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.

Independence Day, Indeed!

July 4th is a wonderful day in America, filled with family celebrations, picnics and fireworks. We are so fortunate to live in a country that allows us so many freedoms! In our family, this day has additional significance, as today marks the 8th anniversary of my mother's independence from Alzheimer's Disease. As we once again visited her grave today, surrounded by the incredible beauty of the wildflowers and the snow-capped mountains, I looked around the cemetery and wondered how many other lives represented there were affected by this disease.

Did you know we have over 5.3 million Americans living with Alzheimer's? Chances are good that you either have a family member or friend affected. We have medications that can improve some behavioral and cognitive functions in people with dementia, but none yet that can stop or cure it. With our aging population, it is clear that this disease alone will consume a progressively larger chunk of our healthcare dollars.

Check out the Alzheimer Association website, and consider participating in a local Memory Walk or other fundraiser.

BOTTOM LINE: Let's celebrate our country's independence today by thinking about the future of our aging population, and pro-actively working towards a cure for Alzheimer's.

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.)

Puppy Love & Alzheimers

This week our family welcomed it's newest member- Tozi (after the Atzec goddess of nature & water), an 8 week old Portuguese water dog (a virtually non-shedding, friendly breed often used as therapy dogs). I want to share a wonderful experience that this young pup has already brought to us. We took Tozi to visit my Dad, who lives in a memory care unit. All of the residents have some form of dementia, primarily Alzheimer's. As we walked in carrying the puppy, we were greeting with smiles, oohs and ahs. Although I was a bit apprehensive about her wiggly body and sharp puppy teeth, I asked if anyone would like to pet her. And did they EVER!

Almost every resident not only wanted to pet her, but asked to hold her. They snuggled her to their chests and chins, encouraging her to give them a "kiss" on their cheeks. I was amazed at Tozi's instinctive, unbelievably CALM response. She went practically limp in their arms, gently raising her head for pats and kisses. One sweet lady balked when we went to remove Tozi from her arms- "Don't rush me! I could hold her and love on her all day!" The joy one tiny six pound pup could bring was immeasurable. I started asking everyone about what pets they had cherished, and all the residents seemed to jump in. One lady had every type of pet you can imagine, and a few I'd never heard of (waltzing mice?!)

Our other dog is a labradoodle, another breed that is often used for pet therapy. Full therapy dog training takes a few years, many courses, and lots of consistent practice. That being said, I believe that a loving snuggle with any cooperative, calm pet goes just as far for most people suffering from dementia. Obviously, you must be careful that the animal does not harm anyone (the lawyers make me add that!) Our pup has already made a second visit, and the smiles & joy keep coming.

BOTTOM LINE: People with dementia are thirsting for love and touch as much if not more than the rest of us. Remember to share some some love & touch- or maybe even some puppy love-on your next visit.

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.

Can Hormone Therapy Prevent Dementia?

As our population ages and more members are developing dementia (primarily Alzheimer's), scientists are constantly on a quest to look for ways to prevent dementia. In the past, we felt the data supported that estrogen ("HRT"- hormone replacement therapy-given to women in menopause) might prevent Alzheimer's. Subsequently, the tide turned and evidence showed that not only did it not prevent, but it may worsen your risk. What do we think today?

A recently published study in the Annals of Neurology, Timing of hormone therapy and dementia: The critical window theory revisited, represents hope and a bit of a compromise. This study suggests that women who take HRT WHEN THEY BECOME MENOPAUSAL (but not later in life) have a significantly reduced risk of developing dementia!

The study was a good size- around 5500 women. Their pharmacy records were used to verify HRT use in their mid-life (average age around 49) and then evaluated again roughly 30 years later, when the women were in their late 70s and 80s. Over a quarter of these women developed dementia (27%) which may sound shocking, but is consistent with the growing incidence of dementia.

The analysis showed that women who TOOK HRT ONLY IN THEIR MIDLIFE had a 26% reduction in their risk of developing dementia compared with women who never took HRT, whereas those who took HRT only in their later life had a 48% INCREASED risk. Interesting, those women that took HRT BOTH midlife and later life had the same risk as those women who NEVER took it.

BOTTOM LINE: Current evidence-based medicine suggests that taking HRT at the time of menopause may DECREASE your risk of developing dementia, but starting HRT late in life can INCREASE your risk. Women, please factor this in when you have your discussion with your physician regarding pros and cons of HRT!

Why Visit Someone with Alzheimer's?

Please, I am BEGGING you, if you have a friend or family member with Alzheimer's disease, STAY IN CONTACT with him or her! The saddest part of my mother's Alzheimer's struggle was that many of her friends seemed to drop off the face of the earth. I understand that they were uncomfortable, worried that she might not remember them. What would they talk about? What if they brought up something she didn't remember- would that upset her or make her feel bad?

