DOCTOR IS IN: Alzheimer’s comes with longevity.

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.

  • James Lah, MD, PhD, associate professor of neurology, Emory University School of Medicine, and a physician in practice with Emory Healthcare.
  • Visit the Emory Neurology Department
  • For more on taking care of the elderly, check out AJC’s Caring and Sharing.

(Information provided by Emory on this site is intended solely for general educational purposes and is not intended or implied to be a substitute for professional medical advice. Always seek the advice of your physician or other health provider for any questions you may have regarding your health and medical condition. If you rely on any information available through this website, you do so at your own risk. You understand that you are solely responsible for any damage or loss you may incur that results from your use of or reliance on any material or information provided by Emory through this website.)

18 comments Add your comment

Paul D. Fowler

March 25th, 2009
9:09 am

I am now 77 and in good health for my age, but concerned to know that my father and his father both
developed dementia at or around age 80. I have experienced intermittent depression since about age 10, and presently take 10 mg of paroxetine. I was hospitalized at VA in Augusta for about 30 days in
1982 for major depression. I am a retired professor from Georgia Southern University, living in Statesboro. I have had some difficulty remembering names for the last 2 or 3 years. I am physically active and play singles tennis once a week. I would be interested in any clinical trials that you under-take.

Trish Gates

March 25th, 2009
9:54 am

I would love to be in a trail or test. My dad died of early alzheimer’s. It was diagnosed prior to age 62. I was told to take two ibupron per day. I have not been doing so.

Earl

March 25th, 2009
10:06 am

My mother in law is currently undergoing therapy at UAB in Alabama for Alzheimers, she is 80. Bother her parents and all four of her siblings that reached adulthood suffered from the disease. She is the only surviving child of her parents. She can recmember most family members but we know this will end soon. Before long we’ll be strangers to her. She is on a blind study medication now, I don’t see the good effects that my wife seems to see with her mom. My wife has undergone early test for the plaque that builds up in the brain and she was told she has a greater than sixty per-cent chance of developing the disease. Good luck

Earl

March 25th, 2009
10:08 am

I intended to say good luck Mr.Fowler, I hope the best for you. I am 55 and I forget names and I have no history of this disease in my family that I am aware of, only by marriage.

Dave

March 25th, 2009
11:16 am

I think most of us fear contracting this disease the most. It causes such a huge burden on caregivers who become as almost trapped as those who get this horrible disease with probably the most guilt and frustration it causes to all involved. If there is one disease we should probably work on in finding a cure this might be the one as it taxes both our health care system and families in such huge ways. Give me cancer or heart disease, but absolutely don’t give me Alzheimers.
Not remembering names is not Alzheimers it is when you can’t remember you car key will start your car or forgetting how to get home when you go to your local mall and have done it a many times.

kay

March 25th, 2009
11:22 am

My mom passed last year at 82, with congestive heart failure and pneumonia. However, she had a stroke seven years earlier and suffered some dementia a few years before she died, which according to her physician, was stroke related; regardless it was still hard to see her decline, but thankfully she still knew my sister and I, we were her caregivers. I don’t know the differences between stroke related dementia and alzheimer’s but I wish the mental decline of both types could be treated successfully.

Big Juicy

March 25th, 2009
11:28 am

Don’t know; I seem to have forgotten —

D

March 25th, 2009
12:07 pm

What was the question?

Dennis Fortier

March 25th, 2009
12:17 pm

This is the most cogent argument for the importance of early detection that I have see. Thank you Dr. Lah for constructing it. I am directing readers here from http://braintoday.blogspot.com.

Jeff

March 25th, 2009
12:19 pm

I lost my dad to Alzheimers. While the disease slowly took him away from us my mother fought and lost a battle with colon cancer. My family and I were the caregivers and watched them both suffer daily. By far Alzheimers is the most devastating disease in so many respects. I worry daily about my risks and I cringe every time I hear someone say that a friend or love one is afflicted with Alzheimers. From personal experience, Alzheimer’s is devastating to the core!

