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Wednesday, October 17, 2018

All About Alzheimer’s

Posted By: Advancing Care

Learn the facts behind this debilitating disease — and why there’s hope for a cure.

By Deborah Skolnik

Alzheimer’s. Few words invoke such instant fear. But for all the anxiety and dread surrounding this disease, few people actually know the facts about it. Here, Stephen Marks, MD, a neurologist and Co-Chief of Cerebrovascular Diseases and General Neurology at Westchester Medical Center, the flagship of the Westchester Medical Center Health Network (WMCHealth) in Valhalla, sheds some light on this progressive illness — and the quest for a cure.

Complex Causes

Contrary to what you may have heard, dementia (loss of intelligence due to a pathological cause) and Alzheimer’s are not the same. “There are 81 causes of dementia, and Alzheimer’s is just one of them,” Dr. Marks shares. But at least in this part of the world, it’s the major culprit: “Approximately 70 percent of the dementia that we see in the Western world is due to Alzheimer’s,” he explains.

What, then, causes Alzheimer’s? “It’s a complex answer; there seem to be two underlying events,” Dr. Marks says. One is the accumulation in the brain of a protein called amyloid. However, the condition that seems to cause brain damage and lower intelligence is the presence of another protein, called tau.

Subtle Symptoms

Given how devastating a diagnosis of Alzheimer’s is, it’s understandable that people get nervous when they have a forgetful moment — say, they misplace their glasses —wondering if this might be the onset of the disease. The good news is that it almost certainly isn’t, says Dr. Marks. “First of all, a lot of normal people put things down and then don’t remember where they put them. And what’s very common is that people who are exhibiting early signs of Alzheimer’s are oblivious to it,” he says. “So when I get a patient who comes in and is worried they may have Alzheimer’s, they usually don’t have it.”

So what is cause for concern? “Repeating things that you said five or 10 minutes ago,” says Dr. Marks. Though some people do this occasionally out of nervousness, “telling and retelling the same story to an audience is always a big concern,” he says. 

Language skills themselves also may be impaired, and sufferers will find themselves fumbling about for the right word. “It’s interesting: It’s a subtle, ‘Give me, uh, that thing you write with… the pen,’” Dr. Marks explains. “We all do it a little bit, but people in the early stages of Alzheimer’s use a lot of generalities when they talk sometimes.”

In addition to affecting language skills, Alzheimer’s can diminish a person’s spatial recognition. Wandering and getting lost are two signatures of the disease. “Getting lost easily in places like airports, and while driving on well-known routes, would be very concerning,” Dr. Marks says. “I’ve had people get lost in their own basement as well.” Lastly, early Alzheimer’s may sometimes cause behavioral disturbances such as paranoia.

Options for Diagnosis

In diagnosing Alzheimer’s, physicians (typically a neurologist or geriatrician) first must eliminate other possible causes for the symptoms. One health issue that can cause Alzheimer’s-like behavior is something called vascular dementia, which occurs after a person has a series of small strokes. “In that case, they typically have gait abnormalities,” Dr. Marks notes. Other degenerative disorders exist, such as Diffuse Lewy Body disease. Problems with vitamin B12 absorption can also affect cognitive skills and gait. For this reason, when a physician sees a patient with Alzheimer’s-type symptoms, “we get a complete chemistry, a cell count, thyroid-function tests, and a B12 level,” says Dr. Marks. Brain imaging with a CT or MRI is also recommended.

Two principal tests can be conducted to provide near 98 percent certainty. One is a spinal tap, to do special studies on the spinal fluid. Occasionally performed, but of some cost due to lack of insurance coverage, is the amyloid-specific Positron Emission Tomography, or amyloid dPET scan.

Early vs. Late Onset

If symptoms clearly present before age 65, the condition is considered early-onset Alzheimer’s. “It looks just like late-onset but often has a strong familial genetic basis,” says Dr. Marks. With certain genes, “the children can have a 50 percent chance of getting early-onset Alzheimer’s themselves.” Fortunately, only 2 percent of all Alzheimer’s cases are early onset. By contrast, late-onset Alzheimer’s often will show up in a person’s late 60s, 70s and 80s.

Today’s Treatments

At present, there are only two types of medicines to treat Alzheimer’s, says Dr. Marks. The first are called cholinesterase inhibitors — they prevent the breakdown of a neurotransmitter called acetylcholine. “Theoretically it makes your brain work better,” says Dr. Marks. However, “Only about 40 percent of people have a good response, and even then, it’s only as if the patient were three to six months back in time,” he says.

The second type of medicine, memantine, can slow progression of moderate to severe stages of Alzheimer’s. “People still get worse, but they don’t get worse as quickly,” Dr. Marks says.

Tomorrow’s Hope

Dr. Marks says people can reduce chances of ever developing the disease. “Excellent vascular health is desirable.” Control your blood pressure and cholesterol.” Be active, but avoid activities such as certain contact sports that can put you at risk of concussions, which have been found to accelerate Alzheimer’s-like brain changes in people who are at genetic risk for the disease.

Food choices also may make a difference. Dr. Marks recommends following a Mediterranean diet, one rich in fruits, vegetables, chicken or fish, and good fats, such as avocado, olive oil and nuts. De-emphasizing red meats and carbohydrates may be helpful as well. Lastly, train your brain: “Early awareness can diminish the likelihood of ever getting Alzheimer’s or forestall it a bit,” Dr. Marks observes. “The brain is a use-it-or-lose-it organ.”

Hope on the Horizon

Will medicine further help future generations of Alzheimer’s sufferers? “A lot of the medical industry is looking at antibodies that will allow our own immune systems to clear out amyloid in the brain,” Dr. Marks says. “These treatments are in the pipeline.” Ultimately, he predicts, Alzheimer’s is a foe that will be felled. “It’s clearly a disease; it’s not normal aging…it will be cured one day,” he says. 

Neurological Services at WMCHealth

Westchester Medical Center 914.345.1313

Maria Fareri Children’s Hospital 914.358.0190

MidHudson Regional Hospital 845.483.5915

Good Samaritan Hospital 845.368.8808

HealthAlliance Hospitals 845.483.5305

Alzheimer’s Care at WMCHealth

Schervier Pavilion, Warwick 845.987.5717

Mount Alverno Center, Warwick 845.986.2267

St. Josephs Place, Port Jervis 845.858.7557

Mountainside Residential Care Center, Margaretville 845.586.1800

Good Samaritan Home Care Servicing Westchester, Orange, and Rockland Counties, as well as the Bronx and Manhattan  845.368.5277