this disease.

"And we hope we can attract more money for research."

For more information on the seminar or Alzheimer's disease, call CareWest-Orem, 225-4741. For literature on the disease, call the National Alzheimer's Disease Association, 1-800-621-0379.