The nicotine patch may present a treatment for Mild Cognitive Impairment and early Alzheimer’s disease. This study is new but the idea is old and there are other studies. Before you run off and ask for the patch or chew nicotine gum, let’s put this in the context of current medical treatment. The only FDA approved treatments for Mild Cognitive Impairment and Alzheimer’s disease are medications known as cholinesterase inhibitors (Namenda is not approved for early changes and works through an entirely different neurotransmitter). These medications have been available since 1993. They work by increasing the amount of the neurotransmitter acetylcholine in the brain. Acetylcholine has important actions on cognitive functions such as attention and some forms of memory. It is one of the neurotransmitters that act on the frontal cortex, amygdala, and hippocampus – structures very important to attention, […]
As discussed last week, depression is frequent in both community dwelling elders (by most standards those over 55) and those with dementia. Depression is more likely in dementias due to either vascular disease (strokes) or Lewy body disease than in Alzheimer’s disease (maybe there’s a benefit to short term memory loss). In short, depression is a common but not inevitable outcome for all of us as we age. What are the best treatments for depression? How well do different treatments work for those who are demented as well as for those who are not? Medications in the class called selective serotonin reuptake inhibitors (SSRIs) such as Lexapro, Prozac, Zoloft, Celexa, and Paxil are the most common medical treatment for depression. However, they are not a panacea – especially in the elderly and those who are demented. A large portion of […]
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 […]
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 […]
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 […]
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 […]
I was giving a talk about assessing memory the other day and I was asked a question that I have been asked often – “When will there be a cure for Alzheimer’s disease?” It is a difficult question to answer. I don’t want to sound as if there is no hope but I also don’t want to give false hope. I would be very pleased to be wrong about my belief that there will not soon be a cure for Alzheimer’s disease, cancer, heart disease, etc. First, consider that Alzheimer’s disease is a complex and progressive degenerative disorder of the brain. It is not the only complex progressive brain disorder. Other progressive brain disorders include but are not limited to Parkinson’s disease, multiple sclerosis, Lewy body disease, Pick’s disease, Huntington’s chorea, and primary progressive aphasia. All are subtle in onset, […]
There are currently two classes of medications that are FDA approved for treating Alzheimer’s disease. The cholinesterase inhibitors have been in use the longest. There are three drugs in this class Aricept (generic name is donepezil and it is now available in generic equivalent form), Exelon (generic name is rivastigmine and is available as either an oral tablet or as a patch), and Razadyne (generic name is galantamine). In general, despite conflicting opinions of efficacy and mechanism of action, drugs from this class tend to increase the level of acetylcholine in neurons and slow the rate of progression in many who can tolerate them. These medications are FDA approved for all stages of Alzheimer’s disease. There is no clear clinical benefit for one over another. The other medication is named Namenda (other brand names are Axura, Akatinol, Ebixa, or Memox […]
Alzheimer’s disease is being redefined to include three phases. An early phase where there are no obvious symptoms but changes are occurring in the brain. A middle phase where the problems are mild and the diagnosis would be called Mild Cognitive Impairment. A third phase where the changes are severe enough to be called dementia (i.e., independence is lost). The most sticking, and hopefully controversial, change is the addition of the early phase where there are changes in the brain but no symptoms of cognitive decline. This phase is defined by the use of biomarkers such as brain scans and tests of cerebral spinal fluid. The problems with this early phase include the fact that there are no standardized biological tests or results defining this phase. Second, 30% of people with amyloid plaques never develop clinical signs of Alzheimer’s disease. […]
We often focus on the cognitive changes such as memory that predict risk of decline and future dementia. But those who work or live with persons that ultimately obtain a diagnosis of Alzheimer’s disease know there is more to it than just memory. Equally as damaging are changes in what researchers at Rush University Medical Center are call “life space.” Life space is getting out and about. Those with restricted life space don’t venture far from home. One of the studies recently coming out of Rush’s longitudinal study of aging demonstrated a link between restricted life space and latter development of Mild Cognitive Impairment and Alzheimer’s disease. There were 1294 participants who had no mental decline at the beginning of the study. Participants were assessed after 4 to 8 years with detailed tests of cognitive functioning. Life space was defined […]
