Go Purple- Help End Alzheimer's Disease!

The heart remembers...Today, September 21, 2012, is Alzheimer's Action Day- so put on your PURPLE and help to raise awareness for this devastating disease. Over 35 MILLION people worldwide and 5.4 MILLION Americans are living with Alzheimer's disease (AD). $200 BILLION will be spent in the US alone this year caring for people suffering with AD. This disease slowly invaded my amazing mother's brain, creeping along for over a decade, steadily pulling her away from our family. As we don our purple today, we stand together with every other family who has helplessly witnessed this "long goodbye". I hope and pray we are in the last decade without a cure or full prevention for Alzheimer's.

Significant memory loss is NOT a normal part of aging. Misplacing your keys, forgetting a friend's name at a chance meeting or not being sure why you walked in to a room are frustrating events- but usually a sign of a busy mind focusing on other things. Missing multiple appointments or bills, not knowing how to drive home from your neighborhood store or losing the ability to balance a checkbook (when that used to be a straightforward process) ARE worrisome signs.

Major advances are being made in understanding how Alzheimer disease affects the brain, and the sequence in which it progresses. The hope is to find a way to block that progression, and research dollars donated today will help scientists find that barrier.

BOTTOM LINE: If Alzheimer's disease has touched YOUR life, join in the fight to find a cure and start with wearing PURPLE today!

New Study Offers Hope for Alzheimer Prevention

A glimmer of hope shines in the devastating world of Alzheimer's Disease (AD), as this week a study published in the Archives of Neurology journal reveals that a class of blood pressure medications (Angiotensin Receptor Blockers, known as ARBs) may reduce the risk of developing Alzheimer's.
Although the mechanism of Alzheimer's is not fully understood, we do know that abnormal deposits of amyloid (a protein) occur early in brain as an early stage in the disease process. This new study, the Impact of Angiotensin Receptor Blockers on Alzheimer Disease Neuropathology in a Large Brain Autopsy Series, looked post-humously at the brains of 890 people who had suffered from AD and high blood pressure, and found that those patients who took ARBs (for their blood pressure) had significantly LESS of these amyloid deposits built up.

The hope is that if we can find ways to prevent the build up of these amyloid deposits, then this will halt the progression of Alzheimer's both pathologically and clinically. Prior studies have shown    some clinical evidence that patients on ARB's for their blood pressure have a lower risk of developing AD, but this is the first study to show us the actual physical changes in the brain- very exciting news!

So, if you have a strong family history of Alzheimer's disease and/or are experiencing progressive memory loss, should you ask your doctor to prescribe you an ARB today? Well... yes and no. I would NOT prescribe an ARB for a patient in this situation who had normal blood pressure. However, if she had newly diagnosed high blood pressure, I would certainly consider starting her on an ARB (rather than a diuretic or beta-blocker, our other first-line medications), and I would be open to a discussion about changing her to an ARB if she had hypertension and was already being treated with another class of medications. Of course, when choosing a medication, there is a range of different issues- from side effects and drug interactions to cost (and health insurance preferences), but potential "side"benefits such as this are absolutely part of the decision process.

BOTTOM LINE: Alzheimer's research is critical to help us find a cure for this debilitating disease, and this new study offers encouragement that ARB's may play a role in slowing the development of AD.

iPads to Prevent Dementia?

When I speak about Alzheimer's disease, people often ask what they can do to help prevent this debilitating illness. Although scientists have looked at innumerable medical interventions such as hormone replacement (estrogen), ginkgo biloba, anti-inflammatory drugs (like ibuprofen), Vitamin E, and many others, we have yet to find the right answer. The best evidence medical trials today suggest that our primary prevention lies in all the health maintenance strategies that prevent heart disease, high blood pressure and diabetes- namely a healthy diet high in vegetables and fruits & low in "junk", plus regular aerobic exercise.

Additionally, many studies have shown some benefit from "cognitive activities", meaning brain exercises, through puzzles such as word games (crossword puzzles or word searches) or number challenges such as sudoku. Is there a way technology might help? Why not? I believe the act of learning new skills in any format will help, regardless of whether it is an old-fashioned crossword puzzle from the Sunday paper, or learning to use... well, yes, an iPad. Let me say now that no, I do not have stock in Apple, though perhaps I should. And, I'm sure any electronic tablet will fit the bill. That being said, let me share our family's personal experience.

We gave my mother-in-law (who looks amazingly younger than her actual age, which I am not allowed to reveal) an iPad 2 for Christmas so that we could "face time" (video chat, for those uninitiated) with her, which would feel more intimate than just a phone call. Although she is very educated (a former RN), she has never had a computer or a cell phone, so we were uncertain how much use she would get beyond this function. May I brag that she is now texting like a teen? She is able to read and follow her favorite blogs, listen to Bible verses, enjoy interactive Rosaries, and best of all, "chat" with us throughout the day. We can text her pictures on the spot, and engage her in our daily lives more easily. As she is eagerly learning these new skills, I can picture those neurons firing up like crazy, and I have to think that her brain is reveling in the new stimulation.

BOTTOM LINE: You're never too old to learn a new skill, and when you do- your brain will thank you!

