Alzheimer’s: Fighting Back

For wOw’s latest installment of its continuing series, Dr. Rachel Schindler of Pfizer demystifies – and humanizes – the nation’s newest epidemic

 

Alzheimer’s disease. What is it? How do you recognize it? When will it strike? How long will it last? How much will it cost? Why me?

wowOwow has been covering this dreaded disease that has afflicted 5.4 million people (and the largest majority, by far, is women) through personal stories, author’s narratives, group discussions, expert interviews, and chats with victims and caretakers.

Now, we are privileged to have access to one of America’s most informed authorities, Dr. Rachel Schindler, Clinical Disease Area Expert in Alzheimer’s and Vice President for Pfizer Inc. She has agreed to host a series that will run on the site over the next few months that we hope will shed light – and hope – on a fearsome disease.

1.  Is Alzheimer’s hereditary?

There is a hereditary form of Alzheimer’s disease (AD) called Familial Alzheimer’s Disease (FAD), but it is relatively rare, occurring in less than 5% of all cases.  It is caused by one of 3 gene mutations, which must be carried by either the mother or the father. If a person’s mother or father carries one of these 3 mutations, that person has a 50% chance of inheriting the mutation. If he/she inherits the mutation, the chance of developing FAD is virtually 100%. In these people, the disease usually starts early, say between the ages of 30 and 60, where the younger range is more rare.

Most people who have Alzheimer’s disease have what is called “sporadic” AD. The onset is typically later (sometimes referred to as “Late Onset AD”), usually after age 60. The causes of this most common form of Alzheimer’s disease are not completely known, but appear to include both genetic and environmental risk factors. If you have a family member with Alzheimer’s disease, your chances of developing Alzheimer’s disease are greater. This risk increases if you have two or more family members with Alzheimer’s disease.

2.  Are women more susceptible to Alzheimer’s than men?

Women are almost twice as likely to develop Alzheimer’s disease as men. In the United States, 3.4 of the 5.4 million people with AD are women. Age is the greatest risk factor for developing AD, and women tend to live longer than men. There have been some studies that suggest that the increased risk is related to the decrease in estrogen that occurs during menopause. However, studies using estrogen replacement therapy have shown mixed results on the benefits and risks.  Furthermore, more recent studies are consistent with the greater incidence of AD in women being due to their living longer.

3.  Is there a difference between normal forgetting and Alzheimer’s?

Yes. As we age, we are often not as quick at many mental and physical activities as when we were younger. And as with most parts of the body, the brain slows down as we get older. In addition to aging, stress and depression can affect memory. It is not uncommon to forget where you left your keys or parked the car. This is especially true in an age where there is so much information coming at us and we do so much multitasking that it is hard to pay attention to everything we are doing. If we don’t pay attention at the time we are parking the car because we are talking on the cell phone, we may never really register or think about the location where we left the car.

This is very different from not recognizing your car keys, forgetting you have a car, or forgetting that you arrived by driving the car.

4.  Is Alzheimer’s a form of dementia?

Yes. AD is one kind of dementia, of which there are many. It is also the most common cause of dementia. “Dementia” is the syndrome, or what you see clinically. It describes a state where someone has lost their ability to function due to cognitive impairment. But it does not connote the underlying cause of the cognitive loss. AD is a cause of dementia, due to a neurodegenerative illness that directly affects the brain. There are in fact over 100 causes of dementia. Some other examples include dementia due to multiple strokes (vascular dementia), Lewy Body dementia, dementia related to Parkinson’s disease, and dementia due to head injury.

5.  Are there any drugs that can alleviate the symptoms of Alzheimer’s?

While there is no cure for Alzheimer’s Disease, current treatments can help manage the symptoms, but they do not alter  the underlying disease.  There are 4 drugs approved for the treatment of Alzheimer’s Disease which work to help with the symptoms of memory loss and behavioral changes.  However, people will still continue to decline, even with these medicines. Three are in the same class, known as acetylcholinesterase inhibitors. They prevent the breakdown of a chemical messenger important in memory called acetylcholine. The 3 medicines are Aricept (Donepezil), Reminyl (Galantamine) and Exelon (Rivastigmine). The fourth medicine is called Namenda (Menantine) and has a different mechanism of action.

6.  Besides medication, are there any other options available to alleviate the disease?

There is increasing evidence that certain risk factors for heart disease may also increase a person’s risk of developing AD. These include high blood pressure, high cholesterol, poorly controlled diabetes, and a sedentary lifestyle. In addition, there have been studies linking lifestyle, including diet and exercise, to the risk of developing AD.

Some data suggest that regular physical exercise helps maintain a healthy brain. This may be at least in part related to the protective effects exercise has against heart disease, stroke, diabetes, and high cholesterol.

Some data have suggested that eating a Mediterranean diet (high in fish, healthy oils including omega 3 fatty acids, and nuts) may reduce the risk of AD. Dark leafy vegetables, fresh fruits, and whole grains are good sources of vitamins, folic acid, and antioxidants.

