You Asked

Questions from Dr. Ames's Lecture
June 21, 2011

What are the early signs/symptoms of Alzheimer's disease?

  • Frequent recent memory loss, particularly of recent conversations and events.
  • Repeated questions, some problems expressing and understanding language.
  • Mild coordination problems: writing and using objects becomes difficult. Depression and apathy can occur, accompanied by mood swings.
  • Need reminders for daily activities, and may have difficulty driving.

Are there AD studies in the Albuquerque area?
There are several organizations such as the Alzheimer's Association of New Mexico the fund and support research in Alzheimer's Disease.

The University of New Mexico is involved in AD research as well. In one recent study, UNM researchers said they've linked herpes to Alzheimer's disease. There is also a current UNM study that links between premorbid intelligence and development of the neuropathology characteristics of AD.

Why is Alzheimer's Disease an "epidemic"?
We're facing an epidemic of Alzheimer's Disease in the next decade.

Advances in medical technology have allowed people to live longer. In addition to these gains in life expectancy, 80 million baby boomers - people born between 1946 and 1964 - are entering the age of concern, and age is the greatest risk factor for developing dementia.

Currently, Alzheimer's Disease affects some 5.3 million Americans and challenges more than 11 million caregivers annually. More than half of all Americans know someone with the disease. It is a family disease, affecting the emotional, physical and financial health of multiple generations.

Already Medicaid is spending more than $24 billion annually on care for victims whose families have gone bankrupt trying to cover those costs.

Is there data concerning turmeric?
Turmeric, an ancient Indian herb used in curry powder, is currently being investigated for possible benefits in Alzheimer’s Disease. The current available data is limited. One study found that those who occasionally ate curry (less than once a month) and often (more than once a month) performed better on a standard test (MMSE) of cognitive function than those who ate curry never or rarely. This is likely related to various effects of curcumin, such as decreased Beta-amyloid plaques, delayed degradation of neurons, metal-chelation, anti-inflammatory and antioxidant properties, which are all hypothesized to contribute to the key event in Alzheimer's disease pathology.

How do you legitimately diagnose dementia in an elderly person (over 85) who additionally is undergoing major physical trauma, has violent MRSA infections and is on a very strong antibiotic? How ethically could dementia be diagnosed under such medical conditions?
It is extremely challenging to diagnose dementia in a person with acute comorbid medical conditions such as infections. Active infections and some medication intake can cause acute mental status changes such as confusion and forgetfulness that can clinically resemble and be mistaken for dementia. In most situations, the cognitive impairment resolves once the offending agent is treated or eliminated.

Does any physiological or/and therapy help decrease progression of Alzheimer's?
There is currently no cure for Alzheimer's Disease nor can its progression be reversed. Nevertheless, present treatment options and lifestyle choices can often slow the progression of the disease. A class of medications called “Cholinesterase Inhibitors” may improve the ability to think and remember or slow the loss of these abilities in people who have Alzheimer’s Disease. However, it will not cure Alzheimer’s Disease or prevent the loss of mental abilities at some time in the future.

The components of a Mediterranean diet, which include fruit and vegetables, bread, wheat and other cereals, olive oil, and fish may all individually or together reduce the risk and course of disease. A 21-year study found that coffee drinkers of 3–5 cups per day at midlife had a 65% reduction in risk of dementia in late-life.

People who engage in intellectual activities such as reading, playing board games, completing crossword puzzles, playing musical instruments, or participating in regular social interaction show a reduced risk for Alzheimer's Disease. Education and learning a second language seem to delay the onset of Alzheimer’s Disease syndrome, but is not related to earlier death after diagnosis. Physical activity is also associated with a reduced risk of Alzheimer’s Disease. It is of importance to acknowledge the limitations of the above findings as they are majorly derived from correlation studies. Correlation does not necessarily imply causation. Correlation could be related to an as yet unidentified third issue. For example, perhaps people who play board games have a brain that is more vigorous and therefore less likely to deteriorate, rather than preventing Alzheimer’s.

