FEATURE
FIT HEART , FIT MIND AUTHOR Kathryn Vance
On Tuesday , Sept . 14 , Dr . Charles Oberst , Chair of the Cato Senior Group , welcomed everyone back after a short hiatus for summer break . Dr . Oberst introduced Dr . David Casey , Chairman of the University of Louisville Department of Psychiatry , with an update on Alzheimer ’ s disease , the sixth leading cause of death in the US .
The term used for Alzheimer ’ s disease and related disorders is dementia . Dementia refers to a syndrome of acquired memory loss and losing one ’ s ability to do normal functions . The most common form of dementia is Alzheimer ’ s disease , accounting for approximately two-thirds of cases of dementia in the US . Alzheimer ’ s has two types : early onset ( before age 65 ) or late onset ( after age 65 ). Early onset Alzheimer ’ s typically runs a more rapid course , but late onset Alzheimer ’ s is much more common and presents with fewer speech and language problems . Short term memory loss is common , and people typically live six to 10 years after the diagnosis is made . Alzheimer ’ s disease does not lend itself to normal staging like some other diseases , but is staged based on symptoms : early , middle and late . At this time , there is no single definitive biomarker or lab test that will diagnose Alzheimer ’ s disease .
In Alzheimer ’ s disease there are three characteristic findings in the central nervous system : atrophy of brain mass , deposition of amyloid protein ( plaques ), and the presence of tau proteins ( tangles ). In all cases of Alzheimer ’ s , both plaques and tangles are present .
People with Alzheimer ’ s have a loss of memory but also a loss of function . More complex activities of daily living are often lost first , such as driving and using technology . Multi-step processes such as learning new technology become very difficult . In later stages of Alzheimer ’ s , people lose the ability to do basic self-care such as dressing and bathing . In the final stages , they have difficulty recognizing people or things , lose interest in food , have falling tendencies and loss of speech . However , many people die from something else before they reach this stage , because they are so vulnerable to infections .
There are more than 50 neurological diseases that can lead to dementia , most of them fortunately very rare . Other more common causes include Lewy Body dementia , Parkinson ’ s dementia , frontotemporal dementia , nutritional deficiencies or infectious disease . Vascular dementia or multi-infarct dementia typically has an uneven progression , but over time will continue to get worse .
This is the second or third most common type of dementia and often has overlap with Alzheimer ’ s .
Frontotemporal dementia is much rarer , and presents with changes in personality , decision making processes and speech and language problems . Over time , it comes to resemble Alzheimer ’ s , but there are characteristic differences found on scans .
Lewy Body dementia is tied for the second most common form of dementia in the US . It does not occur with a stroke , so often scans are normal . Falls and coordination problems are common , and it often looks like a mild form of Parkinson ’ s disease . Unlike Alzheimer ’ s , Lewy Body dementia occurs fairly suddenly , and patients are normally younger than the typical Alzheimer ’ s patient .
Some behavioral and psychiatric symptoms of dementia that are common include speech and language changes , “ sundowning ,” wandering , shadowing a caregiver , agitation / aggression , catastrophic reactions and delusions / paranoia . Emotional lability is common and stresses the caregiver .
There are currently only four prescription medications used to treat Alzheimer ’ s or related conditions . Three of them are cholinesterase inhibitors : Aricept ( Donepezil ), Razadyne ( Galantamine ) and Exelon ( Rivastigme ) and they increase the brain ’ s supply of acetylcholine . These drugs are supportive for months or maybe years , but not curative . Another drug , Namenda ( Memantine ), suppresses glutamate but is also supportive , not curative , and is used primarily in mid-to-late disease progression .
People often ask Dr . Casey what someone can do to reduce risk of Alzheimer ’ s or non-medical things that can be done to help address symptoms of Alzheimer ’ s . The common Western diet that predisposes people to heart disease and stroke may also predispose people to Alzheimer ’ s or vascular dementia . There are various alternatives , such as the Mediterranean diet , with foods such as dark-colored berries , bright fresh fruits and vegetables , whole grains and fish rich in oils . Lifestyle habits affect the risk of Alzheimer ’ s . Dr . Casey said , “ Smoking is probably the single most powerful controllable risk factor .” Type 2 diabetes , elevated cholesterol and hypertension are also risk factors for Alzheimer ’ s disease . Regular exercise , seven hours of good sleep , a high level of mental activity and things that are new or novel for the brain , such as playing an instrument or learning a new language can be beneficial as well .
Kathryn Vance is the Communication Specialist at the Greater Louisville Medical Society .
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