My last two articles focused on medical treatments for Alzheimer’s disease. Cholinesterase inhibitors donepezil (Aricept), Rivastigmine (Exelon), galantamine (Razadyne), produce statistically significant but small effects. Namenda (memantine) appears to only work in moderate to severe dementia. Attempts to find effective drugs that modify the disease process have so far failed. As long as there are no powerful treatments for Alzheimer’s disease, we need to consider strategies for delaying the onset. Physical exercise and diet are the best strategies for delaying onset. The so called Mediterranean diet may be an effective way to slow down the progression of Alzheimer’s disease based on epidemiological evidence. Although there are many variants, the main components of a Mediterranean diet are high consumption of fruits, vegetables, nuts, legumes, cereals, and fish. Olive oil is the central source of monounsaturated fat (canola oil is the main […]
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Dr. Beckwith will conduct a three hour workshop (fee $100 per person/$150 per couple – limited seating) in Naples October 17 (call 591-6226 to register).
Placebos have powerful effects on the mind and the body. They can produce improvements, cause side effects, and reverse the actions of medications. Indeed, placebos are so powerful that medications are approved by the FDA only if they are proven better than placebos in clinical trials. For example, Namenda was not approved for treatment of mild to moderate Alzheimer’s disease because it did not do better than placebo. But treatment versus placebo effects is complicated as is demonstrated by teasing out whether antidepressants work better than placebos in treating depression. Irving Kirsch (2008) completed a technical review (called a metaanalysis) of antidepressants and placebos as they are compared to no treatment. Among his findings were that some get better by treatment with active medications. Some get better with placebos (as many as 30% of study participants by some estimates). The […]
Behavioral problems like aggression, agitation, and hallucinations are often treated with medications called “antipsychotics” or “neuroleptics.” Newer medications in this class include Risperdal, Zyprexa, Geodon, Seroquel, and Abilify. Older medications, including Thorazine, Haldol, and Melleril, are not widely used today. The benefits of these medications are modest at best. However, the list of adverse effects continues to grow. A recent study adds to the concerns with use of these medications to treat behavioral problems associated with dementia. Antipsychotic medications caused significant decline in remaining cognitive skills. There was a significant drop in neuropsychological test scores when compared to placebo after 12 weeks of treatment. It is unclear from the results whether the decline is permanent and would be reversed by cessation of the drugs. This adds another element to the growing concern over the use of antipsychotic medications to manage […]
Pat Summitt is a legendary coach and achiever. She has won more major college basketball games than any other coach in the history of the game. She announced yesterday that she has had memory problems, at least over the past year. Furthermore, she announced that she has a family history of dementia. Her story will hopefully encourage others to seek early assessment and treatment for memory issues. However, the condition she described is not a dementia. Dementia means cognitive impairment that compromises the ability to work and live independently. Ms. Summitt would not be able to continue to coach if she were already demented. Her condition would be more appropriately referred to as a confusional state or forgetfulness. She is still in control of her future and can plan to compensate for memory changes and continue to work. She has […]
Undergoing general anesthesia may cause cognitive decline especially in the elderly. Delirium and postoperative cognitive decline are the two most common untoward effects of surgery. Delirium is transient and obvious but may last days to weeks. Delirium may occur in 10% of postoperative patients. Postoperative cognitive decline is a more long lasting condition, often subtle, and neuropsychological testing is necessary to detect these changes. One recent study estimates that postoperative cognitive decline occurs in 35% of those under 40, 56% of those 40-59, and 69% of those 60 and older at one week after surgery. By three months the rates decline to about 7% in those under 40, 13% in those 40-59, and 24% of those 60 and older. Another study indicated that about 25% of all surgery patients experience postoperative cognitive decline at one week. Fortunately, this rate drops […]
The Alzheimer’s Association International Conference met in Paris in August, 2011. This is an annual meeting that brings out all of the latest research findings. The first results from the Dominant Inherited Alzheimer’s disease study indicated that that there are measurable changes in cognition, biochemistry, and imaging up to 20 years before symptoms appear. These results are based on studies of high risk individuals who are carriers of a mutant gene that induces early onset Alzheimer’s disease that may develop as early as the 30s and 40s. These findings again confirm that Alzheimer’s disease comes on over the course of decades and that treatment approaches must be proactive. If you wait for symptoms, you lose your advantage. New research suggests that traumatic brain injury doubles the risk of dementia. These findings are based on a retrospective study of older (55 […]
Depression has been associated with dementia. For example, the Framingham study followed 949 men and women (average age was 79) for 17 years. There was a 50% increased risk of developing a dementia in those reporting symptoms of depression during the study. Similar findings are evident from the Baltimore Longitudinal study of aging. Depression robs motivation and enjoyment, drives poor self-esteem, adds to the discomfort of pain, and produces social isolation. Depression also distorts memory. In very severe depressions, one is so focused on inner feelings of despair that there are few memory resources left to process information from their surroundings. As if this weren’t enough, people who develop a depression in later life are more at risk of experiencing cognitive decline. There are four explanations for the association of depression and cognitive decline. First, depression is a symptom of […]
The American Heart Association and the American Stroke Association have issued a 42 page statement regarding the vascular contributions to cognitive impairment and dementia that was published in the July issue of Stroke. Although Alzheimer’s disease has received the most attention vascular changes make significant contributions to cognitive decline and should be routinely addressed in clinical practice. The statement suggests a new term, “vascular cognitive impairment,” to incorporate the varied cognitive disorders associated with stroke ranging from mild cognitive disorders through dementia. Don’t be confused by the introduction of a new term as accumulating evidence indicates that vascular factors also play a role in neurodegenerative cognitive disorders such as Alzheimer’s disease that develops latter in life and the recommendations below apply to all of us. Two criteria are needed to diagnose vascular cognitive impairment: (1) neuropsychological evaluation to demonstrate cognitive […]
One of the most frequent questions I am asked is “What is the difference between Alzheimer’s disease and dementia?” Dementia is a general term that is often misunderstood. Dementia refers to mental deterioration to the point that one can no longer do higher level mental tasks like balancing a checkbook, using a computer, or preparing a meal. In more severe forms of dementia, one may no longer be able to tend to personal needs such as bathing, toileting, or dressing. In other words, dementia refers to mental decline where one can no longer function independently (i.e., needs at least some level of external care). Dementia refers to the severity of the mental deterioration. Dementia is caused by a loss of skills that used to work well (e.g., finding your way around, paying bills, dressing). There are many possible causes of […]
