iStock_000011872971Small1Since November is National Alzheimer’s Disease Awareness month, I’d like to dedicate today’s post to answering some of the most frequently asked questions about dementia. 

The statistics are staggering:

  • No less than 1 in 3 seniors will die with Alzheimer’s disease or another dementia.
  • One in 8 people over age 65 has Alzheimer’s disease, and nearly 50% over age 85. (As boomers age, and we all live longer, these numbers add up to a “silver tsunami.”)
  • Alzheimer’s disease is the 5th-leading cause of death in the United States for those age 65 and older, but the only one in the top 10 without a means of prevention, a way to slow its progression, or a cure.

 
Should we feel hopeless?  Absolutely not. I believe that the more we educate ourselves about dementia, the less we will fear or avoid people with dementia, and the less we will fear developing dementia ourselves.

In my experience at caregiver conferences, people often ask the same questions about dementia. Calling upon the research I did for my book, here is my humble attempt to answer them:

The 5 Most Common Questions About Alzheimer’s Disease:

1. What is the difference between dementia and Alzheimer’s disease?

Dementia” and “Alzheimer’s disease” are often used interchangeably, but they are different. “Dementia” is an umbrella term for a variety of diseases and conditions that develop when nerve cells in the brain no longer function properly. Symptoms of dementia include changes in one’s behavior or judgment, memory, and ability to plan activities and finish tasks.

Alzheimer’s disease is the most common type of dementia, at 60-80%. With Alzheimer’s disease, changes in the brain eventually affect basic bodily functions such as walking and swallowing. (For an outline of the stages of Alzheimer’s disease, visit the Alzheimer’s Association website.)

elderly couple 2There are over 100 types of dementia.  After Alzheimer’s disease, the most common form is vascular dementia from tiny, almost imperceptible strokes, at up to 20%. (When my mother was in her late 60s a CT scan of her brain showed evidence of vascular dementia.)

Some researchers believe that up to 45% of dementias are “mixed dementia”—Alzheimer’s disease plus another dementia. (I believe my mother had mixed dementia, as her decline followed the stages of Alzheimer’s disease.)

Other types of dementia include dementia from Parkinson’s disease, Frontotemporal dementia, and Lewy Body dementia. “Early onset” (or “Familial” Alzheimer’s disease) occurs before age 60, and comprises 5-7% of Alzheimer’s disease cases.

2. Is there a test to diagnose Alzheimer’s disease?

No tests exist to confirm a diagnosis of Alzheimer’s disease. However, doctors can diagnose “probable Alzheimer’s disease” with 90% accuracy with neuropsychological testing and by ruling out other causes of memory problems and cognitive decline. A medical history can rule out depression; lab work can rule out urinary infection, thyroid dysfunction, and vitamin deficiencies; and a CT scan and MRI can rule out strokes, trauma and tumors.

A new PET scan is available in some memory care clinics, in which an intravenous injection of florbetapir, a radioactive drug approved by the Food and Drug Administration in April 2012, binds to amyloid plaques, a protein most researchers think plays a role in Alzheimer’s disease. Amyloid PET scans show plaques on 96% of people with severe Alzheimer’s disease and two-thirds of those with mild cognitive impairment. Researchers caution that one-third of people aged 65 and over exhibiting normal cognition also show amyloid plaques on these PET scans—and they may never develop Alzheimer’s disease. That’s a large false-positive rate. And at this time, Medicare does not cover the test, which costs several thousand dollars.

3. If there is no cure for Alzheimer’s, why is early diagnosis a good idea?

If you suspect that you or a loved one are showing signs of cognitive decline, there are a number of reasons why early detection and diagnosis are important:

  • The cognitive decline may be caused by something treatable, such as depression or a vitamin B12 deficiency, and early diagnosis prevents further decline;
  • It’s important to discuss the diagnosis with family members and begin the search for appropriate support services;
  • Such a discussion reduces anxiety by naming the problem;
  • Medication and other approaches may be used to manage symptoms;
  • Early diagnosis gives people the option of joining clinical trials;
  • It allows more awareness of how some combinations of medications make symptoms worse;
  • It alerts doctors and family members to the possibility that the person may need assistance with daily tasks such as cooking and managing medications;
  • It may reduce falls and other accidents because caregivers are more aware of the dangers;
  • It allows an awareness of financial problems such as the person giving money to scams; and
  • It allows the person with dementia and their family members to plan for the future.

 
Schedule a Wellness Visit and Cognitive Assessment

It’s important to note that under the Affordable Care Act, anyone with Medicare Part B is eligible for an annual wellness visit that includes a cognitive assessment, an evaluation of risk factors for diseases such as Alzheimer’s, and recommendations for referrals to programs to help reduce those risk factors (such as seeing a nutritionist or joining a smoking cessation program). This annual visit is fully covered with no deductible, co-insurance, or co-payment.