So here is the real deal. Yes, it's awkward. No one wants to see a dear friend struggle for words, or looking at you with a blank stare. On the flip side, even once someone who has dementia no longer recognizes you for the relationship you once shared, he or she still can sense the so-human link of affection. A big smile and laugh as you are "reminding" them of an old story involving the two of you will bring a moment of joy and often a real connection. Know that in the early and moderate stages, when the Alzheimer's patient no longer initiates conversation, she may still have full recall of remote events.

Pictures and music are also very powerful bonds. Think of that commercial jingle you can't shake out of your head. Similarly, old songs from the radio or traditional religious or patriotic songs pop right back into an otherwise confused brain. Simply flipping through old photo albums or singing songs can also turn on that faulty switch in their brain.

Finally, if there is a spouse, keep in touch with them as well. Pick up the phone and give them a call, and don't worry about what you are going to say. Saying ANYTHING is a million times better than nothing!

BOTTOM LINE: This Thanksgiving week, reconnect with any friends or family members who have been struggling with the non-glamorous challenge of dementia, and give thanks if your brain is still healthy!

PS. Our family is TREMENDOUSLY thankful for all the friends and family who continue to love and support first our Mom and now our Dad in their battles with Alzheimer's and Parkinson's dementias. God bless you!

Supplements for Alzheimer's Disease

Bummer- another study that shows a specific supplement does NOT, in fact, delay or halt progression of Alzheimer's Disease. This study is titled Docosahexaenoic Acid Supplementation and Cognitive Decline in Alzheimer Disease, better known as DHA. We believe that DHA, a fatty acid used in the brain, has beneficial effects when taken as a supplement in humans. The question was whether or not taking this supplement would help to delay the progressive memory loss and other dysfunctions in Alzheimer's.

The completed study involved around 300 people with mild to moderate Alzheimer's disease. They randomly received either a placebo or 2g of DHA daily for eighteen months (it was randomized and double-blinded- our gold standard in research.) Cognitive tests were given at the onset and a year and a half later. Unfortunately, the people in the trial who received the DHA supplements were no better off on cognitive tests nor on brain atrophy at the end of the study.

We have been through this same process with Vitamin E, estrogen, and a number of other over the counter supplements. I remain optimistic that there may be a dietary or behavioral modification that does make a difference, as well as new medications that will not only stop the progression but some day reverse the dreaded decline of dementia with Alzheimer's.

BOTTOM LINE: Let's continue to support Alzheimer research, as we now have yet another supplement (DHA) proven to NOT be successful.

Dementia- Remember THIS!

Today I am speaking at the AAFP Scientific Assembly about DEMENTIA. Why? Because I know first hand what it is like to CARE for someone with dementia, and have experienced frustrations from the family member/care giver standpoint, and I want to help other family physicians gain some insight from our family's experience. Our mother faded for twelve years from Alzheimer's, and now our father is battling Parkinson's dementia. We have the unique view from both the provider and patient aspects, and I hope my talk can make a difference.

What are a few things I want to share?
1. How to recognize what is "normal" age-related memory change versus true dementia (see Do I Have Alzheimer's?)
2. Docs need to be the "bad guy" and say it's time to stop driving. (See Driving Safely while Aging)
3. Subtraction skills are used every day- figuring out change, recipes, and even counting backwards to see what time you need to leave the house to arrive on time for an appointment. When this SKILL goes, what you SEE is trouble with those activities.
4. Pills-especially with generics, pills can LOOK ALIKE and add to confusion of poly-pharmacy. Simplify, simplify, simplify!
5. Pill delivery- all pill boxes are not created equally. Finding one that works can make a beautiful difference.
6. Stopping medications- there comes a point when it is time to stop pills aimed to prolong life (statins, aspirin, etc.) If there are no side effects to the patient quality of life to STOP them, I do.

That tops the list, and we'll see what input others have today!

BOTTOM LINE: Primary care physicians can do more to help their patients facing dementia, and I hope to help them see how!

PS It's OCTOBER FIRST- Time to change those AIR FILTERS!

World Alzheimer's Day

Today is World Alzheimer's Day, and a new report was released on Capital Hill that documents the global cost of Alzheimer's and related dementias to be more than $600 BILLION, and 70% of the costs occur in North America and Western Europe!! Dementia actually costs 1% of the entire world's GDP (gross domestic product.)

This disease affects all societies, and with our aging population, the cost is anticipated to increase drastically. "People with dementia, their families and friends are affected on personal, emotional, financial and social levels. Lack of awareness is a global problem. A proper understanding of the societal costs of dementia, and how these impact upon families, health and social care services and governments may help to address this problem."

