With more than five million Americans living with Alzheimer's, chances are you know someone who has been affected by the disease. And although one in three seniors dies with Alzheimer's or another form of dementia, it is not, in fact, a normal part of aging. Doctors still haven't found a breakthrough medication to stop the progression of the disease, but we do know that a person with Alzheimer's will start experiencing changes in their brain 20 years before they show any symptoms. So in addition to finding a cure, doctors are in a race to identify the disease in its earliest stages so they can intervene before the illness sets in.
Alzheimer's and Dementia:
What is the difference?
According to alz.org, dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Alzheimer's disease, however, accounts for 60 to 80 percent of these cases. "Dementia is like an umbrella, and underneath are the different types," explains Leslie Anderson, CEO of the Alzheimer's Association, Georgia Chapter. "But Alzheimer's is the most prevalent by far."
So in other words, dementia refers to a symptom like language difficulty, loss of recent memory or poor judgment, but not the disease itself. Alzheimer's is one type of dementia. "The term [dementia] does not imply a specific underlying cause or disease," says Dr. James Lah, Director of the Cognitive Neurology Program at Emory University School of Medicine. "Alzheimer's disease is a well-defined entity with specific clinical, pathological and molecular features, and it is the most common disease causing dementia in adults."
And although Alzheimer's disease accounts for a majority of cases of dementia, other disorders that cause dementia include vascular dementia, Parkinson's disease, dementia with Lewy bodies and frontotemporal dementia.
Who Is Affected?
Because dementia is most often caused by Alzheimer's, and Alzheimer's risk is most often influenced by age, older adults are at the greatest risk. "Starting at about 65 years of age, one's risk of having Alzheimer's doubles roughly every five years until the risk reaches 40 to 50 percent in those over age 85," Dr. Lah says.
Today Alzheimer's is the sixth leading cause of death in our country, and according to Anderson, it's the only disease in the top ten whose numbers are going the wrong way. "Over the last eight years, its prevalence has increased by 66 percent," she says. "Now our biggest concern is the baby boomer generation. Every day, 10,000 people are turning 65, which means that every day, one in eight of those people will develop Alzheimer's."
Lowering Your Risk
According to Dr. Shravantika Reddy, who specializes in geriatric medicine at WellStar Medical Group, the most common risk factors for Alzheimer's disease are age, family history, head trauma, fewer years of formal education, late onset of a major depressive disorder, hypertension, diabetes and obesity. "Previously it was thought that vitamin E and ginkgo biloba extract helped [lower risk]. However, recent studies show that they have no effect in treatment," she says.
There is also new evidence that wheat, carbs and sugar may have adverse effects on our brains. In his book, "Grain Brain: The Surprising Truth About Wheat, Carbs and Sugar – Your Brain's Silent Killers," neurologist David Perlmutter suggests that carbohydrates can cause a number of issues including chronic headaches, depression, ADHD and dementia. He makes the case that a wheat-free diet can preserve brain health and functioning and may even reverse the process of certain brain diseases.
If you or your relative is showing signs, you may want to consider an early detection treatment like Brain SPECT Imaging, which measures the blood flow and activity patterns in the brain. "One of the biggest challenges with Alzheimer's is that the disease is very progressed by the time a person experiences symptoms," says Dr. Jay Faber, who offers this treatment at Amen Clinics. "With Brain SPECT Imaging, we can see the beginning of the disease process as early as 20 years before symptoms occur. It is also a powerful tool for relatives of an Alzheimer's patient, who may be fearful of developing the disease."
While nothing we know of yet can stop Alzheimer's disease from occurring, there are things we can do to delay the onset of symptoms. "It's important to manage your numbers like weight and cholesterol," Anderson says. "Anything that is heart healthy is also brain healthy. Studies have shown that the Mediterranean diet can be beneficial. Exercise can also slow progression of disease, so it's important to stay active mentally and socially by engaging our brains. If you can get that cognitive reserve built up, the symptoms won't progress as fast."
Dr. Lah recommends activities such as regular bridge clubs, playing musical instruments and dancing. "These work best if the activities are enjoyable pastimes that have been cultivated over many years," he says. "Don't wait until you think your memory is slipping and force yourself to do a bunch of things that you hate to do. Find mentally challenging and stimulating activities that you enjoy doing and pursue them as lifelong activities."
People may also want to think twice about early retirement. "A French study has shown that dementia risk can be reduced by delaying retirement," Anderson says. "For every year of additional work, the risk of dementia is reduced by 3.2 percent."
Living with the Disease
It's no secret that Alzheimer's and dementia can take just as big of a toll on the caregivers as it does on the person with the disease. This is why it is so important to find a support system as soon as possible. "As soon as you get diagnosed, we like to be the first phone call," Anderson says. "We have a 24/7 help line, and we can help with things like financial planning and assisted living so people don't have to do research themselves."
The Alzheimer's Association can also help with the day-to-day challenges that caregivers might not be equipped to handle. "We're really concerned with wandering," Anderson says. "Seventy percent of people who have the disease will wander at some time. Fortunately we have something called Mattie's Call. It's like an Amber Alert but for people with dementia, and it helps get the emergency alert out to the media."
