Alzheimer’s disease is an international challenge! Scientists throughout the world are working at an accelerated pace, focused on identifying the causes and testing different treatment options.
Alzheimer’s disease was first identified in 1906 (over 110 years ago), actually discovered by Dr. Alois Alzheimer. Since then the science community has created microscopes, imaging devices and other tools to identify the pathology of the disease. They are still trying to definitively answer the questions – when does it begin, where does it begin, how does it begin, how does it spread throughout the brain, who is susceptible? We have answered parts of these questions – but we still need much more information. Many clinical trials are underway focused on obtaining answers.
And as scientists continue to work on these challenges, what should you do in the mean time? First, take care of your overall health. That seems like a simple answer, but for some individuals it can be challenging. If we remember a few general things like; “what’s good for the heart is good for the brain” and add “continue learning”, “stay engaged socially”, and “minimize stress” – we are doing the right things for overall better brain health. It is never too late to adopt good brain health habits!
A study calculated that an intervention that would delay the onset of AD by 12 months would lead to 9.2 million fewer cases of AD globally. Research has estimated that reducing inactivity by 10-25% could prevent between 380,000 to one million cases of AD worldwide. Based on published reports, if the cost of care for an AD patient is $10,000 more per year than a patient without AD, we would save 3.8 to 10 billion dollars a year.
Despite the benefits of exercise, research suggests that the subpopulation of older adults actually exercise less. In general, health-promoting behaviors tend to increase with age, with the exception of exercise. Different factors as to why this age group is more sedentary include: lack of self-efficacy, inadequate education, poor support, limited access to recommended exercise and abnormalities of mobility.
Isolation, cost, lack of socialization as well as poor physician emphasis are also factors. Exercise is a cost effective, non-pharmaceutical treatment to delaying the onset of dementia and improves outcomes. A critical challenge is how to help older adults overcome obstacles that prevent them from developing a healthy exercise habit. One major obstacle is a lack of motivation for exercise.
A growing amount of research reveals that an “enriched” environment may be crucial to improving brain health. “Enriched” simply means that influences such as physical exercise and intellectual stimulation can affect your brain’s functioning. Findings from brain health studies at UC Berkeley have corroborated the importance of exercise on brain health.
It all makes perfect sense, as the brain is a vital part of the body. Since it is comprised of cells nourished by your blood, your heart’s health also plays an important role in your brain’s wellbeing. Regular physical activity improves cerebral blood flow, which promotes better mental functioning. So, it’s easy to see why both physical and intellectual exercises would help improve brain functioning.
Secondary dementias, for the most part, begin with disease outside the nervous system. They are not associated with a degenerative process like Alzheimer’s disease in which the pathology usually involves the brain itself and no other parts of the body. The secondary dementias usually involve some general systemic process which affects the brain secondarily. I have divided these secondary dementias into groups: Infection, Metabolic, Brain Tumors, and Trauma, which I hope will be have some benefit.
One important issue to remember about secondary dementias is that in many cases they are treatable dementias. For example, thyroid dysfunction or toxic states.
The most difficult infectious disease is called Creutzfeldt-Jakob disease (CJD). Creutzfeldt-Jakob is a disease caused not by a virus but by an infectious protein very similar to a virus. In the past it was quite difficult to diagnosis CJD because we didn’t have adequate neuro-imaging studies. We used to frequently biopsy the brain in Creutzfeldt-Jokob, but in association with this biopsy there was the potential for the spread of the disease itself. Now as one recent article suggests an MRI scan with contrast shows abnormalities of the cortical ribbon in the frontal areas. These findings represent a typical picture associated with CJD and assist greatly in the diagnosis of this condition.
AIDS dementia complex, which is the dementia associated with HIV/AIDS used to be very common. It’s of particular interest because the brain is one of the few if not the only organ in the body which is actually invaded by the abnormal virus like particle associated with HIV/AIDS. AIDS dementia complex has undergone a dramatic change as it has become much less common with the new and helpful treatments for HIV/AIDS. Twenty years ago I saw 5 patients a year with AIDS dementia complex and in 2013 I saw zero.
Cryptococcal meningitis usually occurs in individuals who have immune suppression, for example, a patient with leukemia. In the past it was difficult to diagnosis but we now have antigen antibodies that can identify it relatively easy even from the peripheral blood. The diagnosis of Cryptococcal meningitis has changed dramatically with advances in our diagnostic tools.
Metabolic states: One of the most common metabolic states is thyroid disease particularly hypothyroidism. I saw an executive person recently who was complaining of a difficulty with memory, unsteadiness, and weight gain. Examination showed that the individual was markedly hypothyroid and improved dramatically with treatment. The positive treatment outcome associated with treating hypothyroidism emphases the idea that many of these secondary dementias are indeed treatable.
Deficiency states: The most common deficiency state is a B12 deficiency. B12 deficiency is an uncommon diagnosis but in my experience it almost always involves the peripheral nerves even prior to involving the brain. The name for B12 deficiency used to be “combined degeneration” and this is because it involved the brain, the nerves themselves as well as a cognitive impairment.
Toxins: The specific toxins we will discuss are heavy metals and the abuse of alcohol and drugs. More specifically the heavy metals consist of mercury and possibly arsenic. There are also, reports of people having skin toxicity from mercury causing a multi symptom disease but also involving abnormalities of the brain and cognitive function. Abuse of alcohol and drugs and I am referring more specifically to continuous long term heavy drinking or use of drugs possibly narcotic abuse has been shown to increase the possibility of cognitive impairment. It is known however, that a relatively small amount of alcohol and this includes two glasses of wine in men and one glass for women actually may have some preventative effect for AD.
