Jeffrey Siegel, MD, is a neurologist on staff at North Colorado Medical Center in Greeley, Colo.
Question: Can you tell us more about Alzheimer's? It seems like such a frightening disease.
Answer: With Americans in general living longer lives, and the consequent aging of our population, it is predicted that Alzheimer’s disease will become the dominant public health problem of this century. For example, approximately one of three individuals will have Alzheimer’s disease by their 80th birthday, and another third will have a milder form of this condition known as “mild cognitive impairment”.
In general, this disease afflicts people age 65 or older (it can rarely begin at an earlier age). Failing memory is typically the first symptom. Other symptoms include difficulty making decisions, problems managing money, difficulties expressing oneself, and personality changes noticeable to family members and coworkers. This can result in impairment of job-related activities and problems with interpersonal relationships.
Alzheimer’s disease is caused by abnormal proteins which accumulate in brain cells, ultimately killing them and causing loss of brain tissue. This results in changes to the chemistry of the brain, and also loss of vital brain circuits which are all needed to maintain cognitive skills and emotional balance. Other health problems (for example: high blood pressure, smoking, strokes, heart disease, sleep apnea) can accelerate this process.
Question: Can Alzheimer’s disease be prevented?
Answer: Not completely, but currently it is thought that a combination of near-daily physical exercise, a heart healthy diet, dietary antioxidants, and “mental exercises” can help prevent or slow down the onset of Alzheimer’s disease. Mental exercises includes anything that engages and challenges your mind: for example, becoming active in one’s community, volunteering, playing chess or bridge, reading, or fostering a new interest or hobby. Specifically avoid being a couch potato who does little but watch TV all day.
Question: Does memory loss always indicate the onset of Alzheimer’s disease?
Answer: No. For one thing, we all experience some memory loss as we age, and to some extent this is normal. Also, other medical conditions can mimic Alzheimer’s disease, and these are readily treatable (examples include low thyroid hormone or vitamin B12, depression, or medication side effects). The important thing is to visit with your physician if you do suspect the beginnings of Alzheimer’s disease. Your physician will most likely have you undergo some memory testing, order some blood tests, and also obtain at CAT scan or MRI of your brain. It’s hopeful that he or she can reassure you that you are normal, or will recommend that you start appropriate treatments to try to stabilize your condition.
Treatments at this time include two classes of medication which together slow down the progression of Alzheimer’s disease. It is important to understand that these medications do not cure the disease, but do slow it down sufficiently to permit individuals to live their lives normally for as long as possible. In addition to medications your physician might recommend that you meet with a cognitive therapist to help teach you better organizational and coping skills, thereby maximizing your ability to live a normal life.
There are currently very many investigational drug trials in progress. These are new drugs which carry great promise for slowing down the disease progression further, perhaps even offering a cure. Some of these medications will undoubtedly prove to be duds, but sooner or later we will identify those medications which are safe and effective. Just remember that it was only 20 years ago that treatment of many cancers was regarded as hopeless. Today, by contrast, most people with cancer are cured. It was only 10 years ago that AIDS ceased to be an invariably fatal illness. One can reasonably expect that Alzheimer’s disease will also turn out to be a curable disease in the near future. This is the hope which we must not abandon as we all grapple with this very common disease.