Experiencing and caring for a loved one suffering from dementia can be a heartbreaking, complex journey.
Dementia is an umbrella term describing a loss in mental abilities due to brain disease or injury. While there are several types of dementia, Alzheimer’s disease is the most common – and there is no single test that can diagnose it.
Instead, diagnosis begins by taking a detailed history from the patient and family members, says Lane Tinsley, a neurologist with the INTEGRIS Neuroscience Institute in Oklahoma City.
“It’s very difficult to obtain a thorough history from the patient alone, so family or caregivers are a vital resource,” she says. “Your doctor may ask details about any difficulties with short-term memory, ability to recognize objects and faces, problem solving, language, planning and multitasking, and taking care of personal issues.”
Tinsley says several standardized memory tests can indicate the level of severity.
“Each dementia has some key characteristics that doctors look for,” she says. “For example, early on difficulties with forgetting conversations, repeating questioning, difficulties multitasking or getting lost may indicate the Alzheimer’s subtype. People who have family members with Alzheimer’s are at a slightly higher chance of getting it themselves. There are also theories that a history of head injuries and heart disease may play a role in developing Alzheimer’s later on.”
Alzheimer’s disease progresses in three stages – mild, moderate and severe – and it’s difficult to predict how quickly a person will advance through them.
“There can be clues in their background history if the progression seems to be slow or fast,” she says. “Typically, patients will continue to live five to 10 years after a diagnosis is made, but many live much longer. Other health issues play a big role as well.”
The disease typically affects those over 65 in what is known as late-onset Alzheimer’s. Early onset Alzheimer’s afflicts those younger than 65 and familial Alzheimer’s disease indicates a genetic component. There is no cure for Alzheimer’s, but the cause of this disease is thought to be a combination of age, genetics, environment, lifestyle and other medical conditions.
“Most cases of Alzheimer’s disease can be explained by genetic changes,” says Linda Hershey, a neurologist with OU Physicians in Oklahoma City.
She says late-onset Alzheimer’s appears to be influenced by environment and lifestyle, and several autosomal dominant genes are responsible for the early onset forms of the disease.
“Common alterations in the apolipoprotein E gene are well-established risk factors for late-onset Alzheimer’s,” says Hershey, adding that it’s important to rule out other medical problems as causes for dementia. “There are sleep disorders (sleep apnea), hematologic disorders (anemia), and endocrine problems (hypothyroidism) that can cause memory loss and behavioral changes.”
Since 1980, the Alzheimer’s Association has united caregivers, provided patient support and spearheaded research.
“The Alzheimer’s Association is the largest nonprofit funder of Alzheimer’s research in the world, as well as the host of the largest global forum to advance dementia research, the Alzheimer’s Association International Conference,” says Toni McGee, director of development for the association’s Oklahoma chapter. “Some of the exciting research being presented at AAIC this year includes focus on prevention as treatment, highlighting … early findings of how a woman’s pregnancy and reproductive history may impact dementia risk, and how intensive blood pressure control could reduce the risk of mild cognitive impairment and dementia.”
The association’s U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk study – known as U.S. Pointer – is a two-year clinical trial evaluating whether lifestyle interventions can protect brain functions in older adults with an increased risk for cognitive decline. Intervention methods, which target many of the factors linked with Alzheimer’s, include physical exercise, nutrition counseling and modification, cognitive and social stimulation, and improved self-management of one’s health.
“Historically, Alzheimer’s disease has been seen as an aging issue, but more and more people are viewing Alzheimer’s as a public health issue because the burden is large, the impact is major and there are ways public health can intervene,” McGee says.
Initiatives for the public health community, as outlined by the Alzheimer’s Association, include increasing early detection, promoting brain health and risk reduction, and implementing the Healthy Brain Initiative Road Map, a national collaboration to view cognitive health as an integral component of public health.
Since German physician Alois Alzheimer discovered the disease in 1906, scientists have researched how it affects the brain. However, they couldn’t actually see the effects of the disease on a living brain until 2012, when the Food and Drug Administration approved a fluorescent dye to help view amyloid plaques during a scan called positron emission tomography.
“This changed the scope of research, allowing scientists the ability to track the pathology of the disease when they could formerly only diagnose with an autopsy,” McGee says. “Scientists now have a better understanding of the effect of amyloid and tau – hallmarks of the disease – on the functions of the brain, spurring much of the research and trials happening today.”
Tinsley says the accomplishments in Alzheimer’s research amaze her.
“The introduction of medication in the early 1990s to slow the disease progression was a big game changer,” she says. “And more recently there have been clinical studies looking at a more effective treatment in preventing the occurrence of Alzheimer’s dementia. We are all eagerly awaiting future research and medications.”