Brain Tumors: We have seen a few patients that have presented with weakness and confusion associated with a brain tumor. I saw one patient who was complaining of headaches and weakness and in retrospect had some unilateral symptoms whom I thought from a clinical perspective had AD. After an appropriate examination he very clearly had a lung cancer which had metastasized to the brain. This can happen particularly in patients who have unilateral frontal lesions. When the lesion is more posterior one can have weakness in the arm or leg and the diagnosis is much more obvious. When the lesion is anterior the diagnosis may be much more difficult.
In the case of a subdural hematoma (blood clot on the surface of the brain usually caused by trauma) particular in older adults, the clinical symptom is frequently new onset headaches. It is very important to take that particular clinical syndrome (new onset headaches) and evaluate it carefully if they have not had a history of headaches.
Normal pressure hydrocephalus (NPH) commonly referred to as “water on the brain” is associated with an increase in spinal fluid within the brain cavities. In the past the diagnosis of NPH was difficult because we did not have adequate tools to measure long term spinal fluid pressure. We now have developed new techniques which can actually tell us the prognosis of inserting a shunt (a tubing that reduces brain spinal fluid pressure by draining the fluid into the abdominal cavity). This allows us to identify patients that would improve with a shunt thus improving the long term outcomes of those with NPH.
Depression is a very important issue in regards to older adults. Depression increases as one ages and the suicide rate can be substantial in older individuals. The important thing is that we actually have rather good treatments for depression. There are a number of anti-depressant medications which are associated with few side effects and can improve depression significantly. Depression can produce a cognitive abnormality but the pattern is usually very different from AD and involves more pronounced attention abnormalities. In addition, symptoms of depression can result in an increase cognitive abnormality in patients with early AD. Often severe depression and associated depressive thoughts can contribute to the lack of attention seen in AD.
It is said that approximately 20% of individuals who present with AD have an associated depression. This is a very important concept because patients that have a dementia or AD actually can have a substantial superimposed depression and therefore the effects can be synergistic. The depression may exacerbate the cognitive problem itself and treatment of depression can be very gratifying.
Diagnosing dementia in the family practice setting has always been a challenge. Join us March 24th from 9:00 to 10:30 AM and learn how medical imaging and cognitive testing is being used today to diagnose the different types of dementia.
Ruth Tesar will begin our workshop with a detailed update on the status of routine and advanced medical imaging for dementia, including PET and MRI. What are the newest imaging agents and what is in the pipeline? Ruth will discuss which imaging tests are appropriate and available, as well as help you understand what role they play in getting to a diagnosis, answering the question, “what is the right test at the right time?”
Sue Halliday will discuss the development of diagnostic algorithms and help you understand how they are used in routine clinical practice. Sue will provide updates on private payer and Medicare guidelines for routine cognitive testing as well as coverage guidelines for diagnostic imaging. What tests are covered and paid for by the different payers and Medicare? She will also provide an update on the status of medical imaging within the large clinical trials.
Andrew Dougherty will discuss the role of cognitive testing in the primary care and neurology practice setting. What are the different tests, what do the results tell your physician and when is it appropriate to obtain more comprehensive tests? Andrew will give an overview of all the primary forms of dementia. The talk will cover screening for areas of cognitive function including: executive function, verbal fluency, visual-spatial, memory, attention and orientation and why it is imperative to test each domain. Andrew will also focus on specific preventative treatment options for each cognitive domain and how it can improve overall cognitive function. Also included will be a brief review of recent studies on diet/nutrition and physical exercise as preventative measures to delay the onset of dementia.
Medinteract’s co-founder, Dr. John Dougherty and Dr. Alan Solomon from the University of Tennessee Medical Center, discuss the exciting research collaboration with Eli Lilly and Co. and the newly FDA-approved Amyvid which is used in the early diagnosis of mild cognitive impairment (MCI) and early Alzheimer’s disease.
Congratulations to Pat Summitt for being awarded the Presidential Medal of Freedom! She has been a role model to millions of people throughout her career and has recently become a key figure in the fight against Alzheimer’s. Her courage in publicly announcing her diagnosis has brought needed awareness to the disease and stressed the importance of early detection. As a member of the Knoxville community, we are excited to support Pat Summitt and her foundation in the fight against Alzheimer’s disease.
Medinteract Co-founder, Dr. John Dougherty, was quoted in the article “Finding A Cure” by Alexander Wolf in the December 12, 2011 issue.
Excerpt – “Early diagnosis is so important,” says Dr. John Dougherty, who runs the Memory Clinic at the University of Tennessee’s Cole Neuroscience Center. “The goal is prevention through delay. If we can delay symptoms by five years with medication and exercise, we can reduce the number of sufferers by six- to eight million—[about] the population of metropolitan Atlanta.”
The two winningest coaches in Division I college basketball history (907 for him, 1,075 for her) have more in common than just extraordinary success. For reaching far beyond their campuses and refusing to be defined by their genders, SI honors them together.
Tech 2020′s Tennessee Valley Technology Council presented its annual Navigator Awards Wednesday, November 16, during the first day of the Entrepreneurial Imperative 2011 Conference. Awards of excellence were given for this year’s top entrepreneur, researcher, and technology company, as well as for the Tech Commericalization Champion of the year.
Selected as the 2011 Technology Company of the Year, Medinteract was cofounded by Andrew Dougherty. Medinteract provides efficient and effective detection of Alzheimer’s disease by their computer based cognitive screening testing technology. Early detection leads to early intervention delaying the impact of the disease. Medinteract is now providing their detection services to a range of medical service providers across the region.