Keeping your mind active is also important. Think of the old adage, “Use it or lose it.” Doing anything enjoyable, whether taking a class (think education), reading, or doing crossword or other puzzles can help keep you mentally challenged. Being socially active can also be important.

7.  Is there an Alzheimer “gene”?

There are 3 gene mutations associated with the relatively rare familial form of AD. They are located on chromosomes 1, 14, and 21. The Apolipoprotein E (ApoE) gene, a cholesterol carrier protein in the blood, located on chromosome 19 has been clearly linked to an increased risk for developing the more common late onset, or sporadic AD. Scientists continue to search for an association between AD and other genes as well.

 8.  Now that we know Alzheimer’s is diagnosable, how early can it be “caught?” And what is the process?

While there is no single test for AD, the condition can be detected through a thorough medical evaluation. An evaluation by a physician should include a thorough history of the cognitive changes, including onset, progression, and the effect, if any, on the person’s ability to function in his or her usual activities. In AD, the onset is usually hard to pinpoint, and there is a slow progression of symptoms. An educational and vocational history is also important in understanding a person’s baseline and expected level of functioning. A general medical history is also important, including the presence of medical conditions such as heart disease, stroke, diabetes, hypercholesterolemia; other neurologic diseases or depression; a list of current medications; a family history of AD; a history of head injury. It is important that someone very familiar with the patient is present to help provide the history, especially of recent changes and events.

After a thorough history, a regular physical exam and neurological exam are performed, with an expanded mental status examination. Most physicians will administer some form of a brief cognitive test to evaluate areas including memory, orientation, attention, judgment, speech and language, and nonverbal skills. The most common screening test is the Mini-Mental State Examination (MMSE). While the MMSE is very useful for people who have significant memory loss, it may not be able to detect very early or mild dementia. In this case, the physician may use other more sensitive tests.

After a history and physical examination, blood tests are typically taken to look for underlying medical conditions which can affect memory and thinking and to help rule out other causes of dementia, such as changes in thyroid function and certain vitamin deficiencies.

Often an image of the brain is obtained, either a CAT scan or MRI, which can help rule out other causes of memory and thinking impairment, such as stroke. Other less common tests, especially in an atypical case, might include a SPECT or PET scan to demonstrate decreased activity in certain parts of the brain associated with AD — or an EEG, which can detect seizure activity or show general slowing of brain activity.

As there is not a single test for AD, the diagnosis is often made by the weight of the evidence of all of the information obtained. It is also important to rule out other conditions that can cause cognitive and neuropsychiatric symptoms, or worsen those due to AD. These conditions might include the use of certain medications or alcohol, hormonal changes, depression, multiple strokes (especially small strokes which may not have been clinically obvious), or other neurological diseases such as Parkinson’s or Lewy Body disease. It turns out that on average, including generalists and specialists, the diagnostic accuracy for AD is about 90%.

9.  If you suspect you or someone you love might be afflicted with Alzheimer’s, who should be on your medical team?

A good general physician, such as an internist or family practice doctor should be able to diagnose and treat patients with dementia due to Alzheimer’s disease, and is a good place to start. For more complicated or atypical cases such as earlier age of onset, very early stages, atypical history, the presence of comorbid conditions which could cause or worsen the dementia, or where a patient may require medications to alleviate the behavioral and psychiatric symptoms of the disease, a specialist such as a geriatrician, neurologist or geriatric psychiatrist might have more experience in diagnosis and management.

10.  What are the most important statistics people should know about Alzheimer’s?

  • Worldwide, approximately, 36 million people suffer from Alzheimer’s Disease and other dementias.
  • In the U.S., 5.4 million people suffer from Alzheimer’s Disease.
    • 3.4 of the 5.4 million Alzheimer’s disease sufferers in the US (about 63%) are women.
    • 16 percent of women aged 71 and older have Alzheimer’s disease or other dementia compared with 11 percent of men
  • 1 in 8 (or 13%) of people in the U.S. age 65 or older have Alzheimer’s disease.
  • Every 69 seconds, someone in the U.S. develops Alzheimer’s disease.
  • The first baby boomer turned 65 on January 1st of this year, and ten million baby boomers will develop Alzheimer’s disease.
  • If Alzheimer’s disease is not prevented by the year 2050, it is estimated that about 15 million people could develop Alzheimer’s disease. More than 60% of these individuals will be over the age of 85.
  • Caregivers of people with Alzheimer’s disease:
    • There are 15 million unpaid caregivers in the U.S.
    • Of people with Alzheimer’s disease who live at home, 80% are cared for by a family member.
    • Sixty percent of family caregivers and other unpaid caregivers are women.
    • Fifty percent of unpaid caregivers live with the person for whom they are caring.
    • Twenty-six percent of family caregivers have children under 18 years old living with them
  • The annual cost of Alzheimer’s disease in the U.S. is $183 billion.
  • The projected cost of Alzheimer’s disease in the U.S. by 2050 if no treatments are found is $1.1 trillion.
  • The worldwide cost of dementia was approximately $604 billion in 2010. This accounts for an average of about 1% of the global gross domestic product.
  • If dementia were a company, it would be the world’s largest by annual revenue, exceeding Wal-Mart (US $414 billion).
  • Up to 50% of people who have seen a medical professional and who have met the diagnostic criteria for dementia have not received a diagnosis. This is more common in earlier stages of the disease.