Are there any inhalers for Alzheimer's disease? What do they do?
There are currently no FDA approved inhalers for the treatment of Alzheimer’s disease or its symptoms. However, there is increasing use of alternate means to deliver medications, mostly focused on patches that may be applied to the person’s skin. There are reports that certain smells may help calm people with Alzheimer’s Disease who are more agitated. Commonly these include lemon oil and lavender.

Does Aluminum affect the brain?
Aluminum is a neurotoxin capable of altering membrane structure and function. One way aluminum damages the brain is by dramatically increasing oxidative stress — that is, accumulation of free radicals and lipid perioxidation products in the brain.

Aluminum neurotoxicity can manifest toxicity as extreme nervousness, forgetfulness, speech disturbances, and memory loss. Autopsies performed on Alzheimer's Disease patients revealed that four times the normal amount of aluminum had accumulated in the nerve cells in the brain. This suggests that long-term accumulation of aluminum in the brain may contribute to the development of Alzheimer's Disease.

Those who enjoy fast foods should be aware that processed cheese has a high aluminum content. The food product having perhaps the highest aluminum content is the cheeseburger. This mineral is added to give processed cheese its melting quality for use on hamburgers.

Please explain the Alzheimer's - Demenia relationship? (It's hard to understand what a person has)
There is a relation between Alzheimer's and dementia. Not all dementia is Alzheimer's Disease, but Alzheimer's Disease is the most common form of dementia, accounting for 60 to 80 percent of cases, and it is estimated to affect more than 4 million Americans. Other types of Dementia include: Vascular, Frontotemporal, Lewy Body and Mixed dementia.

The most prominent symptom of Alzheimer's and dementia is memory loss accompanied by significant changes in personality.

Alzheimer's Disease is forgetfulness that is much different from the normal mild forgetfulness commonly observed in elderly individuals. Over the course of time, the affected individual forgets about himself and the external world surrounding him. This condition is often accompanied by anxiety, depression and paranoia. There is no cure for Alzheimer's Disease, however, there are medications that slow its progress. Alzheimer’s usually has an insidious onset, gradual decline and recent memory is worse than remote memory.

Vascular Dementia is the second most common cause of Dementia after AD. It is due to problems with the small blood vessels in the affected brain. The most common type is called multi-infarct dementia. This is like having many tiny strokes, throughout the 'thinking' part of the brain. So, the section of brain supplied by that blood vessel is damaged or dies (an infarct occurs). After each infarct, some more brain tissue is damaged. So, a person's mental ability declines in a ‘stepped’ progression with symptoms remaining at a constant level and suddenly deteriorating. Vascular Dementia can also sometimes occur after a more major stroke. Symptoms of Vascular Dementia include: problems concentrating and communicating, depression, symptoms of stroke (such as physical weakness or paralysis) and memory problems.

Risk factors for Vascular Dementia include high blood pressure, smoking, high cholesterol, diabetes mellitus, cardiovascular and cerebrovascular disease.

It may be possible to slow the progression of Vascular Dementia by taking medication to treat any underlying conditions (mentioned above) and adopting a healthier lifestyle by smoking cessation, regular exercise, healthy diet, moderate alcohol drinking.

There are other certain types of dementia that cause major and critical symptoms. For example, people suffering from dementia accompanied by Lewy bodies experience highly detailed visual hallucinations. On the other hand, people with frontotemporal dementia may have significant changes in their personality, so they exhibit unusual behavior. These types of people seem to be extremely careless toward others, or others may find them rude.

Lastly, some people can have a degree of two different types of dementia at the same time. For example, both Alzheimer's Disease and Vascular Dementia, or both Alzheimer's Disease and DLB. This is known as mixed dementia.