Advances in a Cure
Most clinicians agree that the biggest advances in the fight against Alzheimer's are the launches of the first prevention trials. "[We're] looking at the damage done and trying to find ways to slow that process, or even reverse it," says Dr. Lisa M. Billars, a neurologist with Kaiser Permanente of Georgia. "Researchers are working on targeting the beta-amyloid and tau proteins which accumulate in the brain tissue of people with Alzheimer's disease, as well as targeting inflammatory mediators. Understanding how blood sugar levels and other metabolic mechanisms affect the brain is another pathway for advances in research."
While there are currently no new drugs available, there are a number of drug studies underway for the treatment of dementia. "In the meantime, several non-medical behaviors have become well established as potentially impacting cognitive disease," Dr. Billars says. "These include increasing social contact with others, getting regular physical activity, getting adequate sleep and engaging in cognitive challenges like 'brain games' such as crosswords, Sudoku and computer-based modules. Certainly following up for treatment of chronic medical conditions is important as well."
Where to Go for Help
If you or a loved one is showing any signs of memory loss, first make an appointment with your family physician or general practitioner. "Lots of things can cause memory loss that are not necessarily due to dementia, for example, medication side effects, stroke, depression or infection," says Dr. Allan Levey, chair of the Department of Neurology at Emory University School of Medicine. If your physician cannot rule out dementia, however, you will generally be referred to a neuropsychologist for further testing. And if you still suspect dementia even though your physician has ruled it out, get a second opinion. "Request a consultation by an expert, because people are often right when they suspect memory loss."
The next step is collecting information about your symptoms for your doctor. "Often this involves meeting with a family member who may have insight," Dr. Levey explains. "Then we assess memory and thinking ability. For example, we'll ask the person to draw a clock and then ask them to remember three words. Then we'll ask them to recall those three words after drawing the clock. This is usually coupled with a questionnaire for family members about their functional abilities. Functional abilities are critical to how advanced somebody is in their illness, so if somebody doesn't need much help driving or managing finances, it is pretty mild. If they can't live independently, it is more severe."
The Future for Alzheimer's and Dementia
Until doctors find a cure, it's important to remember dementia isn't just an "old person's disease." It can start attacking the brain in people as young as their thirties and forties, so if you or a loved one is experiencing memory difficulties or changes in cognitive skills, don't ignore them. The earlier the diagnosis, the greater the chance of delaying the onset of subsequent symptoms and getting the most out of new medical treatments as they come available.
Alzheimer's is the most common cause of dementia that causes problems with memory, thinking and behavior. There is no current cure for Alzheimer's. However, a number of studies promise to lead to new treatments.
Vascular dementia is a decline in thinking skills due to reduced blood flow to the brain. It is generally considered the second most common cause of dementia, accounting for 20 to 30 percent of the cases, but the FDA has not approved any drugs to treat vascular dementia.
Parkinson's disease dementia is an impairment in thinking that ultimately affects many people struggling with Parkinson's disease. To date, there are no treatments to slow or stop the brain cell damage caused by Parkinson's disease dementia, so most physicians focus on managing the symptoms with a number of medications including antidepressants and cholinesterase inhibitors.
Dementia with Lewy bodies (DLB) is a type of progressive dementia that leads to decline in thinking, reasoning and independent function due to abnormal deposits that damage the brain over time. Most experts estimate that dementia with Lewy bodies is the third most common cause of dementia, accounting for 10 to 25 percent of cases. Currently there are no treatments that can slow or stop the brain cell damage caused by dementia with Lewy bodies.
Frontotemporal dementia (FTD) is a group of disorders caused by progressive cell degeneration in the brain's frontal or temporal lobes, which control planning and judgment, emotions, speech and certain types of movement. FTD was once considered rare, but it's now thought to account for up to 10 to 15 percent of all dementia cases. Antidepressants and anti-psychotic drugs are the most common medications used to treat behavioral FTD symptoms. However, none of these drugs have been approved by the FDA for use in FTD.
— Information courtesy of the Alzheimer's Association
Leslie Anderson, The Alzheimer's Association - www.alz.org
Dr. Lisa M. Billars, Kaiser Permanente of Georgia - www.kaiserpermanente.org
Dr. Jay Faber, Amen Clinics - www.amenclinics.com
Dr. James Lah, The Emory ADRC - www.med.emory.edu/ADRC/
Dr. Allan Levey, Emory University School of Medicine - www.emoryhealthcare.org
Dr. Shravantika Reddy, WellStar Medical Group - www.wellstar.org
To raise money for the Georgia Chapter of the Alzheimer's Association, local Atlantans will partner with professional dancers for the 5th Annual Dancing Stars of Atlanta event on Saturday, May 3, 2014. Vote for your favorite dancers by donating money to the fundraiser, which takes place for one night only at the Loews Atlanta Hotel. For information about the event, please visit www.alz.org/georgia