On a personal level, my mother died after a twelve year struggle with Alzheimer's, and now my father is fading away from Parkinson's dementia. The emotional toll alone is devastating, but the financial and time consumption adds dramatically to the burden of this disease. If this illess has not affected your family or loved ones yet, be aware that chances are very high that it will. Increasing awareness of dementia should help focus more attention on research for both cure and prevention of this crippling disease.

BOTTOM LINE: Read the 2010 World Alzheimer's Report for a sobering look at the staggering costs of dementia.

Happy Independence Day!

July 4th is a wonderful day in America, filled with family celebrations, picnics and fireworks. We are so fortunate to live in a country that allows us so many freedoms! In our family, this day has additional significance, as today marks the 6th anniversary of my mother's independence from Alzheimer's Disease. As we visited her grave today, surrounded by the incredible beauty of the wildflowers and the snow-capped mountains, I looked around the cemetery and wondered how many other lives represented there were affected by this disease.

Did you know we have over 5.3 million Americans living with Alzheimer's? Chances are good that you either have a family member or friend affected. We have medications that can slow down the progression of dementia, but none yet that can stop or cure it. With our aging population, it is clear that this disease alone will consume a progressively larger chunk of our healthcare dollars.
Check out the Alzheimer Association website, and consider participating in a local Memory Walk or other fundraiser.

BOTTOM LINE: Let's celebrate our country's independence today by thinking about the future of our aging population, and pro-actively working towards a cure for Alzheimer's.

Memories...like the corner of my...what was that word ?

Okay, have you ever had trouble finding a word? Or how about a name? Why did you walk in the room, anyway? Were you supposed to be checking e-mail, or did you sit down to look at your calendar? And, by the way, where the heck are the keys/remote/charger/phone??
Many of us have what we jokingly refer to as "senior moments". Something basic simply slips out of the grasp of our mind for the moment. Is it dementia? Do we have early onset Alzheimer's disease?

Let me reassure you that MOST of us do NOT. Sadly, there are a few that do. In fact, when my own Mom told me tearfully (when she was a mere 61 years old) that she and my father were concerned that she had Alzheimer's disease- I laughed. Seriously. I laughed, when indeed, I perhaps should have cried.

The truth is that my mother had several medical conditions that all could cause memory loss- and all were correctible. She had thyroid issues, B-12 deficiency, took a medication that caused memory loss and was a bit depressed. ALL of those conditions in and of themselves CAN cause memory loss sufficient enough to look like Alzheimer's disease.

The frustrating thing was that with my Mom, we were able to correct all of those issues, and yet the memory loss progressed.
If YOU have memory loss, PLEASE talk to your doctor about your symptoms. Have a physical and check blood work. Chances are good that you may simply have a medication side effect or a correctible metabolic issue. If, however, you DO have early dementia (such as Alzheimer's), starting medications sooner rather than later will absolutely slow the progression of your disease.

BOTTOM LINE: If you are having trouble with your memory, REMEMBER to schedule an appointment with your doctor TODAY!!

PS. It's the FIRST of the month! REMEMBER to change those AIR FILTERS!!!

Do I have Alzheimer's?

Do you forget why you walked in a room? Can't find your keys or the tv remote? Couldn't think of an old friend's name when you ran in to them at the store? RELAX- none of these episodes are unusual for a healthy, busy adult. Typically these things happen when you are stressed and simply not paying much attention to your task at hand.
What is concerning, then? Forgetting directions to the grocery store where you always shop; missing multiple appointments because you confused times/dates; being unable make change or figure out tips (when you could before) or not being able to name common objects (like a watch or a shirt.)
If you think you are having significant memory issues, please go and see your doctor! There are many causes of memory loss that are correctable, and even if you do have early Alzheimer's disease, we have good medicines that really slow the progression of disease.
CHECK OUT the Alzheimer's Association's "Ten Signs of Alzheimer's"
Bottom Line: Memory loss with Alzheimer's Disease can be distinguished from memory changes with normal aging; if you are concerned, go see your doctor!

Still Alice- a MUST READ

My mother passed away five and a half years ago after a twelve year struggle with Alzheimer's disease. Now, my father has dementia from Parkinson's disease (which for all intents and purposes looks Alzheimer's). Dementia- which means progressive memory loss- is tough on everyone. There is no "noble battle" aura like we have when people fight cancer. Friends often disappear, rather than increasing their presence. No one knows what to say. To quote my mom in a lucid moment, "It's not exactly FUN losing your mind!" Instead, our loved ones slowly, steadily slip away. It is absolutely heart-breaking.
Still Alice is a must-read for everyone, because if you don't yet have a friend or loved one suffering from Alzheimer's, odds are good that you will. Still Alice tells the story of Alzheimer's from the point of view of a young 50 year old Harvard neuropsychologist as she is diagnosed with and rapidly declines from early onset Alzheimer's. Although this is a fictional account, it is very accurate and insightful.
BOTTOM LINE: Pick up a copy of Still Alice today, read it, and pass it on.