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The New Perspective on Alzheimer's Disease

By September 30, 2010

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There is a growing consensus that the amyloid plaques that are characteristic of Alzheimer's disease actually begin accumulating in the brain decades before symptoms like memory loss and personality changes begin to display themselves. This is one of the main reasons that the whole process of diagnosing Alzheimer's disease is set to change for the first time in over 25 years. If Alzheimer's disease is viewed as a disease with a lengthy (years or decades) preclinical phase, the new goal is to identify people at risk of developing the clinical phase of Alzheimer's disease in the future, so that drugs that can slow, modify, or halt the disease's progression will have the most effect.

One of the key driving forces behind this new perspective on Alzheimer's is the role of biomarkers, biological properties that can be detected and measured that indicate either normal or diseased processes in the body. Body temperature, for example, is a well-known biomarker for fever, and cholesterol level is a biomarker for heart disease. In Alzheimer's disease, several biomarkers have emerged that appear critical to early recognition: these include structural changes in the brain (like decreased size of the hippocampus), results of actual imaging of amyloid in the brain, spinal fluid abnormalities, and genetic markers.

One of the implications of viewing Alzheimer's disease as having a lengthy preclinical phase is the question of whether large scale screening tests should be done. Other diseases like breast cancer and prostate cancer have preclinical phases, but unlike Alzheimer's disease they also have effective early-stage treatments available now. An example of the debate over large-scale screenings for Alzheimer's that has been going on for some time now is available in a Washington Post article from December 2007. My feeling is that until we do have effective early stage treatments,most people would rather not want the anxiety that would accompany a positive screen for Alzheimer's disease. Since screening tests are not 100% accurate, others may feel falsely reassured if they screen as normal. Please share your comments below.

October 1, 2010 at 8:18 am
(1) Shena says:

I want to know so I can get the treatment to stop or slow it. My doctor refuses to acknowledge or discuss it with me. MRI shows early signsof dementia and my tests are borderline. I cant remember two of the words but I can draw a clock. Sporadic. I am 43 yrs old. Doctor keeps referring to me as simply “depressed” and ignoring the mood changes.

October 1, 2010 at 4:54 pm
(2) KatieZ says:

Are you receiving this information from a general practioner or a neurologist that specializes in Dementia? I am a Dementia education specialist, just an FYI.

First, if this doctor is a general practioner, he or she may not be well-informed about the early signs of Dementia and/or Alzheimer’s. If I were you, I would try to see a neurologist that SPECIALIZES in Dementia. If you are properly diagnosed, you can be properly treated. There are both reversible and irreversible types of Dementia. You could have something so simple as a b-12 deficiency (which is reversible), best case scenario.

Either way, I would ask for a proper dementia screening and a visit to a neurologist.

Best wishes.

October 5, 2010 at 10:55 pm
(3) Rovshan M Ismailov,MD MPH PhD says:

While I agree with many points of view in the original post, there is a problem with regard to the fact that amyloid plaques can be characteristic of early stage of Alzheimer disease. A controversy as to whether amyloid deposition can actually cause cognitive decline has appeared as a result of studies which showed that the extent of amyloid deposition does not necessarily correlate with synaptic or neuronal lost or with severity of cognitive decline (de la Torre, 1997)]. Subsequently, Davis et al. showed that older individuals can have extensive plaque deposition while having no symptoms of Alzheimer’s disease (Davis et al. 1999).

Assuming that it takes years for Alzheimer’s disease to develop, and taking into account the rapid growth of newly discovered diagnostic methods for Alzheimer’s disease (i.e. testing biomarkers in the CSF), it is very important to identify those who are potentially at risk.

For instance, we do have some research evidence that patients diagnosed with atrial fibrillation may be at higher risk for Alzheimer’s disease. Thus, on one hand, patients diagnosed with cardiac arrhythmias may benefit from early screening for Alzheimer’s disease. On the other hand, if cardiac arrhythmias contribute to the existing Alzheimer’s disease, worsening its prognosis, then a more aggressive treatment of arrhythmias should be considered. Finally, findings that suggest that arrhythmias and Alzheimer’s disease are associated should raise the important question: What is it about this association that may further advance our understanding of Alzheimer’s disease?

Rovshan M Ismailov, MD MPH PhD
“New Insights into the Mechanism of Alzheimer’s Disease: A Multidisciplinary Approach” Amazon Kindle Book

October 9, 2010 at 1:55 pm
(4) nissrinezzat says:

i am 41 years old. i fear i might suffer from alzehimer.so many important events in my life i cant remember.i forgot words and names.while speaking with others i may stop for not remebering what i have been saying. my doctor told me it is because of laking of blood to reach the brain .he prescribed . stugeron but i didnt feel well while taking it. ididnt do MRI.