Thank You, Glen Campbell

Many diseases have the face of a celebrity- we think of Michael J. Fox for Parkinson's, or Katie Couric (on behalf of her husband) for colon cancer. Although President Reagan had Alzheimer's, I don't think there is as strong of a link there. Alzheimer's is the disease we don't want to talk about. It's just too uncomfortable, right?

Well, hat's off to singer Glen Campbell & his wife. Mr. Campbell gave a televised interview last night to openly talk about his experience of memory loss and his diagnosis of Alzheimer's Disease. I loudly applaud his public acknowledgement of this relentless disease. I hope that his singing tour will bring increasing awareness to this incredibly common disease. Right now, over 5 million Americans suffer from Alzheimer's disease. I love that Mr. Campbell is highlighting how music memory is something that is preserved...often beyond when the person suffering the memory loss no longer recognizes their family. I have bittersweet memories of singing Christmas carols with my mom- her not skipping a beat nor stumbling on words that I couldn't recall- and she only knew me as a "nice friend," not her youngest daughter.

What's my take-home message here? If you have a loved one with Alzheimer's memory loss, and you struggle to get them to interact with you, consider a song. Old commercials, school fight songs, traditional carols, hymns or anthems are all good choices. I have found in my personal experience that often once the person begins singing, it often "gets the juices flowing" enough that they are able to carry on a conversation (where they were not interested or able when you began your visit.)

BOTTOM LINE: Hitting a communication wall with someone struggling with Alzheimer's? Try a tune!

PS. I recommend sites like ElderSong- a wonderful source for music geared to trigger memories! ( I have no financial interest in this company, but have purchased many sing-along CDs and videos from them.)

Visiting Someone with Memory Loss

Visiting a friend or relative with memory loss can be daunting. What will you say? What if she doesn't remember you? What if he is inappropriate? If you are taking your child, will she be nervous or scared around the other residents? What about the smell? There are so many potential barriers to a simple visit.
So, take a deep breath, and relax. PLEASE GO VISIT. Period. Perhaps I should change that- exclamation point is better- GO VISIT!! Or pick up the phone, and at least call, if they are able to talk on the phone. Ultimately, that friend or relative will have a better day if you visit. Whether they can carry on a full conversation with you about your high school high jinks together or they have no clue what you are talking about, they are human, complete with the full range of emotions that we all enjoy. Sadly, loneliness and boredom often occupy much of your time when you are suffering from memory loss. People treat you differently, talking to you as if you were less intelligent or perhaps deaf. Even if you don't catch a punch line, you can share a hearty belly laugh with someone.
So, here are a few suggestions for an easier visit:
1. Bring pictures, especially of you and your friend together.
2. Use technology- iPhones, iPads, and laptops are wonderful for sharing pictures or for finding images of special places and events (think the Grand Canyon or the Olympics) to chat about.
3. Music- again, the MP3 players are terrific for finding a tune or a snippit of a song.
4. Avoid food that requires utensils, but finger foods like french fries, or a small ice cream cone can be a delight to enjoy together if conversation is a challenge. (Obviously, check with your friend's caregiver for appropriate food choices.)
5. Consider a "Sunday drive". Often folks enjoy simply getting out and about for a short car ride. Pop on the radio or seasonal music and cruise around for a half hour. Yes, this is expensive in gas dollars, but often well worth the price for the sense of "escape" from the residence.
BOTTOM LINE: Visiting someone with memory loss (dementia) need not seem so stressful- relax, smile, hug, laugh...and your friend will, too. And hopefully, when we are the one with memory loss, our friends and families will return the favor.

Independence Day...and When to Give t Up

If you know an aging independent-living senior, most likely his or her greatest concern is maintaining that INDEPENDENCE. In a perfect world, we would all be able to mentally and physically care for ourselves as we age. Unfortunately, especially with all the advances in medicine that prolong our lives, that is too often NOT the case.

Driving is probably the hallmark of independence. As long as we can find our keys to GET to the car, we feel a strong sense of freedom. Getting groceries, heading to a doctor's appointment, visiting a friend or attending church is simple, because we simply get in the car whenever we feel like it. No one wants to give up driving, but here are some issues to consider:
Hearing
Vision
Limited neck mobility
Slowed reflexes/stiff muscles in arms

If you have trouble hearing, you may not hear that siren or warning honk, or even the loud motorcycle approaching.
Decreased vision (think cataracts and macular degeneration)- well, this seems obvious, but you can see cars with pretty poor vision. However, you need to be able to read SIGNS, too, as well as see colors of lights.
Stiff neck? You can't turn your head to check your blind spots.
Slow or stiff muscles- you can't manuever your car quickly enough to react to sudden changes.

Please check out an earlier blog on Driving Safely while Aging Gracefully.
BOTTOM LINE: There are many options to driving yourself that do NOT involve giving up your independence. Please do NOT wait to give up or limit your driving until you've hurt your car, yourself or another person.

Alzheimer's Disease- Why So Hard to Diagnose?

