Early detection, available drug therapies and promising research are bringing hope to Alzheimer’s patients, their families and caregivers who have long found little reason for optimism about this disease.
“I wish there was a cure for Alzheimer’s,” said Cheryl A. Faber, MD, a Missouri Baptist Medical Center neurologist. “We’re not there yet, but there is exciting research on treatments that may not reverse the disease but can slow its progression. Before long, we may be able to totally put the brakes on Alzheimer’s if it is diagnosed early.”
While researchers study ways to short circuit the disease process itself, Dr. Faber and other neurologists largely rely on early diagnosis and two relatively new classes of medicines to treat its symptoms. And, a better understanding of Alzheimer’s and new technologies are making for earlier and more accurate diagnosis, so that treatment can begin.
WHAT ALZHEIMER’S IS AND ISN’T.
Alzheimer’s disease is the most common form of dementia, which is a broad classification for progressive memory loss and other intellectual disorders that are serious enough to interfere with daily activities. Non-progressive, mild cognitive impairment, according to Dr. Faber, is not dementia. And, while not all dementias are Alzheimer’s disease, it is estimated that Alzheimer’s disease comprises 50 to 80 percent of dementia cases. About one in three senior adults who die from other medical problems also have Alzheimer’s or another dementia, and the number of Alzheimer’s patients is increasing as the American population ages.
Most people with Alzheimer’s are aged 65 and older, but Alzheimer’s is not considered to be a normal part of aging, and younger people do develop the disease. Researchers believe the affliction is rooted in physical changes in the brain, possibly related to abnormal growth of protein-based plaques and twisted fibers. These plaques and tangles begin growing in brain regions that govern memory and then spread to other areas where they are suspected of damaging and killing nerve cells that control brain functions.
WHY EARLY RECOGNITION IS VITAL.
Early detection of Alzheimer’s is vital to its management and slowing progression. The recent development of advanced brain scans now allows us to measure the plaque density in the brain.
“People who are treated early do better,” she said.
And, when it comes to early detection, family members and friends are important. That’s because the victim may not recognize the disorder.
“Alzheimer’s patients often lack awareness that they are missing something or have a problem at all,” Dr. Faber said. “In fact, when a patient self-reports memory problems and is very aware of their mistakes, they probably don’t have Alzheimer’s.”
Difficulty recalling newly learned information is usually the first sign of Alzheimer’s. Increasingly distressing symptoms — such as disorientation, mood and behavior changes, and confusion about time and place — may soon follow.
GETTING AN ACCURATE DIAGNOSIS.
The first step in the diagnosis process is a conversation with the person’s primary care physician, Dr. Faber said. The physician may do some initial testing and, if Alzheimer’s is suspected, may choose to treat the disease or refer the patient to a neurologist. Unfortunately, some physicians may mistakenly believe that today’s medications for Alzheimer’s are ineffective and may not treat the patient at all, Dr. Faber said. When that occurs, the patient or his family member should ask to see a neurologist, she added.
For Dr. Faber, diagnosis begins with development of a detailed patient history, including a determination of mental abilities over time, cognitive testing, “to snap a picture of how things are right now,” blood tests to rule out other medical problems, and possibly brain imaging to detect abnormalities.
A new brain scan, called the Amyvid™ scan, which is available through Missouri Baptist, can detect brain plaques thought to be related to Alzheimer’s. It is considered to be the only imaging tool that can identify Alzheimer’s disease brain markers in a living person.
“It’s more accurate than any other technology we have,” Dr. Faber said.
Dr. Faber reports that she has had good success with two classes of drugs that within recent years have become available to treat the cognitive functional failings of Alzheimer’s patients. One class consists of cholinesterase inhibitors, such as Aricept®, Exelon®, and Razadyne® for treatment of early-stage patients. The second class is memantine, represented by the Namenda XR™ brand, for moderate to severe patients. Both classes treat the cognitive symptoms of Alzheimer’s disease, and the two types may be prescribed in tandem.
“Sure enough, they work,” Dr. Faber said. “Patients and family will tell me, ‘I feel more like my old self again.’ They are a little sharper; a little faster. But they don’t reverse the disease. The real goal of the drugs is to slow down Alzheimer’s progression as much as possible.”
In addition to drug therapy, Dr. Faber treats patients by ensuring that they:
Stay or become cognitively and socially active. “We know that people who are socially active and interactive just stay sharper longer,” Dr. Faber said. “I suggest games, crossword puzzles, computer activities, card games and other stimulating activities.”
Maintain a healthy, balanced diet. “There is not one super-food, but a good diet is important,” Dr. Faber said, adding that she may also prescribe a B vitamin complex.
Stay active. “People who do a lot of physical exercise stay sharper up top, too,” Dr. Faber said.
Obtain family and community support. “If someone comes in and they are already having problems and it’s pretty clear that we are dealing with Alzheimer’s disease, we will get them to the Alzheimer’s Association (www. alz.org). This group is a great support organization with a chapter right here in St. Louis; they provide a lot of free resources to people, and they help patients and caregivers access other kinds of community support, such as adult day care services.”
Cheryl A. Faber, MD, is a board-certified neurologist on-staff at Missouri Baptist Medical Center and a member of BJC Medical Group. She earned her medical degree from the University of Kansas School of Medicine and completed her internship and residency at the University of Kansas Medical Center.