Fading memories: LVHN doctor talks about Alzheimer’s
The holidays are a time to share memories and make new memories with those we love. But Alzheimer’s disease and other forms of dementia can rob people of that ability.
Dr. Shahzad Khan, a neurologist with Lehigh Valley Health Network, said there are different types of dementia, but Alzheimer’s disease is the most common.
Dementia is a general term for when a person has problems with memory, reasoning, judgment and language that is progressive in nature, he said.
Usually this impairment interferes with a person’s ability to think and their social skills. It affects their daily life and doing things, such as their ability to drive, shop, work, communicate, keep track of bills and using electronic devices.
“In the United States alone, approximately 6.08 million Americans had either AD or mild cognitive impairment due to AD in 2017,” Khan said. “That number is expected to grow to 15 million by 2060.”
Causes and risk factors
The cause of Alzheimer’s disease is unknown, but he said researchers think it could be due to a combination of environmental and genetic factors that cause multiple changes over decades.
“These changes include deposits or plaques of a protein called beta-amyloid, loss of nerve cells or neurons in important parts of the brain, and disorganized masses of protein fibers within the brain cells. These are known as neurofibrillary tangles,” he said.
There are risk factors that have been identified for Alzheimer’s disease. They include: advancing age, family history, APOE 4 genotype, obesity, diabetes, dyslipidemia, hypertension and Down syndrome.
Another possible factor could be the bacteria that causes gum disease. Khan said an analysis led by scientists at the National Institute on Aging suggested that it could be related. Clinical trials still need to be conducted to test the effectiveness of treatments to reduce bacteria possibly related to dementia.
Other causes for memory problems
Khan said that if a person is concerned about his or her memory problems, then the next step is to talk to a primary care physician. There are common treatable causes for memory impairment such as depression, hypothyroidism, nutritional deficiencies (like Vitamin B12), and brain mass or tumor. These can be determined through simple blood tests and imaging studies of the brain.
Following the tests, the doctor may recommend that a neurologist be consulted.
Khan said a neurologist will evaluate thinking or cognitive functions through additional tests.
Getting the right diagnosis
Neuropsychologic testing measures thinking skills, such as memory, attention, reasoning and judgment, language skills and orientation. From there, the neurologist may order more extensive testing to look for different causes for dementia.
“The diagnosis of AD is made in large part by clinical and neuropsychologic assessment,” Khan said. “However, ancillary imaging studies (such as) computed tomography, magnetic resonance imaging, single-photon emission (CT scan), or positron emission tomography (PET scan) and laboratory tests may be used. These tests help exclude other possible causes of dementia.”
Khan discourages using genetic testing for the purpose of routine evaluation, but research is closer to providing an accurate diagnosis with a blood test, he said.
There are medications available to treat Alzheimer’s disease.
“The current standard pharmacologic treatment for AD in the United States is the use of neurotransmitter modulators act on acetylcholine (ACh) or glutamate to delay cognitive deterioration in patients,” he said. “This medicine includes donepezil, galantamine, rivastigmine and memantine.
“Several drugs are under (clinical) trial for the treatment of AD and physicians are optimistic to hear the good news in the next 1 to 2 years.”
There are multiple over-the-counter medicines that can make the symptoms of the disease worse, Khan said.
Medicines used for sleep or cough can cause confusion, dizziness and increase the risk of falls in an elderly patient. He recommends talking to a primary care provider before taking those medicines.
He encourages patients to eat a healthy diet and to get both physical and cognitive exercise.
Some good cognitive exercises are crossword puzzles or brainteasers, because they help to slow progression of the disease.
In addition to cognitive issues, people with dementia can also experience psychiatric symptoms such as changes in mood and personality, depression, agitation, aggression, hallucinations and delusions, Khan said.
These symptoms can be treated with the use of antidepressants, anxiolytics or antipsychotics and would be addressed by a primary care physician, neurologist or psychiatrist.
Khan said the life expectancy can vary, because Alzheimer’s disease is progressive.
On average, most people live 8 and 10 years after diagnosis, but it can range from 3 to 20 years.
There is no cure.
Khan said current research is focusing on prevention, early detection, and treatment of early-stage Alzheimer’s disease.
“The recent discovery of biomarkers associated with Alzheimer’s disease has prompted a shift to the prevention of the disease. Vaccine trials against Alzheimer’s disease are promising and could change projections of Alzheimer’s disease, future costs to health care industries worldwide, and lead to healthier elderly populations,” he said.