Alzheimer's disease (AD) should be simple to diagnose, right? How hard can it be for a doctor to decide if memory loss is a normal part of aging, or if it is severe enough to "count" as Alzheimer's? Well, if diseases only occurred one at a time, it might be simple. Unfortunately, as old Texas doc's say, when you itch, it's possible you've got ticks AND fleas. I find in family medicine, it's rare we see any disease state by itself, and Alzheimer's is no exception.

Many different issues can affect memory. Depression and/or anxiety very frequently preoccupy the brain so much that short term memory loss can be a predominant issue. Low thyroid levels can decrease memory. B12 deficiency is another cause. The list of medications that can affect memory seems to be growing each year as well.

When my mother first noticed significant memory issues at the age of 61, she was convinced she had Alzheimer's. I literally laughed when she told me her concerns...We had no family history of early or even late onset dementia. She had recently started a medication known for impairing memory (Digoxin.) As her medical workup progressed, I was relieved to find out she had not only that medication as a possible cause, but literally every cause I listed above- B12 deficiency, hypothyroidism and depression. I felt confident that as we addressed each of these problems, her memory would improve. In many cases, that would have been true, but unfortunately for Mom, she did indeed have underlying Alzheimer's, which took roughly another two years to fully decipher.

If you are concerned about memory loss, please make an appointment with your family physician to address your concerns. Head to the Alzheimer's Association website and review the 10 Warning Signs of Alzheimer's. Until those biomarkers for AD become more refined, physicians will not have a quick or simple answer, but a thorough history and exam, combined with possible neuropsychiatric testing, will take us a long way in the right direction.

BOTTOM LINE: Memory loss can have many different causes, and these causes can and frequently do overlap.

Alzheimer's Biomarkers- What ARE They?

In yesterday's post about the new Alzheimer Disease (AD) guidelines, I talked about how Alzheimer's biomarkers represent hope for future early diagnosis and treatment of AD. But what the heck ARE biomarkers? Today I will clarify...

Biomarkers - short for biological markers-are any naturally occurring substances in the body that reliably predict or indicate a disease. Cholesterol, for example, can be considered a biomarker for heart disease. We know when cholesterol levels are very high, it is likely that plaques of cholesterol could be building up in the heart arteries, making it more likely that that person could have a heart attack. In the case of Alzheimer's disease, the pathological changes in the brain involve the buildup of certain types of protein around the nerve cells in the brain, as well as degeneration and breakdown of other nerve cells. The combination of these two problems makes it hard for the brain to function correctly, as messages can't be passed effectively from one part of the brain to another.

Biomarkers for AD include beta-amyloid protein (that builds up in plaques) and tau protein, which is part of "neurofibrillary tangles"- clusters of protein that block nerve conduction. Right now, these proteins must be measured in spinal fluid, which means the patient must have a spinal tap (aka. lumbar puncture) which involves a needle in your back near your spinal cord. The hope is that measuring levels of these proteins in blood or urine may also prove to be accurate predictors of AD, so the more invasive procedure is not needed.

Not all of today's biomarkers require spinal fluid. Genetic testing for APOE-e4, as well as other genes that increase risk for AD, can be done by a simple blood test. Additionally, imaging of the brain using MRI and PET scans can provide valuable information as well.

Unfortunately, the diagnosis of Alzheimer's disease is not black and white, even with use of biomarkers and the new guidelines. I'll delve more into the challenges of diagnosis tomorrow.

BOTTOM LINE: Biomarkers for Alzheimer's include blood tests, spinal fluid tests and brain imaging, and these procedures are primarily restricted to research settings in 2011.

Breaking News about ALZHEIMER's

Over 5.4 million Americans suffer from Alzheimer's dementia (AD), and we believe that an equal number of people are in the early, yet UNdiagnosed stages of Alzheimer's. If you don't know someone affected yet, you will soon. My mother battled AD for over a decade, so I have a very personal face for this disease. For the first time in nearly three decades, there are new criteria for the diagnosis of this challenging disease. What's new?

Now there are THREE stages, with the first stage existing before there is any memory loss, called PRE-Clinical AD. This is based on research settings ONLY, where levels of biomarkers can be measured. The second stage is Mild Cognitive Impairment (MCI), where there are early memory and other cognitive changes, but these developments do not significantly impair the person's ability to perform daily tasks. The final stage is Dementia, where there are not only memory, orientation and judgement difficulties, but they are to a level that affects the patient's daily life.

Biomarkers represent a very exciting FUTURE for Alzheimer's disease research and treatment. Right now, these tests are not readily available to those of us in private practice, and even if they were, we have not established solid reference points to allow for accurate interpretation of the data. The importance is THIS- just like we can measure and treat cholesterol levels BEFORE someone has a heart attack, or see rising blood sugars before full diabetes, elevated AD biomarkers may warn us of impending AD. Obviously, the next step is then to develop medications that will PREVENT the full development of dementia, if they are started during the earliest stage.

We're making progress! Go to the Alzheimer Association website and see how you can help make a difference.

BOTTOM LINE: We are learning more and more about the early stages of Alzheimer's disease, and biomarkers represent an exciting new diagnostic tool...but they are still ONLY IN RESEARCH protocols.