Alzheimer’s Disease – More Insight

The August 1, 2019 issue of the journal Neurology carried a report of a team of researchers who have developed a blood test that can detect the presence of amyloid in the brain with 94% accuracy.  Amyloid is one of the chemical constituents found to be tangling up the neuron nerve communication pathways in humans with Alzheimer’s disease.

The article emphasizes this is currently a strict research tool. It is not a laboratory test that your physician or clinic can order or use to detect this form of dementia early. The results of the blood test correlate well with imaging studies currently in use. It is one small step in the investigation of the causes of this progressive, and fatal, heartbreaking disease and hopefully will allow us to evaluate Alzheimer’s at its earliest stages.

In a journal specifically dedicated to this disease entitled Alzheimer’s and Dementia, researchers at the University of California, San Francisco discussed the increased tendency of patients with Alzheimer’s disease to nap and sleep inappropriately and ineffectively. Previously it was felt that this inappropriate sleep pattern when observed was in fact a risk factor and marker for the development of the disease.

Lea Grinberg, MD and her co-authors feel it is a symptom of the disease instead. They believe that the disease process has already destroyed or inhibited those neurons (brain nerve cells) responsible for wakefulness and alertness. In the absence of this stimulation, patients nap and sleep ineffectively and inappropriately.

Imaging of these areas is difficult to obtain because of their location in the skull and brain but, on detailed studies, more tau protein deposition in these wakefulness areas is visualized.   This concept now allows researchers to zero in on other brain chemicals associated with wakefulness, alertness and sleep as a potential form of treatment of Alzheimer’s disease in addition to those chemicals in the cholinergic system that most medications attack.

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Tidbits on Dementia and Alzheimer’s Disease

A few years back I attended a lecture given by the director of geriatrics and memory / wellness program at the Massachusetts General Hospital. She began the program by asking the audience for a show of hands as to how many doctors and health care providers were suggesting that their older patients try brain teasers and brain games and puzzles to keep their geriatric patients mentally sharp and stave off dementia.  Everyone’s hand shot up indicating that we all were trying this method to stave off memory loss. She responded with, “Your patient’s will all be great problem solvers when we diagnose their dementia.”   She delivered a message of the importance of older patients maintaining a social network of friends and family that provided the stimulation rather than relying on computer games and brain teasers.  Like everything else in medicine, time and research modify your approach as to what works.

Two studies published in the Journal of Geriatric Psychiatry promoted the use of regular puzzle attempts by seniors. The first by Helen Brooker, Ph.D. from Exeter in the United Kingdom showing that older adults who regularly use word and number puzzles have higher cognitive functioning than those who do not.  She looked at 19,000 plus cognitively healthy individuals aged 50-93 years.  Participants self-reported their frequency of playing word puzzles.  Their frequency of performing word puzzles correlated positively with 14 measures of cognitive function.  They then compared individuals who used number puzzles against those who did not and found similar positive results for the puzzle participants.

Clearly being able to enjoy solving puzzles is correlated with beneficial cognitive performance. It is probably one piece of a larger puzzle including socialization, healthy lifestyle choices, genetics and human interaction that contributes to overall health.

What’s New in Dementia, Alzheimer’s

Alzheimer’s Disease is a form of dementia and considered to be a progressive, fatal neurologic disease. Medications to slow it down are successful in about 50 % of patients for a very limited amount of time (6 -12 months).  As Baby Boomers age and move into the retirement sector, we are always looking for positive data regarding the disease to offset the expected epidemic of dementia.  We have a limited amount of good news to report.

Japanese researchers report that they have developed several types of contrast material for imaging studies which will allow doctors to see accumulating plaque in the brain and possibly the tangles of neurons associated with the disease at a much earlier stage.  At the same time researchers now claim to be able to do a spinal tap and, by examining the spinal fluid, make an earlier and more accurate diagnosis. At this point there might not yet be an advantage to early detection of the disease but as research proceeds it may become an important advantage.

The British Medical Journal is reporting that cognitive decline actually starts in midlife. They studied a mix of 7,300 men and women at five years intervals beginning in 1997 and found a decrease in intellectual functions beginning at 45 years old. They concluded that “what is good for our hearts is also good for our heads.”  They stressed the importance of controlling hypertension, obesity and abnormal cholesterol as a way to prevent dementia.

