Every 65 seconds, somebody in the United States develops Alzheimer’s disease. The number of cases of Alzheimer’s disease will grow to 70 million by 2033.
In Vermont, medical experts predict that the number of people with Alzheimer’s disease will increase by 41 percent by 2030. Here to talk with us is Dr. Michael LaMantia, a geriatrician and head of geriatric medicine at the University of Vermont Medical Center.
Why the increase in diagnosis of Alzheimer’s disease nationally and in Vermont?
Dr. LaMantia: We see an increase in the number of persons affected by Alzheimer’s disease and dementias in general because the population as a whole is getting older. Aging is the largest risk factor for the development of Alzheimer’s disease.
There are other factors though that put one at risk for the development of Alzheimer’s disease. We’ve noticed over the years that there are associations between the development of metabolic syndrome and subsequent development of Alzheimer’s disease.
What is metabolic syndrome?
Dr. LaMantia: We define metabolic syndrome as having three or more of the following conditions: elevated sugar, elevated cholesterol, elevated triglycerides, obesity, or high blood pressure. A person who has just two of any of those conditions does not have metabolic syndrome by strict definition. Someone who has three or more of those does.
Metabolic syndrome is associated with the development of cardiovascular disease. Those things that put you at risk of developing heart disease, stroke, and cardiovascular disease are associated with the development of Alzheimer’s disease.
How common is Alzheimer’s disease among all types of dementia?
Dr. LaMantia: Alzheimer’s disease is the most common of all of the dementias out there. When people come to see us in the clinic, they frequently have the question, “Is dementia the same thing as Alzheimer’s disease?” A simple way to look at it is that dementia is an umbrella with lots of different types of memory-affecting conditions underneath it.
Alzheimer’s disease happens to be the largest of the categories that fits underneath that umbrella. If I were to see 100 people walk in my clinic who you tell me have dementia, if I were to guess that they had Alzheimer’s disease, I’d be right 60 to 80 times out of that 100.
What are the signs and symptoms of Alzheimer’s disease?
Dr. LaMantia: There’s a wonderful resource out there and that’s the Alzheimer’s Association website. They have wonderful resources all available for free. You can get to it by visiting www.alz.org. They have on their website ten early signs and symptoms of Alzheimer’s:
- Memory loss that disrupts daily life;
- Challenges in planning or solving problems;
- Confusion with time or place;
- Difficulty completing familiar tasks at home, at work or at leisure;
- Trouble understanding visual images and spacial relationships;
- New problems with words and speaking or writing;
- Misplacing things and losing the ability to retrace your steps;
- Decreased or poor judgment;
- Withdrawal from work or social activities; and
- Changes in mood or personality.
What is the difference betweennormal aging and pathological or more concerning memory problems?
Dr. LaMantia: Typical age-related changes would be making a bad decision every once in a while. A sign of Alzheimer’s disease or other dementia would be a pattern of having poor judgment and repeatedly making bad decisions or making bad decisions of significant seriousness.
Typical age-related changes: missing a monthly payment every once in a while. Signs of Alzheimer’s disease might be inability to manage a budget when you used to manage all the family finances before.
Typical means forgetting which word you use. A sign of dementia could be repeated difficulty having conversation.
It’s the larger pattern of this, and it really has to represent a change from baseline for that person. I tell people the first option would be with their primary care doctor. Hopefully they’ve developed a relationship with you over the years and know your medical history, know what medications you’re on, know how you’ve been functioning in the past and whether this represents a new change for you. Then that person, that doctor or nurse practitioner or physician’s assistant could make the decision at that point to send you on for more in depth testing.
There’s some testing that they may be able to do on their own, and they may decide to follow you in their own office for a period of time. There are also specialists in memory care who you could be referred to if your primary care provider were to be more concerned.
What does testing or screening look like?
Dr. LaMantia: Testing or screening usually consists of doing some simple tasks with people. It depends a little bit from clinic to clinic on what instrument a doctor or nurse decides to use, but they typically will ask you to do a variety of tasks that highlight certain functions that the brain has.
We’ve been talking about problems with memory, but changes in cognition can encompass memory, but also a whole range of different functions that the brain does. The brain not only is remembering what it was I said five minutes ago, but it also is constantly having me evaluate ahead of time, use judgment around what is effective, the word that I’m formulating. What is the word that I’m looking for? What’s the language that I need to use in this given situation? It has me interpreting visual images that I have coming towards me, and it has be coordinating my physical actions around me.
Any of these functions can be disturbed by having a disturbance somewhere in the brain, and as memory care doctors, what we do is we look at your performance on these tests. We look for patterns, and we look for the consistency of the patterns and try and see whether there is a signal in there that could indicate that you have a progressive illness like dementia or Alzheimer’s disease.
Is memory loss not always the most prominent problem?
Dr. LaMantia: I certainly have seen patients before who come in to see us in the clinic, and either they or their family members can tell that things have changed, but memory may not be the most prominent problem that they come in with.
They may be concerned about judgment. They may be concerned about word choice and say, “Listen. Mom or dad is losing their temper in ways that they never did. They’re cursing like a sailor, and they never used to curse like a sailor before. This is very much unlike them.” That would be personality change. That could show that they have changes in their judgment, and some of those features, yes, it could be a sign of somebody being depressed or stressed, but it also could be a sign of them having another type of cognitive change that could be Alzheimer’s disease or it could be another type of dementia.
A smart doctor has to be like a smart detective and listen to a person’s story, ask questions to ferret out different angles on it, listen to family members so that we get more than one person’s perspective on what’s going on, and then put that all together and come up with a plan.
Those plans of care are important reasons to come to your doctor and talk with you if you think that you’re having memory problems, because your doctor is well positioned to that point to follow you over time, see whether or not the changes are staying constant, whether things are getting better, whether they’re getting worse, and they can talk with you about preventive strategies to try and promote your brain’s health.
What are some preventive strategies?
Dr. LaMantia: A lot of the things that are good for our brain are also good for our heart, and a lot of the strategies that we’ve learned to promote cardiovascular health, that health of our heart are the things that help promote a healthy brain in the long run.
We tell folks that they should do at least 30 minutes of exercise five days a week. Getting out and walking day to day can be very good for the heart as well as for the brain in the long run.
We think that just like you exercise your heart, you should exercise your brain. That translates into doing games, puzzles, Sodoku, the jumble, having a stimulating conversation with your family member about what you just read in the newspaper every morning. Those are the types of things that you can do that are mentally stimulating.
Other people will go out and volunteer and work with children in the community. Staying social is incredibly important particularly for my Vermonters who live in more rural areas where the temptation can be, in the middle of winter, to hole up. That’s not good for us. Human beings are social creatures, and we need connections with other people.
I tell my folks that they need to manage their stress. They need to get good night’s sleep. I say most folks should get between six and eight hours of sleep per night. If they’re not getting that, they should talk with their provider about it.
They should eat healthy meals during the day. I tell people that a balanced diet does not include Burger King or other fast food three times a day, seven days a week. You need to have a diet that follows the guidelines that the government puts out there for us.
What’s your final piece of advice?
See your doctor regularly. Most people who come in to see me for memory issues are on the older end of the spectrum, and they do have multiple medical conditions, so as you get older, you can expect that having multiple medical conditions may mean that you need to see your doctor more regularly than just once a year.
Make sure you know them and they know you so that you can have these types of conversations with them about what’s changed or how to take care of your other medical conditions, because in order to take care of your brain, you have to take care of the rest of your body.