Steve

March 25th, 2009
12:32 pm

There is a link between vaccines and Alzheimer’s. Why don’t they publish that?

Elaine

March 25th, 2009
1:25 pm

My father passed away almost 3 years ago from the effects of Alzheimers but we lost him long before that. He no longer knew his family and friends and didn’t even remember who he was. He lost a lifetime of memories before he lost his life. So I guess that’s what it’s like to have your life taken away from you before you die. Very sad.

Jo Ann

March 25th, 2009
2:11 pm

My father died from alzheimers in 93……………my sister just turned 60 yesterday and has for the past few years been experiencing memory loss……………….I expressed my concern to her husband and her daughter……………………I took matters into my own hands and flew up myself and drove her to the daughter……….long story short I wasn’t pleased with the dr…………..I flew back home………………another 2 weeks her husband took her to another doctore…………………..blood tests were done and she was told to come back in 3 months!! My plan is to go back up and request that further testing be done because her memory is horrible! Any testing that I should request would be appreciated………………..I am not exaggerating the memory………you have to take your health in your own hands, but if you aren’t capable or you’re scared, then a family member must step in !

HSR0601

March 26th, 2009
12:14 am

The elderly are required to engage in some ’sporting activities’ to stay active and for ’soft landing’, and to consume more comfortable to digest diets such as fruits and veggies, which are instrumental for their metabolism and blood stream, from my perspective.

Cal

April 1st, 2009
12:10 pm

“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”, THIS STATEMENT IS A BIG CONCERN TO ME along with possible side effects of the drugs. We are well aware that pharmaceuticals are very profitiable – sometimes at the cost of health and wellness. If I’m “still kicking rear ends at bridge clubs”, I wouldn’t want to take anything that might hinder that “kickingness” even if it means a better quality of life later on. AND, if I’m 88 with few physical ailments, taking a drug that might decrease my physical condition would not be welcomed. I agree that the 3-minute MCI test is not enough. I experienced this first hand with my mother. I was even sent out of the room. It should be common knowledge that some cognitive impaired indiv. can answer some of those simple questions well enough to pass that test. I could have given them a more accurate picture of what was actually going on. AND this happened at a geriatric clinic. But, I’m sure we all agree, a lot needs to be done.

Sarah

April 6th, 2009
12:40 am

I recently came across your blog and have been reading along. I thought I would leave my first comment. I don’t know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.

Sarah

http://blanket.ws

christy

May 19th, 2009
4:23 pm

alheizmer’s runs in my family as my father passed away last fall as a result of this family gene. thank you for your work in the early detection of this disease. http://www.christyhulsey.wordpress.com

Hank

June 14th, 2009
12:21 pm

It is nice to see that Dr. Lah and his colleagues are developing a simple screening test for MCI. I have been experiencing symptoms of MCI for several years now and no one could find a cause. The general response I would get was, your depressed, everything seems normal. Other health problem were found and treated but my core complaint, Cognitive problems, was always dismissed as in my head. It’s an easy out when the doctor doesn’t have the answer
I’m lucky I guess, as I am a stubborn SOB and would not let it rest. I recently had some disc problems and I saw a Neurologist. I told his PA about my cognitive problems and talked her into doing an MRI and a one hour Neuro Psych exam.. I had had an MRI about 3 years ago which two Neurologists looked at, including the author of this article, and I was told then that there was no physical problems in my brain that could cause my MCI..
My new neurologist told me that I have been having silent strokes for quite a while. He even showed me the MRI and pointed out where I had many white matter lesions. Looking back over my previous MRI results these were evident and even pointed out by the radiologist yet ignored in the final diagnosis. .
I’m starting Aircept. I’m told that it should greatly reduce but not eliminate the progression of the MCI. If I had started it 3 years ago when the problem was ignored, I would probably not have lost (and will never regain) anywhere near the cognitive functions I have. Early detection tests are only good if the doctors actually pays attention to them. As JoAnn said, “you have to take your health in your own hands” For whatever reason you can’t always depend on doctors to do what is in your best interest.