October 9, 2010 at 3:09 pm
(5) Shaye says:

Since Alzheimer’s disease is literally, ‘brain cells dying off’, then it would seem that many cells could die before one actually experiences noticeable ‘symptoms’’. However, there are numerous ‘things’ that can cause memory loss, some reversible, some not. Vitamin deficiencies, depression, other dementia’s, alcohol or drug abuse, head/spinal injury, stroke etc.

Both grandmother’s and my mother had Alzheimer’s; I would like to know if I was going down that road, to be able to make more decisions about my care in the future, while I can. So far, I understand that only a small percentage of Alz is hereditary. And I’m encouraged to note that research is becoming more proactive in the study of this disease.

I do have two comments, after traveling this path with my mom & stepfather.
#1. I think Alzheimer’s is the new ‘buzz word’ and not enough tests are done to completely exclude other diseases/causes. As, both my parent’s exhibited different symptoms throughout their diseases, and my mother had other complications (heart disease, gum disease, atrial fibrillation) that if treated differently, may have extended the quality of her life, in my opinion.
#2. Medical staff was totally unaware of the ‘proper’ care of dementia patients unless they had a family member or worked one on one with an Alzheimer’s patient. In total, the hospitals & doctors were good, yet they treated my parents as if they were ‘stupid’ not that they had a ‘brain disease’. If they had brain tumors, they’d have been treated with much more respect. They were not listened to, assuming that they didn’t know what they were talking about…up until very close to the end for both of them, they were aware of things that they ‘knew’ about; personal comfort, etc.

October 10, 2010 at 3:58 pm
(6) Andrew Rosenzweig says:

Shaye, thank you for your comments. I was so intrigued by your reference to Alzheimer’s disease as the new “buzz word” that I decided to blog about it. Check it out and let me know what you think. And you’re absolutely right that many health care professionals in hospitals and elsewhere are poorly educated about Alzheimer’s disease and other dementia, and wind up treating patients with dementia “like children.” People with dementia are often extremely perceptive about non-verbal cues and facial expressions in others, and having a condescending or disrespectful attitude will usually be noticed by others.

October 9, 2010 at 5:52 pm
(7) Sally says:

My mother was diagnosed with Alheimers four and a half years ago. She didn’t tell anyone until she was hospitalized for another problem concerning her colon. This was in December of 2009. She has been on Aricept and Namenda all along. I can not see a difference in her memory. She ia also a diabetic, and has Macular Degeneration. She is 77 yrs. old. I read that Alheimer patients usually have the diesease about five years and really can’t care for themselves. I beleive she has dementia,not Alheimers. She was diagnosed by a Family doctor. What do you think?

October 11, 2010 at 9:52 am
(8) Seorsa says:

I worry about alzheimers because I have had 5 diagnosed concussions starting when I was 12. I would be tempted to test because of that. I focus on diet, exercise, supplements )turmeric, B and a few others) and life long learning. Two years ago I took a bike mechanics class, this year I am studying to be an EMT, next I think I will learn spanish. I definenitly need to keep on the diet and exercise to maintain a healthy blood glucose level (current am ave 109). Like one of other posters I have issues with memory concentration etc. Not enough to test positive for anything (I am a CEO) and I am 48.

January 25, 2011 at 1:36 pm
(9) Denise says:

My mother is 91 years old. She has had this dreaded disease for around 10 years of which the last 6 have been in a nursing home. For the last 4 years she has been able to do word searches. It has been absolutely wonderful to watch her be able to remember the word she was trying to find. For the last 2 months her cognitive abilities have been regressing tremendously and she has since quit being able to do the word searches. Her hearing has left her so she is in a scarey world even more. I have made flash cards for her to read that have simple commands she needs to do or understand in the nursing home daily functions. She reads them outloud and then obeys them. Also, I made cards with numbers from 1-20 on them. She works hard to put those in order and touches and says each number. I taught 2nd grade for 35 years. Those skills of 7 years olds is now coming in handy. I thought i would share the use of the flash cards.

March 26, 2011 at 11:49 pm
(10) Ken says:

I think large scale testing would be useful from a research standpoint. As to individuals, some will want to know and prepare and some won’t. I suspect only those that want foreknowledge would participate in screening. Myself, I would want to know as my father and all 6 of his siblings have developed dementia/alzhemiers. For someone like my father, I doubt he would have participated. Even today, he simply refuses to acknowledge there is anything wrong with him beyond some simple memory problems. But he is barely functioning.

If I had the opportunity to prescreen, I would also want to know before proceeding what is the percent accuracy of the tests, the costs and ….the spinal tap sounds a little painful. I do see mental changes in myself at age 54 but I just don’t know if they are the normal senior moments or not. To be honest with myself, I doubt they are the normal changes to be expected with aging. But I just don’t know. Regardless of the answer, knowing can bring relief.

Dr. Rosenzweig, you are doing good work here. Your efforts are appreciated.

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