I recently received a question about whether I stand by my concerns over the new criteria for diagnosing Alzheimer’s disease (original article from April 2011). The short answer is yes. Alzheimer’s disease presents in three broad ways. The first is an early stage where there are no obvious symptoms but changes are already occurring in the brain. This is the stage targeted by the new diagnostic criteria. The idea is that the failure of treatments in clinical trials to date is that we wait too long to start taking the drugs as the brain is too damaged to benefit. Successful treatment would delay or prevent progression to the next stage called Mild Cognitive Impairment where the problems are mild and there is no disability. Dementia is the third phase where changes are severe enough to cause loss of independence and […]
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The question that I have been confronted by this week is how I know if memory slips are normal for my age or signs of memory loss. This question is central to boomers as they approach aging. As you age you expect to change. You can’t run as fast. You can’t burn the candle at both ends as long as you used to. On the other hand, you know more, you are better at solving problems. Your brain will shrink (starts at 20 so not a big deal). Is it any wonder that you have small changes in the efficiency of your memory – senior moments? Mental and memory skills show up in predictable ways as we age but we do not normally lose our memory. Normal aging is associated with slower thinking and inefficient multi-tasking – working memory. This […]
An interesting article was published in the British Medical Journal (April, 2012). Based on recent data from the Framingham Heart Study, survivors of malignant cancers have a lower risk of developing Alzheimer’s disease and those with Alzheimer’s disease have a lower risk of cancer. The Framingham Heart Study is a longitudinal study began in 1948 with over 5,000 participants ranging in age from 28-62. A second phase of the study enrolled children of the original participants beginning in 1971. A subset of these groups (who were not demented) was followed for 10 years to provide the data for this study. The cancer survivors had 33% less risk of developing Alzheimer’s disease than comparison subjects who never had cancer. Interestingly, survivors of smoking related cancers were less likely to develop Alzheimer’s disease than survivors of nonsmoking related cancers – however, they […]
Last week, I discussed the latest on intranasal insulin and Alzheimer’s disease. In mid February, I mentioned in passing that I was asked about coconut oil as a treatment for Alzheimer’s disease. Since then I have been besieged by questions about coconut oil. Bizarrely, the two articles converge. Let me try to provide a reasoned response to whether to try coconut oil as a treatment for neurological disease. The idea of using coconut oil to treat Alzheimer’s disease gained popular attention through Alzheimer’s Disease: What if There Was a Cure: The Story of Ketones a recent book written by Dr. Mary Newport. The book is an extended case study of Dr. Newport’s husband. She was frustrated with current treatments and theorized that the problem behind Alzheimer’s disease was that brain cells were starved for glucose. This is the same mechanism […]
Everyone wants a simple fix for their memory and health. If only you could take a supplement that “fixes brain wiring so you dramatically improve your memory.” If only you could take a supplement that “restores lost neurotransmitters for a steel-trap memory.” Marketing is clever and plays to our fears with a mix of a few findings from tangentially related studies, “miracle memory molecules,” or “guarantees of your money back.” There are no short cuts. It takes time and effort to remain healthy. The latest Mayo Clinic Health Letter (March 2012) puts vitamin supplements in objective perspective without selling anything. Their review of well conducted research concludes that many vitamins and minerals that we used to think prevented diseases may not help after all. Furthermore, there are small but consistent findings that vitamins and supplements may cause harm – even […]
I am often confronted by questions about whether to take cholinesterase inhibitors such as Aricept, Exelon, or Razadyne. Anyone with a diagnosis of Alzheimer’s disease is better off taking one of these medications (it may not matter which one based on limited studies that directly compare these drugs) – if they tolerate them. The most troublesome early side effects are gastrointestinal, neuromuscular, and vivid dreams. Longer term use may slow heart rate and cause fainting. There are studies demonstrating the effectiveness of these medications in all stages of Alzheimer’s disease from mild to severe. For example, I conducted a study a few years ago on the effect of Aricept on total score on the Dementia Rating Scale. The Dementia Rating Scale provides an objective measure of severity of cognitive decline. A perfect score is 144 points and we should all […]
I was asked an interesting question during my last workshop. To paraphrase, “I go to my doctor and complain of anxiety, depression, memory …. Often, he or she gives me a prescription and reassures me that I will do better. What if I don’t want to take a medication? Is that my only choice?” Fortunately the answer is no. We live in a reductionist world. Biological interventions such as medications are helpful for many problems. Drugs change physiological systems. But behavioral and psychological interventions also change physiological systems. When I learn something new, I alter my brain. When I exercise, I alter my biology. We often lose sight of the fact that biology changes behavior and behavior changes biology. The best interventions focus on both sides of this equation. For example, there are medications that help manage changes in motor […]
A part of any good memory evaluation needs to address practical skills in addition to a thorough work up for treatable causes of memory loss and a thorough testing of cognitive skills. These questions take many forms and should be asked of both the person being assessed as well as someone who knows him or her well such as a spouse. Why ask an informant? Simply because the person with memory decline may forget that they forget. This is a major problem in early detection as forgetfulness extends to one’s own deficits. The best way to describe the changes that reflect Alzheimer’s disease is “first in last out.” This means that skills such as complex reasoning and problem-solving change much earlier in the course of the disease than personal care and orientation skills. With the current diagnostic push to identify […]
I have had several questions asked of me this week that are based on recent news about Alzheimer’s disease and cognitive decline. First, in response to my article on nicotine “Is Nicotine a New Treatment for Alzheimer’s Disease” (January 31), I was asked “Should I start smoking again?” The question arose in response to the recent finding that the nicotine patch may be helpful to those with mild cognitive decline or Alzheimer’s disease. The answer is clearly no. A study published in the Archives of General Psychiatry (February 6, 2012) links smoking to cognitive decline – especially in men. Smoking delivers a multitude of chemicals in addition to nicotine as well as carcinogens. The nicotine patch delivers only nicotine. Another client asked “Should I be giving coconut oil to my husband [he has significant dementia]?” She gave me an article […]
Memory loss can sneak up on families. Those with early and mild decline changes are adept at coping. Furthermore, others don’t notice until changes are more dramatic. You can even fool yourself. For example, you notice a “senior moment” and ask your friends and they often report the same problems. But how do you know a senior moment from beginning memory loss? The overlap between normal changes of aging and mild memory loss is substantial. There is a push for early detection of dementia including the addition of memory screening as part of Medicare’s annual wellness program. The problem is that the recommendations don’t go far enough for two reasons. First, the screenings are too superficial to find truly early changes. Consider a screening consisting of telling someone three random words that they are to recall later. The words are […]
