Friday, January 20, 2012
Let's face it: Alzheimer's early diagnosis and treatment is the best way to go
By Dr. Andrew Frank
The medical profession has learned a great deal about Alzheimer's disease and related dementias in recent years, and we know that early detection can determine how successfully people who have the disease -- and their caregivers -- will cope.
As the medical field unlocks the secrets of this fatal disease through painstaking research, we have determined a pattern of the most likely recipients, how the effects can be delayed, and how to retain and enhance quality of life after diagnosis. We predict that many more cases of Alzheimer’s and related dementias will arise in lockstep with the longer life expectancy of baby boomers. While today's seniors' population encompasses many affected by Alzheimer's disease, the number of these individuals is but a small precursor to what lies ahead for the next generation of seniors.
Should we live in fear of the ravages of these diseases? I would rather see a more proactive approach. We do have some control over the severity and speed with which the disease can take hold. As well, beyond the direct deleterious effects on the person with the condition, we strive to avoid “caregiver burnout” for family and friends who provide care in the home. Burnout is imminent if outside resources remain untapped. Fortunately, there is help available to those who need it.
This year's slogan adopted by the Alzheimer Society, “Let's Face It! Get the facts. Know for sure” to encourage early detection of dementia, is on the mark. We need to face the possibility and identify Alzheimer's disease early, so that we can cope with it better. January is Alzheimer's Awareness Month, and early detection can directly affect how the future will unfold for people living with the disease. Early medication, education, and support can stave off problems associated with the later stages of the disease and prolong the ability to remain at home. Research clearly shows that early detection can determine quality of life for everyone involved.
We no longer believe that “senility” is a natural part of aging – it never was. Senility is an outdated label for a host of symptoms that may affect memory, judgement and mood. Today, we use the word “dementia,” a medical term referring to memory loss that impairs an individual's daily independence and ability to function. Alzheimer's disease, a toxic protein build-up in the brain, is the most common cause of dementia. Other dementias may result from stroke, head injury, or Parkinson’s disease.
It is important to note that memory loss comes in many forms and is often unconnected with Alzheimer's and related dementias. A third of the people who come to my office for Alzheimer's testing do not have it.
Forgetting where you put your car keys is not an Alzheimer's symptom, but forgetting how to play cards after years of membership in a bridge club could be. Failing to remember who starred in Gone with the Wind, and then recalling the names of Clark Gable and Vivien Leigh later on, demonstrates that the memory is actually intact. But, forgetting the name of an old friend who drops by for tea, and remaining unable to retrieve it, could show physical changes in the brain that are blocking delivery of a once-familiar message.
It's quite normal to walk into a room and immediately forget why you entered it. Often, the reason why you entered will return to you later. It's embarrassing to forget a word, only to remember it hours after a conversation has occurred. The feelings of frustration at these changes is vexing, but this frustration is actually a good sign -- being aware of our own forgetfulness is an indication of normal memory changes. Yes, some memory changes with aging are normal. We can see our body aging on the outside, but we can't bear witness to our brain aging on the inside, which it does. However, when an individual forgets one's own forgetfulness, and cannot recognize that it is occurring, then we should look for disease.
We strive to delineate between perfectly normal “seniors' moments” and the abnormal lapses of memory and judgement that will eventually lead to loss of independence. Memory loss for important personal events, or repeating something without recollection of saying it before, can indicate the presence of disease. Personality changes are also indicators, in which one may act quite childish, or simply lose interest in the world around them, lapsing into a “flat” emotional state. We also look for skills erosion, where someone who was perhaps an excellent cook, woodworker, or piano player, can no longer perform these habituated tasks. These faltering traits are often noticed by friends and family, but may not be noticed by the person who is affected. Mental and physical testing by medical professionals can determine if Alzheimer's and related dementias is at the root of the problem.
Early diagnosis means refusing to live in the shadow of denial. It can make a world of difference to a person living with Alzheimer's disease and their caregiver. Medical treatment is available to slow the disease, and it is important to start this before someone develops severe functional limitations. It isn't practical or affordable to screen the entire population with CT (cat) scans, MRIs or perform blood tests – there must be symptoms present before we test. Since these symptoms often need to be identified by family and friends, early detection is a group effort. Early consultation with the medical community and Alzheimer Society provides the care and support that can make this disease manageable for everyone involved.
People who live with Alzheimer's disease and related dementias eventually lose the ability to care for themselves, and this can be dangerous. Many will have trouble heeding medication schedules, paying bills, preparing meals, shopping, driving, dressing and maintaining personal hygiene. While these are the day-to-day activities we tend to take for granted, they all play an integral role in personal well-being.
Denial and refusing to address the symptoms is common, but it only makes life tougher for both the person living with the disease and the caregiver. At worst, if symptoms worsen without treatment or support, a crisis often arises when an unexpected illness erupts, such as an infection or fracture from a fall. This could lead to an agonizing and lengthy hospitalization, possibly with discharge to a nursing facility. There is no reason to suffer in silence or isolation with so many resources available to help. Indeed, while there will be some difficult days ahead if the disease is found, the future is brighter when detection, treatment, and support occur earlier.
Impairment from Alzheimer's disease works on a sliding scale from early to severe stages. It is a fatal disease with no cure, but the journey from early to advanced stages can be as long as nine years or more, and that journey can be made easier with early detection. Behavioural problems can occur between years two and six, and nursing home placement is common between years five and seven.
Is Alzheimer's disease going to be a threat to baby boomers? The incidence of occurrence doubles every five years, so the 2.5 percent of seniors who have it at 65 years old will escalate to about 40 percent by age 85. With baby boomers poised to live longer than any previous generation, we can expect this disease to affect an even larger portion of the population. In the United States, there were 4.5 million people affected in 2000 and we expect 13.2 million Americans will be affected by 2050. There were an estimated 480,000 seniors affected in Canada in 2008 with an associated health care cost of $15 billion. The number of women affected was double the number of men affected, likely because women tend to live longer. By 2038, we predict 1.12 million Canadians will be affected by Alzheimer's and related dementias, with a staggering health care cost of $150 billion.
Can aging baby boomers take action to prevent these diseases? We know that there is less risk to those who maintain better general health. What is good for the heart is good for the brain. It helps to control vascular (blood vessel) risk factors such as high blood pressure, diabetes, high cholesterol, smoking, and excessive weight. It is also an excellent idea to engage in frequent physical and mental exercise, and encourage social interaction. The old maxim “use it or lose it” applies to Alzheimer's prevention. Meanwhile, new treatment options are currently under investigation, which could be available within the next three to five years.
At the invitation of the Alzheimer Society of Ottawa and Renfrew County, I presented a special seminar entitled, “Early Diagnosis and Treatment of Alzheimer's Disease and Dementia” on January 18, 2012 in Ottawa and discussed the benefits of early diagnosis, warning signs, and what you can do to cope with this debilitating disease. For more information on upcoming local events, visit www.alzheimer.ca/ottawa.
Dr. Andrew Frank, M.D., B.Sc.H., F.R.C.P.(C) is a Cognitive and Behavioural Neurologist with the Memory Disorder Clinic at the Élisabeth-Bruyère Hospital in Ottawa, Ontario. He is an expert in the field of Alzheimer's disease and related dementias.
The Alzheimer Society of Ottawa and Renfrew County extends its thanks to Dr. Andrew Frank for his generous support in being the featured speaker at our chapter's seminar offered during January's Alzheimer Awareness Month.
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