UNDERSTANDING ALZHEIMER'S DISEASE

By Rosemary Black

Four million Americans are believed to have Alzheimer’s disease, a progressive brain disease that is the most common form of dementia. A startling 47 percent of those who reach 85 years of age will face a diagnosis.

Who hasn’t worried from time to time that Alzheimer’s disease might be setting in when we can’t find the right words or remember where we put the car keys?

What if I Forget My Keys?

Thankfully, everyday memory glitches most likely don’t mean you have Alzheimer’s Disease.  “Simple memory problems are okay,” says Joanne Koenig Coste, author of Learning to Speak Alzheimer’s (Houghton Mifflin).  “It’s normal to wonder where you put your glasses; it’s another thing to not remember that you wore glasses.”

Most people, starting at around age 40, experience a little difficulty recalling names, says Gary Kennedy, MD, professor of psychiatry at Montefiore Medical Center and Albert Einstein College of Medicine in New York City.  “Our brains are on overload because we know a lot of names by the time we reach age 40, so it can be hard to recall something immediately,” says Dr. Kennedy.  And, he continues, “Besides being overloaded with too much information, it is normal for memory to be affected by stress and sleep deprivation.”

What to Worry About

Some symptoms, though, are worrisome because they point to Alzheimer’s Disease.  “As people age, they achieve a higher likelihood of Alzheimer’s,” says Daniel Kaplan, director of social services at the Alzheimer’s Foundation of America, a nation nonprofit organization based in New York City. “In people over age 65, it is the most common cause –though not the only cause - of dementia.”  Dementia is actually an umbrella term for various symptoms that all relate to a steady decline in thinking skills.  Loss of memory, disorientation, problems with reasoning, and the loss of language skills are all common with dementia, as are agitation and anxiety. 

Alzheimer’s progresses at various rates and typically can last anywhere from three to 20 years.  The first area of the brain to be affected by the disease controls memory and thinking skills. As the years pass, other regions of the brain are affected and in the end the individual will need complete supervision and care.

Risk Factors

The greatest risk factor for developing late-onset Alzheimer’s (by far the more common form of the disorder) is the one we can’t do anything about--growing older.  Genetics also plays a part:  If someone in your family has the disease, in particular a parent or a sibling, you have a four-fold increased risk, explains Todd E. Feinberg, MD, professor of clinical neurology and psychiatry at the Albert Einstein College of medicine and chief of the Yarmon Neurobehavior and Alzheimer’s Disease Center at Beth Israel Medical Center in New York City. 

By contrast, early-onset Alzheimer’s is found in few families. In these cases individuals inherit specific genes that have been identified with Alzheimer’s. This condition can strike people as early as age 30 or 40, but fortunately, it is very rare.

High blood pressure and high cholesterol (which can contribute to strokes and heart disease) also may increase the risk for Alzheimer’s, says Dr. Feinberg. But claims that consuming aspartame, drinking out of aluminum cans or cooking in aluminum pots and pans cause Alzheimer’s are unfounded, he explains. 

Signs & Symptoms

The Alzheimer’s Association, based in Chicago and the leading nonprofit organization dedicated to Alzheimer’s research, describes 10 warning signs of the disease:

• Loss of memory
• Difficulty performing familiar tasks
• Problems with language
• Disorientation as to time and place
• Poor or declining judgment
• Problems with abstract thinking
• Misplacing things
• Changes in mood and behavior
• Changes in personality
• A loss of initiative

Although there is no clear-cut diagnostic formula, if you have several of these symptoms you should see a neurologist, advises Dr. Feinberg.  And while most of us have occasional trouble finding the right word, the person with Alzheimer’s forgets simple words or even substitutes unusual words so that it is difficult to understand him. It’s not uncommon for an individual with Alzheimer’s to put things into unusual places –the car keys into the sugar bowl, for instance, or the coffee pot in the freezer. 

Rapid mood swings –going from calm to tears to anger –can be a signal that Alzheimer’s is developing, especially if the mood swings appear in conjunction with a loss of initiative, such as sitting for hours in front of the TV and not wanting to do the usual activities.

How Is It Diagnosed?

If you have concerns, talk to your primary care doctor, who might recommend an appointment with a neurologist. This specialist will perform a physical, neurological and psychological exam as well as take a complete medical history to document serious illnesses, hospitalizations and family members’ illness and causes of death. The individual will be asked about medications, eating habits and alcohol intake.  The neurologist will also order an MRI to look for possible changes in the brain.

Scientists think that the deterioration of nerve cells that process store and to retrieve information might be damaged years before a person experiences symptoms. The brain of an Alzheimer’s patient shows two abnormal microscopic structures: amyloid plaques (clumps of protein that accumulate outside the nerve cells) and tangles (twisted strands of another protein that form inside brain cells).  It’s uncertain what exact roles these plaques and tangles have, but they are the focus of ongoing research.

Not everyone with Alzheimer’s- like symptoms turns out to actually have the disease.  As many as 15 percent of those who get tested do not have Alzheimer’s, says Coste. 

“There can be many other causes for the symptoms.  These include metabolic disorders, emotional problems, even drug interactions.”

What about Treatment?

As recently as 15 years ago, there were no FDA-approved drugs to treat Alzheimer’s.  But now four different drugs are available that can prolong and preserve mental functioning for at least a couple years, says Dr. Feinberg. While none will cure the disease, they might at least buy time for the patient and his family.

One group of drugs has been approved for use in beginning to moderate Alzheimer’s.  Known as cholinesterase inhibitors, these are meant to prevent the breakdown of the chemical in the brain that is important for memory and other thinking skills. 

In about 20 percent of the people taking one or more of these drugs, cognitive skills may slightly improve. Another 40 percent may decline more slowly than they would have without drug therapy, while the remaining 40 percent don’t get any benefit at all, explains Dr. Kennedy. 

Can Alzheimer’s Be Prevented?

Alzheimer’s has no cure, and there’s no clear-cut way to prevent it.  But at least 20 studies are going on right now, explains Bill Thies, PhD, vice president of medical and scientific affairs at the Alzheimer’s Association. Some studies are focusing on developing medications to alleviate symptoms. Other research, meanwhile, is directed toward finding drugs to stop the formation of amyloid plaques. “This research,” explains Dr Thies, “is trying to interrupt the pathology of the disease.”

Finally, there are certain physical and brain exercises you can do to keep your mind healthy and preserve memory.  Walking, swimming, and playing tennis are all great ways to keep active.  “If you are doing this, keep up with it and if not, it is never too late to start,” says Coste.  Also, reversing the patterns that you’ve used your whole life is a neurobic exercise that can be helpful in keeping your memory in tact.  If you’ve always written with your left hand, try writing with your right, says Coste. Take a different road to work.  If you always put your underwear on first and then your socks, change the order.  Crossword puzzles are terrific brain workouts, and if the level of puzzles you’ve been doing becomes difficult, don’t give them up, just do easier ones, says Coste. Also, listen to books on tape when you’re in the car –and try to keep TV-watching to a minimum, because it does nothing at all to help your brain stay fit.