You might ask why I consider the fact that dementia begins in midlife a positive?  It’s a positive because we have the ability to control our weight, blood pressure, cholesterol and exercise level. Anytime a disease is modifiable by how we live our life we are given the chance to prevent it or limits its impact. This fact is supported by a recent study published in the Archives of Neurology looking at individuals with a genetic variant which predisposes them to develop Alzheimer’s Disease.  They found that older adults with the genetic predisposition for Alzheimer’s Disease who exercised regularly, at or above the American Heart Association recommended levels, developed “amyloid deposits” on scans of their brain less than expected and in line with the general public who did not have a genetic predisposition to develop the disease.

These are small but positive steps in facing dementia. We can find it earlier and slow down or turn off genetic predisposition by living a healthy life.

Alzheimer’s Disease – Recent Data

Researcher’s gathered in Paris, France this month to present their data on new developments with Alzheimer’s disease.  In reviewing the meeting’s material, it is clear that much of what is “new” is old.

In the past we were taught that patients placed on medications for Alzheimer’s Disease would derive a benefit about 50% of the time. This benefit would last for six to twelve months.

One of the world’s authorities on this topic is Susan Rountree, M.D. of Baylor College of Medicine in Houston.  She has followed 641 patients since the late 1980’s.  In 2008 she reported that patients treated with medicines such as donepezil (Aricept) and rivastigmine (Exelon) survived about three years longer than patients who did not take these medications.  She re-analyzed that data, updated it and came to the conclusion that “using anti-dementia drugs doesn’t seem to prolong survival.”   She did however recommend continuing their use because her data showed that patients taking them had improved cognition and ability to function.

At the Paris event there was material presented that was not surprising but needs the legitimacy of a well planned study to turn theory into scientific evidence and fact.

The study showing that military personnel who suffered traumatic brain injuries during the Vietnam War were more likely to develop dementia has great implications for today’s veterans fighting in Iraq and Afghanistan where brain injuries are on the rise.  It will clearly help us as well in terms of long-term planning for the development of dementia in private citizens suffering from traumatic brain injuries.  It was not surprising either when certain medications were cited as being more likely to contribute to the development of Alzheimer’s Disease. This year’s culprits seem to be anticholinergic drugs which make a patient’s mouth dry and cause constipation.

What was not surprising were the studies that showed that elderly individuals who engaged in regular and vigorous physical exercise were less likely to develop cognitive impairment.  Those patients who get regular and vigorous exercise who show signs of cognitive problems declined at a slower rate than those who don’t.

While much of the material discussed confirmed the fact that healthy lifestyle is the best defense against this disease; there was also much hopeful discussion of research which is untangling the relationship between brain chemicals, development of plaques in the brain and its relationship to Alzheimer’s. On an encouraging note, we are much closer to early detection and therapeutic intervention than we were a decade ago.

An Alzheimers Epidemic is Inevitable

Alzheimers Disease is a fatal progressive neurological disorder with no known cause and no known cure. This year the first wave of the Baby Boomer generation will begin turning 65 years old. This means that an additional ten million individuals are now susceptible for developing this illness.

Alzheimers Disease is the most common form of dementia or loss of cognitive function.  Patients develop short term memory problems, withdraw from social situations and eventually reach a point where caring for themselves and survival is no longer important. Contrary to common belief, medications generally do not slow down or retard the progression of the disease.  The most common medications available to treat the disease only work in 50% of the people who take them with the effect lasting no more than 6 – 12 months in most. The medications are accompanied by numerous unpleasant side affect’s making patient compliance a problem.

Research into the cause and potential treatment and cure is proceeding rapidly but tangible benefits to the public are still a few years off.  This is a disease that not only affects and destroys individuals but does the same to families. There are 5.3 million people living with the disease at the moment. Those with the disease unknowingly put a major strain on their partners and family responsible for providing supervision and compassionate care while carrying on with their own lives.

The Alzheimer’s Association is leading the charge to make Americans aware of the coming crisis and is trying to find solutions for the prevention, treatment and cure of this devastating disease. At the same time it is trying to provide resources for the millions of uncompensated caregivers providing compassionate care and supervision of loved ones who are unable to care for themselves.

As time goes on, and more data becomes available, it is imperative that individuals see their personal physicians to discuss ways to prevent becoming a victim of this disease. It is also important to inform our elected officials of the need to continue funding for research in this area.  The Alzheimer’s Association website at www.alz.org is a comprehensive resource for information about the illness and related disorders.