Explain the family genes that create Dementia/Alzheimer’s in a person?
Alzheimer's Disease is an irreversible, progressive brain disease. It is characterized by the development of amyloid plaques and neurofibrillary tangles, the loss of connections between nerve cells, or neurons, in the brain, and the death of these nerve cells. There are two types of Alzheimer's—early-onset and late-onset. Both types have a genetic component.

The early-onset form of Alzheimer’s Disease occurs in people age 30 to 60. It is rare, representing less than 5 percent of all people who have Alzheimer’s. Familial Alzheimer's Disease is caused by any one of a number of different single-gene mutations on chromosome 21, 14, and 1. Each of these mutations causes abnormal proteins to be formed. Mutations on chromosome 21 cause the formation of abnormal amyloid precursor protein (APP). A mutation on chromosome 14 causes abnormal presenilin 1 to be made, and a mutation on chromosome 1 leads to abnormal presenilin 2.

It is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. In most cases, an affected person inherits the altered gene from one affected parent. The early-onset group holds a great promise for research on treatment and prevention but further work is needed.

The inheritance pattern of late-onset Alzheimer’s Disease is uncertain. People who inherit one copy of the APOE e4 allele have an increased chance of developing the disease; those who inherit two copies of the allele are at even greater risk. It is important to note that people with the APOE e4 allele inherit an increased risk of developing Alzheimer’s Disease, not the disease itself. Not all people with Alzheimer’s Disease have the e4 allele, and not all people who have the e4 allele will develop the disease.

Why does Alzheimer’s Disease suggest embryonic stem cells, when there have been no positive results from them?
Stem cell research is at a very early stage and there is a lot of vital information that researchers do not yet know. There are many obstacles which researchers would first have to overcome. Simply transplanting stem cells into the brain is unlikely to be the answer.

Nevertheless, some potential aims of stem cell research into dementia treatment could be to
• Get the stem cells already naturally present in the brain to replace the cells destroyed by dementia
• Put new stem cells into the brain and get them to replace the cells destroyed by dementia.

Stem cells could also help dementia research in other ways, for example:
• Use stem cells to produce large amounts of cells (for example, brain cells) which are hard to obtain in other ways, in order to test drugs.

Do you consider a concussion a head injury which contributes to Alzheimer’s or Dementia?
The link between head injury and dementia/Alzheimer's Disease is controversial. Recent epidemiological studies have shown that head injury is a risk factor for the development of dementia/Alzheimer's Disease, whereas others have shown that maybe brains that are susceptible to Alzheimer’s are more likely to concuss.

Repeated mild head trauma in both animals and humans can accelerate amyloid beta peptide accumulation and cognitive impairment. There is also some data suggesting that severe traumatic brain injury, with long-lasting morphological residuals, are a risk factor for the development of dementia/Alzheimer's.

Have you had any contact with the (US) group that thinks we may have it all wrong and that plaque, rather than a destroyer, is a protector of the brain (from amyloid ) damage?
The amyloid hypothesis as detrimental to brain functioning is still debated. Yes, there are groups who are researching protective aspects of plaques just as there are groups who postulate that amyloid is an incidental occurrence in the development of Alzheimer’s Disease. The creative tension this generates leads to very helpful discussions and debates.

The National Alzheimer’s Project Act was recently passed in the U.S. making Alzheimer’s Disease a national public health state-give priority. Any lessons for the U.S. from Australia in making NAPA realize its promise?
Much of the effort in Australia towards tackling the problems presenting with Alzheimer’s is government driven and very successful. The lessons learned from Australia hopefully will benefit the government-led efforts in the United States.

Was wondering what kind of coordinating research is going on between countries (for example Australia and the U.S.)?
Through groups such as the Alzheimer’s Association and the International Psychogeriatric Association, there are formal and informal efforts to coordinate research throughout the world. For example, this July, the Alzheimer associations from multiple countries sponsored an international meeting of scientists, researchers and clinicians named “The International Congress for Alzheimer’s Disease.” Many of the most recent advances tackling Alzheimer’s Disease are first presented at this meeting.