June is Alzheimer's and Brain Awareness Month
It is estimated that 5.8 million Americans are living with Alzheimer’s. While the statistic is sobering, there’s even more dire news: that number is expected to double by the year 2050, barring the development of medical breakthroughs to prevent, slow or cure it, as our growing population lives longer.
According to the Alzheimer’s Association, out of the total U.S. population, approximately 1 in 10 people over the age of 65 will develop Alzheimer’s, and 1 in 3 people over the age of 85 have Alzheimer’s.
As the sixth leading cause of death in the U.S., the average life expectancy of someone who has been diagnosed with Alzheimer’s is approximately five to 10 years, but everyone is different. Each case of Alzheimer’s runs its own course, and patients can live up to 20 years with the disorder.
Dr. Lane Tinsley, a neurologist in Oklahoma City, shares important facts you need to know about Alzheimer’s disease.
What Is Alzheimer’s?
Alzheimer’s disease is the most common type of dementia. It is a progressive brain disease that leads to issues with memory, problem solving and information processing.
"Once someone has been classified as having Alzheimer’s dementia, that means they are probably experiencing short-term memory loss, but the long-term memory from their childhood years past is still working," says Dr. Tinsley.
To evaluate Alzheimer’s, physicians examine activities that impact the ability of a patient to remain independent. Activities of daily living (ADL) include eating, bathing, using the restroom, getting dressed and personal hygiene.
Instrumental activities of daily living (IADL) are also assessed and include activities like managing medications, preparing food, managing money, grocery shopping, balancing a checkbook and housework.
"People with Alzheimer's typically start having difficulties in the IADL category, such as having a hard time remembering to take their medications or pay their bills," Dr. Tinsley says. "As the disease develops, more personal and self-care issues arise. People with Alzheimer’s are not typically safe to live completely independently; they need someone to help them."
Symptoms and Diagnosis
Alzheimer's disease usually presents in late middle age or old age with symptoms like impaired memory, impaired communication, disorientation and a decline in everyday living skills. Alzheimer’s disease usually progresses in three stages: mild, moderate and severe.
However, another stage, called "pre-clinical Alzheimer’s," means changes in behavior aren’t present, but brain changes can be seen. CAT scans, MRIs and PET scans can be used to image a changing brain. Sometimes a "mini" mental exam is given, which is a 30-point test that helps identify troubles with memory, problem solving, counting and more.
Modern medicine still does not completely know what causes Alzheimer’s, though a genetic factor is one small part of the picture.
"Having certain genes usually means a person has a higher risk of developing Alzheimer’s, but it is not a 100 percent guarantee," says Dr. Tinsley. "There are many other environmental and health-related problems that might play role, such as high blood pressure, smoking, diabetes, heart disease and strokes, to name just a few."
Four different genes that are linked to Alzheimer's can be tested in the blood, but "just because someone has a mutation in one of these four genes does not mean they will develop the disease," says Dr. Tinsley. "At this time, these tests are more for research purposes."
Likewise, not everyone with memory issues requires a blood test. A neurologist or neuropsychologist will diagnose Alzheimer's based on an evaluation. Information from the patient and family is compiled together to make an assessment, and standardized memory tests are performed before making a diagnosis. Most people who are diagnosed with Alzheimer’s do not get tested for the Alzheimer’s gene.
Dealing with Alzheimer’s
When a loved one has been diagnosed with Alzheimer's, learning the “new normal” is the hardest thing for caregivers to do.
"We often wish and hope that our loved ones will just go back to the way they used to be and this, unfortunately, this doesn't happen," Dr. Tinsley says. "The first question I get asked is 'how much time does my loved one have?' but that is something we can’t predict. In general, I have the family look at the prior one or two years to see how much change has occurred. This can help illustrate that the process may be a very slow one. Sometimes, however, it is quite rapid."
Dr. Tinsley says she always starts a conversation with the dreaded "end-of-life" talk to help family members think about things they need to do to plan ahead and prepare. "It's important to set goals and expectations as early as possible, so a loved one can participate in the discussion," she says.
Topics that need to be discussed include driving cessation, power of attorney assignment, a living will and an advanced directive. A discussion about long-term care is also important. Can the patient live by himself? Can the family afford in-home care?
"It is much less stressful for everyone if these things are planned ahead of time, even if it is years in advance," Dr. Tinsley says. "Not having a plan often leads to disagreement and distress between family members."
Can Diet Affect Alzheimer’s?
Medical experts know that diet can play a role in overall health, and it makes sense that healthier diets promote healthier brains. But there is no scientific data that shows a diet can completely prevent dementia. However, the MIND Diet is a relatively new theory that combines the Mediterranean Diet and the DASH Diet, both of which are thought to prevent heart disease and lower blood pressure.
"The main components of the MIND Diet are whole grains, dark leafy greens, vegetables, berries, nuts, beans, poultry and fish. Limiting processed food, sweets, fried food, fast food, cheese, butter and red meat play a part in keeping a healthy mind," says Dr. Tinsley.
"I think the most important thing we have found is that starting these dietary practices when you are young is likely much more effective than waiting until you are far into Alzheimer’s," she says.
Medications and Hope for the Future
Currently, there is no cure for Alzheimer’s, but research is in the works. "There is a wealth of research happening now to develop drugs to stop Alzheimer's from progressing, or prevent it from happening in the first place," says Dr. Tinsley.
Right now, certain medications are used to slow the dementia process (although eventually dementia will persist).
The most common medications are a category called "cholinesterase inhibitors" that help prevent the breakdown of an important neurotransmitter in the brain. These medications include donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne). Most of these have general side effects of nausea, changes in appetite and increased frequency of bowel movements.
Memantine (Namenda) is a second category of medication that regulates a chemical called glutamate, which is important in information processing. Says Dr. Tinsley, "Often, a patient will be placed on two medications at once to optimize treatment."
According to the Alzheimer’s Association, a lack of volunteers for clinical trials is one of the major obstacles in finding new treatments. If you are interested in participating in a current clinical trial, use the Alzheimer's Association TrialMatch, a free, easy-to-use clinical study matching service that generates customized lists of studies based on user-provided information.
"Studies for new drugs take many years. Those of us in the medical community who treat dementia are just as anxious as you are to learn about new treatments. They are always looking for patients to be involved in research, so if this is your calling please check out the Alzheimer’s Association website to learn more," says Dr. Tinsley.