By James Lah, MD, PhD.
With millions of baby boomers entering their golden years, the number of patients with Alzheimer’s disease threatens to rise dramatically over the next several decades.
Recent news stories link a number of factors to the risk of Alzheimer’s disease. These range from the inheritance of certain genes from our parents to illnesses such as diabetes and lifestyle choices. Understanding these links is important, but when it comes to Alzheimer’s risk, the 900-pound gorilla is age. Live longer, and you increase your risk of Alzheimer’s.
Every five years beyond age 65, the risk of developing Alzheimer’s doubles. As a result, the number of affected individuals has increased geometrically with the linear increase in life expectancy during the past century. That’s the bad news. The good news is that if we can delay onset of the disease by five years, we can cut the number of people afflicted with the disease in half. (I’ll leave it to you actuaries to explain the math behind this in your comments.)
If you conjure the image of Alzheimer’s disease in your minds, I’d bet that most of you see a depressing picture of a devastated mental landscape. In my clinical practice, I have seen this terrible reality far too many times. However, I also have images of vibrant, smart, funny, and delightfully insightful men and women with Alzheimer’s disease. They are snapshots of the same disease at different stages.
Long before we achieve the goal of eradicating Alzheimer’s disease, we will have treatments to slow disease progression. Given the magnitude of the impending threat, successful drugs are likely to become multibillion-dollar blockbusters for big pharma. I encourage, support, and participate in these efforts, but I fear that an equally important piece of the solution is lagging.
Let’s imagine that tomorrow, a drug is proven to be effective in slowing the progression of Alzheimer’s disease. Fantastic, right? Maybe, but consider the implications. In all likelihood, the next breakthrough drug will slow but not stop disease progression. At what point would you want to take such a drug? When you are still kicking rear ends at your weekly bridge club? How about when you are too confused to drive safely? When you no longer recognize your loved ones? This consideration highlights the importance of early detection.
Increasing awareness and firsthand experience with Alzheimer’s disease has produced widespread fear and loathing among today’s elderly and baby boomers. Too often, this leads to denial, difficulty confronting symptoms, and delay in seeking appropriate evaluation. In addition, systemic problems contribute to the challenge of early detection and diagnosis.
Mild cognitive impairment, or MCI, is an early stage of memory loss that may herald the development of Alzheimer’s disease. At this stage, individuals appear normal and remain independent in their daily activities. Diagnosing MCI can be difficult and requires extensive evaluation, usually including 40-60 minutes or more of formal cognitive testing. Since the average encounter between a primary care physician and a patient is estimated to last 10-15 minutes, MCI usually goes undetected.
My colleagues and I have been evaluating a rapid screening test for MCI that would be practical for widespread use. Our recent study published in the Journal of Alzheimer’s Disease showed that the combination of a very brief (3 minutes or less) paper and pencil test along with a questionnaire (completed by a family member or friend) could help identify individuals with MCI. This tool does not provide a definitive diagnosis, but its ease of use may encourage routine screening for memory loss by primary care physicians. Such surveillance is the first step in early diagnosis of abnormal cognitive decline. If you suspect that you or a loved one may be experiencing symptoms of cognitive decline, do not delay in addressing your concerns with your physician.
To sustain brain health, eat right, exercise, take care of chronic conditions such as high blood pressure and diabetes, and stay mentally active. Remember to support funding for Alzheimer’s research, and, if it is right for you, consider getting involved as a research participant to test new treatments or develop better ways to detect and diagnose Alzheimer’s disease.
Atlanta, what has been your experience? Share your stories, share your ideas. Post.
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