To review from last week, the brain changes associated with Alzheimer’s disease are found 25 years before onset of symptoms. This finding is based on longitudinal study of families with a particularly aggressive form of Alzheimer’s disease and can probably be extrapolated to the late onset form of the disease. Furthermore, memory decline starts 10 years before symptoms and current medical screening (the MMSE) does not detect changes until 5 years before symptoms. In short, Alzheimer’s disease unfolds over a very long time. It gives us opportunity to develop a comprehensive wellness plan. What does this mean for me and for my clients? There is hope for better managing memory disorders such as Alzheimer’s disease. So often I hear “Why should I address memory issues as there is nothing I can do?” This adds to the feelings of hopelessness and […]
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The article I wrote two weeks ago, “Timeline for the Development of Alzheimer’s Disease,” got me thinking. I have known for some time that most progressive dementing conditions unfold over the time span of decades, but having concrete data makes the natural history of Alzheimer’s disease all the more clear. Brain changes associated with Alzheimer’s disease are found 25 years before onset of symptoms. One way to use these data is to label the changes as being Alzheimer’s disease early on. Indeed, this is what has been done with the new diagnostic criteria. There are many unfortunate effects of doing this. We do not know the base rate of those who have these brain changes and don’t go on to show symptoms of Alzheimer’s disease. Recall that imaging studies produce a high rate of false alarms when completed on general […]
Diabetes mellitus is associated with increased risk for developing Alzheimer’s disease. As with many areas of science, the data are inconsistent. Few studies have explored the impact of using diabetic medications and the development of Alzheimer’s disease. One study, Rotterdam study, showed that diabetics treated with insulin had a greater risk for developing Alzheimer’s disease. On the other hand, another study demonstrated that diabetics treated with insulin or oral antidiabetic drugs had a lower density of neuritic plaques (associated with Alzheimer’s disease) than individuals who do not have diabetes. A recently published study (Journal of the American Geriatric Society, 2012, 60, 916-921) explored the association between diabetes and the use of Metformin (a popular antidiabetic drug). The data were gathered from the United Kingdom General Practice database that was established in 1987. The study was completed by assessing the data […]
How long does it take to develop Alzheimer’s disease? A study published in the New England Journal of Medicine (July 11, 2012) indicates that a rare and aggressive form of Alzheimer’s disease produces measurable changes 25 years before clinical symptoms appear. There is a rare form of familial Alzheimer’s disease where carriers of a gene mutation are afflicted with symptoms in their 30s and 40s (20s for some). This early onset (autosomal-dominant) form of Alzheimer’s disease is inherited in a pattern similar to Huntington’s chorea. We inherit pairs of genes (one of two possible from each parent). In early-onset Alzheimer’s disease one gene is normal and the other carries the program for the illness. In carrier families half of the children with develop the disease and half will not. Fortunately, most cases of Alzheimer’s disease are late-onset – we are […]
I had two discussions this last week about the distinction between delirium and dementia. The first was with a client who underwent major surgery several weeks ago. I have been following this client for several years and several evaluations demonstrating excellent memory. Subsequent to surgery, the client developed a delirium which has cleared. However, for the first time his evaluation scores have dropped. Second, the discussion during Minder’s Keepers at the Alzheimer’s Support Network turned to the same topic. So let me try to clarify the difference between a delirium and a dementia. By the dictionary a delirium is “an acute mental disturbance characterized by confused thinking and disrupted attention usually accompanied by disordered speech and hallucinations.” By the same dictionary dementia is “usually progressive condition marked by deteriorated cognitive functioning with emotional apathy.” The critical thing to know is […]
Depression in midlife and late life is associated with an increased risk for developing Alzheimer’s disease and/or vascular dementia. The most recent study was completed on 13,535 members of Kaiser Permanente (a not-for-profit health plan with its home in Oakland, CA) and published in the Archives of General Psychiatry (2012, 69, 493-498). The design of the study was retrospective and included any member who had a medical diagnosis of depression or neurological based diagnosis of Alzheimer’s disease or vascular dementia. Records were reviewed from 1964 to 1973 (midlife) and 1994 to 2000 (late life). Depressive symptoms were reported in about 14% of those in midlife and about 9% of those with depressive symptoms in late life. Those who were depressed at midlife had a 20% increased risk of dementia (either Alzheimer’s disease or vascular dementia). Those who were depressed in […]
I am often asked about the use of medications to help with adjustment to memory care or skilled nursing facilities. For example, I was asked “would my mother do better in a memory care unit if she was given Xanax.” This is a logical and compassionate question. As with most persons who need the total services, her mother is mildly agitated and trying to plan how to escape now that she lives in a locked memory care unit. The intent of the question is to find out if use of a calming medication makes the adjustment easier. The issue of adjustment is complex and involves both the memory impaired person and their caregiver (spouse or child). In my experience it often takes several weeks or months to actually get settled with a move and all of the associated changes. Who […]
I am often asked “What is the most important thing to do to help my brain?” The evidence seems clear to me. Physical exercise is the key. The results of several recent studies add to my confidence. A prospective study of 700 elders (average age = 80) showed that vigorous exercise lowered the risk of development of Alzheimer’s disease and slowed cognitive decline. The study was a part of the Rush Memory and Aging Project. The prospective study (participants were enrolled and followed forward) was the first to objectively measure the amount of exercise rather than rely on self-report of amount of exercise. Data were analyzed after 3.5 years. The exercise effect was evident even after statistically adjusting for social activity, cognitive stimulation, depression, health, and APOE status (a “risk” gene for Alzheimer’s disease). But beware that the benefits of […]
Dementia comes in many forms and many stages. The term is so often used without a formal definition. Many confuse Alzheimer’s disease with dementia. The terms are not interchangeable. Dementia is a permanent and irreversible brain disorder that robs a person of independence. There are no current treatments that can reverse a dementia. There are no “pseudodementias.” If one is confused because of thyroid disorder or deficiency of vitamin B 12 and replacement makes the confusion go away, the person was not demented. There are many possible causes of dementia. Dementia many arise from a stroke or a head injury. Dementia is often associated with Alzheimer’s disease, Lewy body disease, and Parkinson’s disease. A less common (estimates are at about 50000 in the United States) and often more challenging form of dementia is called frontotemporal dementia. Frontotemporal dementia is a […]
Last week I discussed my concerns about using biomarkers and brain scans to diagnose Alzheimer’s disease. This week Medscape (www.medscape .com) published an article that suggested that “misdiagnosis of Alzheimer’s disease [in about two thirds of participants] based on positron emission tomography scan readings appears to be a troubling problem that could get worse as more amyloid-specific tracers become available.” This is the first study to my knowledge to present objective evidence suggesting caution about the use of brain scans to make a diagnosis of Alzheimer’s disease. The unique thing about this study was that the scans were done on community dwelling participants (mean age of about 64 years). Studies used to make the case for the accuracy of scans have so far only used highly selected participants – a sampling bias that distorts results. The bottom line is that […]