4. Is Alzheimer’s hereditary?

In Familial (early-onset) Alzheimer’s (5-7% of Alzheimer’s cases), gene mutations cause a cascade of effects in the brain leading to increased amyloid, a protein that many researchers believe plays a role in the development of Alzheimer’s disease. If one parent carries the mutated gene, the child has a 50% chance of developing the disease; if both parents carry the gene, the risk increases to 75% percent.

In Alzheimer’s disease over age sixty, there is something called a “risk factor” gene—APOE ε4 allele. This gene increases your risk somewhat if you inherit it from your parents. According to the National Institute on Aging, “Some people with one or two APOEε4 alleles never get the disease, and others who develop Alzheimer’s do not have any APOEε4 alleles.” For that reason a blood test for the allele is not recommended for people at risk for Alzheimer’s disease.

Some studies suggest that you are more likely to develop Alzheimer’s disease if you mother had it. (Sorry to be the bearer of bad news!)

5. Is there any way I can reduce my risk of developing dementia?

There are no proven ways to prevent Alzheimer’s disease, the most common type of dementia.  Take heart, however. Research suggests many ways you may be able to reduce your risk.

couple with grandchildExercise:  Put down your Sudoku puzzle and go for a walk

Some researchers say that exercise may be our most powerful antidote for dementia. The Alzheimer’s Association recommends 30 minutes of daily exercise. A study by neurologists at Rush University Medical Center shows that daily activity of all kinds—from formal exercise to activities such as washing dishes, cleaning, and cooking—may reduce the risk of developing Alzheimer’s disease, even in people over age 80. In another study, subjects who walked forty minutes a day for a year regained volume in their hippocampus, reversing brain shrinkage. In a third study, people with mild cognitive impairment who did resistance weight training two times a week over six months showed an increase in their memory and executive function (the ability to multi-task).

The most common risk factors

If you can, try to avoid the most common risk factors for Alzheimers. In addition to factors you can’t control, such as a family history of Alzheimer’s, these risk factors include serious head trauma; poor cardiovascular health; high blood pressure; stroke; diabetes; high cholesterol; obesity in middle age; and smoking. To that list I’d add two lesser-known risk factors:  sleep apnea and high blood sugar levels. Both sleep apnea and pre-diabetes (blood sugar levels that are normal but high) are woefully under-diagnosed, so if you suspect that you have either (I have both), please get tested. Both conditions affect the health of your brain.

Diet and dementia

As far as diet is concerned, there is little agreement on what exactly will help prevent dementia, though doctors say that what is good for the body is good for the brain. (In this article I argue for a low-carb diet.) And no dietary supplements have been proven to reduce the risk of dementia, though there is anecdotal evidence that coconut oil may be helpful. (Read more about dementia and dietary supplements.)

Social and mental stimulation

Social activity and mental stimulation are crucial. Combining social activity and mental stimulation with regular exercise is more effective than doing only one or the other. Sports, cultural activities, emotional support, and close personal relationships are all key. We should work as long as we can, volunteer, join social clubs, and travel. We should turn off the television, read, write, do crosswords and puzzles. Play games, do memory exercises, learn a new language, or learn to play an instrument.

How have you been affected by Alzheimer’s disease or another dementia? If you have any other questions about dementia, post them here and I will try to answer them.

3 Comments

  1. Martha Stettinius

    To follow up on the question above, “Is there a Test to Diagnose Alzheimer’s,” I’d like to direct our readers to a relevant op ed in the New York Times, “Alzheimer’s Anxiety”: http://www.nytimes.com/2013/11/17/opinion/sunday/alzheimers-anxiety.html?_r=0

    Dr. Ezekiel J. Emanuel correctly points out that with the new PET scan for amyloid beta in the brain, which is not covered by Medicare, about a third of people with normal cognitive functioning will show these amyloid beta plaques in their brains, but they will never develop Alzheimer’s. However, in a response to his op ed, in a letter to the editor November 20th, Amanda Hunsaker, a doctoral candidate in the School of Social Work and Alzheimer Disease Research Center at the University of Pittsburgh, claims that for “the patient who has not reached those later years in which Alzheimer’s is most prevalent but who is experiencing cognitive changes that significantly affect work and family life, amyloid imaging provides some measure of certainty that an Alzheimer’s process is or is not occurring, allowing the family and their care professionals to both give and plan for care as appropriate.” (http://www.nytimes.com/2013/11/20/opinion/confronting-the-specter-of-alzheimers.html)

    Hunsaker makes a good point. If you are showing cognitive decline in middle age, and can afford the new amyloid PET scan (several thousand dollars if you are not part of a study), a scan showing a lot of amyloid plaque makes it more likely that you have the beginning of Alzheimer’s as opposed to one of the more than 100 other types of dementia. So it could be a useful diagnostic tool.

    If anyone has other insights to share on this, please share them with us here. Thank you.

  2. phyllis

    Doctors are talking about long-term and current research and findings on dementia and brain health.
    Listen to this podcast for current information from Dr. Paul Anderson. These findings are in the American Medical Journal.
    http://personalpower.podomatic.com/entry/2014-11-06T08_30_01-08_00

  3. Rose Fox

    My husband can’t remember how we met. What degree is dementia is this?

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