brain health Alzheimers disease

Our bodies change as we age. In general, we see changes in our hearing, hair, or even height. We may also notice changes in our vision or our sleeping patterns. Memory changes occur, too. For a growing number of aging Americans, Alzheimer’s disease and other forms of dementia may take hold.

William Pendlebury, MD, medical director of the Memory Program at the UVM Medical Center answers commonly asked questions about aging and the brain.

What is the state of Alzheimer’s disease and dementia in the United States and Vermont?

We project that in the first third of this century, the number of cases of Alzheimer’s disease will grow to 70 million. People age 85 and over are now the fastest growing cohort within the United States population. That means the incidence of disease among this age group increased by a factor of 2.5 between 1980 and 2000. By the first third of this century, it’s actually going to go up by another factor of 2.5.

Vermont is rapidly aging. By 2030, we project that 1 in 4 people in Vermont will be over 65 and the number of people with Alzheimer’s will increase by 41 percent. Age is the number one risk factor.

As we age, what’s normal and what’s not when it comes to memory loss?

If a memory problem affects a person so significantly that they lose the ability to recall activities of daily living or take care of themselves, it is a serious issue.

An occasional lapse of memory or occasionally not being able to remember someone’s name is not something to be concerned about. We do often see people who we describe as the “worried well.” We’re very happy to do an evaluation and confirm that it is not Alzheimer’s disease or another form of dementia. Then, we have a baseline. If something develops in the future, we’ll have that to compare against.

How does Alzheimer’s disease change the brain?

In a patient with end-stage Alzheimer’s disease patient, we see brain atrophy, that is, brain shrinkage.

We look for plaques and tangles. These are the pathologic changes we look for to confirm by autopsy whether a person who had memory loss and dementia in life actually did have Alzheimer’s disease.

What treatments are available that can help with the symptoms of memory loss?

Current treatments do not cure or halt the progression of the disease. They do treat the symptoms. Patients see an improvement in quality of life. This lasts for a variable amount of time, but eventually the progression of the disease continues. Of the medications currently available to treat Alzheimer’s disease, everybody diagnosed with it receives at least a six-month trial of one of these medications.

Brain health: Are there strategies besides medication that can improve memory?

Medical studies and literature support several healthy lifestyle strategies, which relate to nutrition, exercise, and what we call social integration.

People who are isolated and alone are at higher risk for progression of their memory problem. And then there is what I call intellectual stimulation. Do something on a daily basis that exercises your brain. It doesn’t have to be rocket science or learning a new language, but something simple like a word search. That sort of activity for an hour or so a day is going to be helpful in reducing progression even in somebody who already has Alzheimer’s disease.

What advice do you have for family members who notice their elder is starting to exhibit symptoms? When should they seek help?

The sooner the better. Studies show that the drugs we currently have work best when started early on in the course of the disease. The other issue is, for the patient who has the memory problem or may be developing Alzheimer’s disease, the earlier we can make the diagnosis the more likely it is that they can participate in the planning and decision-making for the rest of their life.

For me, it’s a difficult situation when somebody is seen for the first time and they already are losing the ability to recognize relatives and their surroundings. Their ability to participate in decision-making about future planning becomes problematic. Early intervention is good for the patient, good for the family, and makes the treatments more likely to be helpful.

What resources are available for family members?

First and foremost, our Memory Program provides information and education through our social work team to give caregivers tools to help them manage a memory problem at home.

We’re also developing specific programs focused on tools for caregivers and an educational program. We are beginning to develop an intensive caregiving program at the UVM Medical Center that will focus on helping caregivers be better caregivers and make it more likely that they’re going to be successful.

Are there any breakthroughs on the horizon that raise hope for a cure or prevention of Alzheimer’s?

Unfortunately, I can’t say that there are. The major approach that is currently taken in the research world around Alzheimer’s disease is to try to intervene before the disease starts. We now know that people who are destined to develop Alzheimer’s disease have pathologic changes in their brain 20 years before they actually develop any clinical symptoms.

How do you know that?

We now have a toolkit of what are called bio-markers. By doing a very specialized kind of imaging with PET scans, high resolution MRI scans, or by analyzing spinal fluid for certain changes in protein, we can make a pretty accurate prediction that a person is destined to develop Alzheimer’s disease.

Right now, worldwide, people are starting treatment 20 years before they develop any symptoms. Researchers want to see if a limiting the pathology in the brain before it causes a lot of damage will prevent the disease from occurring. That’s the direction the research is taking. Having said that I don’t see any breakthroughs on the horizon or in the foreseeable future for people who have developed Alzheimer’s disease, except to provide excellent care.

Learn more about the Memory Program at the UVM Medical Center. 

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