Source:  Alzheimer’s Association 2010 Facts and Figures and Alzheimer’s Disease International 2010 World Alzheimer’s Report

Dr. Rachel Schindler is a neurologist with subspecialty training in Neuropsychiatry and Behavioral Neurology. After completing her training, she was Director of Behavioral Neurology and Neuropsychiatry, Chief of Neurorehabilitation, and Assistant Professor of Neurology at the State University of New York at Stony Brook. There, she founded and directed The Neurobehavior and Memory Disorders Program, a comprehensive multidisciplinary program serving patients and their families with neurobehavioral and memory disorders related to Alzheimer’s disease and other dementias, head injury, stroke, epilepsy, and other neurological disorders. In 2000, she joined Pfizer, where she is currently Vice President, Clinical Disease Area Expert in Alzheimer’s disease. In addition to her leadership role in development of medications and setting strategy for AD, she has been involved in various U.S. and global initiatives and consensus groups to advance research, public policy, and the care of Alzheimer’s patients. Currently, she is the Co-Chair of the Alzheimer’s Association Research Roundtable and Chair of the Medical and Scientific Advisory Board of the Long Island Alzheimer’s Foundation.

6 comments so far.

  1. avatar Joan Larsen says:

    Over the years, I have watched Alzheimers begin and develop in those around me, making me alert to even the slightest changes in those I know.  One of the most difficult problems to confront, I have found, is to attempt to suggest that it is time to no long drive the car.  Ensuing conversations become hurtful – worse – and close relationships suffer. 

    BUT – as for tests that allow us to know very early that we are going to have Alzheimers – I see little point in them when little or nothing can stave the progress of the disease.  Instead, the person, I would think, is apt to give up or – at the very least – fall apart. 

    Instead of going that route for naught (or almost naught), my own long-term observations tell me that the longer road ahead is fraught with many dangers.  We are not coming out alive.
    Knowing those words of wisdom, our best course of action is to make every day count.   Live life to the fullest.  .  . and exercise your brain.  Being sharp, smart, attracts others to you and that is reason enough.  But – if we are told as we are here – that just PERHAPS that high brain activity will delay the inevitable – -well, it is good enough for me.

    We need to be apprised of Alzheimers so – if nothing else – we can help and understand others who are now in its throes.  But for us, let’s make each day the best we can make it and not worry about what we ultimately are not likely to change — until new research tells us differently.

  2. avatar Deeliteful says:

    The only reason I would want to know that I was probably going to develop AD would be to do something to prevent it. As Joan so eloquently posts, there’s not much, if anything, one can do to prevent AD.

    I suppose one could make preparations for the onset, but what would those preparations be? I believe my maternal grandmother had Alzheimers – she died in 1987 -, one of my maternal aunts definitely has it – she’s 81 and has been in a nursing home for several years -, my mother and another of her sister’s have some of the symptoms of the disease, but maybe, what’s going on with them is a part of aging. My paternal grandmother was as sharp as a tack until the day she died at age 84.

    Does my personal history mean I have better than a 50/50 chance of developing AD? Maybe, but as Joan said what should I do about it? Not much, except make each day the best I can and not worry about it.

    I am very sensitive to changes in my older loved ones, but would I notice a change in myself? Probably not. I do think articles like this one are informative and hopefully will lead to more research and possible cure of AD. The predictions for the year 2050 seem to suggest otherwise. Let’s hope that is not the case.

  3. avatar Linda Myers says:

    What is the purple shading that seems to overtake the rest in the disease?

    • avatar Chris Glass` says:

      Linda, The dark areas are where the brain is shriveling up. A brain not affected is plump showing activity. In Alzheimer’s or dementia it shrivels and begins to darken as those areas are lost to the person with the dementia.

  4. avatar Chris Glass` says:

    In some ways I find that family and friends are too eager to jump on the band wagon to “diagnose” Alzheimer’s or dementia. We can’t forget that many other conditions from Parkinson’s to depression or head injuries can mimic those symptoms. If something seems out of place a friend or loved one should be fully evaluated medically including a neurological work up. Even those who do develop a form of dementia do so at different rates.

    I have noticed that as we age peculiar personal traits become enhanced as part of the aging process. Noticing them more clearly does not mean Alzheimer’s. As we age we have more on our plates, the care of elderly family members, children as well as worries about retirement or health. It is natural not to recall a name or occasion instantly. Is that incipient dementia or an over full plate of responsibility? The diagnosis should come from a panel of experts.

  5. avatar J Holmes says:

    Thank you for making this a regular feature - I learn something new every day.