Getting ahead of dementiaJun 15th, 2012 | By Caryn Sullivan | Category: Recent Pioneer Press Columns
At age 50, Harvard professor Alice Howland is diagnosed with early-onset Alzheimer’s. In a relatively short time her world unravels as her memory fails her and she is unable to lecture, advise students or go for unsupervised runs. Alice is the protagonist in “Still Alice,” a New York Times bestseller by Lisa Genova, who holds a Ph.D. in neuroscience from Harvard.
While it’s fiction, “Still Alice” provides a realistic depiction of how the disease affects both patient and family. Knowing that family history is a risk factor, I turned the pages apprehensively, mindful of my grandfather’s slide into advanced Alzheimer’s.
Dementia describes a range of symptoms associated with a decline in memory or cognitive ability. Alzheimer’s, the most common form of dementia, is characterized by memory loss and impairment of activities of daily living. Most common among people 65 and older, it afflicts 5.5 million Americans but is expected to affect more than 7 million by 2030. Nothing can cure the disease.
“Still Alice” has generated thought-provoking discussions among my contemporaries, many of them caregivers for parents who were once independent and productive but are now incapable of managing their own lives.
I have wondered — if I’m also going to suffer Alice’s fate, does it pay to know sooner rather than later?
A Minnesota dementia expert says yes.
Dr. Michael Rosenbloom, clinical director of the HealthPartners Center for Dementia and Alzheimer’s Care, advocates both prevention and early diagnosis.
The earlier a patient begins taking medications, such as Aricept (an enzyme blocker that restores the balance of natural substances in the brain), the greater the benefit, he explained. Aricept, the current drug of choice, improves memory, awareness and the ability to function for six to 12 months, though Rosenbloom has observed benefits in his patients for much longer.
Upon diagnosis, the patient and family can be counseled about behavioral interventions and provided with useful resources. An Alzheimer’s Association’s handbook, “Living Well: A Guide for Persons With Mild Cognitive Impairment and Early Dementia,” offers suggestions about exercising both body and brain. It extols the benefits of the Mediterranean diet — rich in whole grains, vibrant fruits and vegetables, olive oil and fish, and low in saturated fats — and it notes that moderate alcohol intake can be protective. It also explains the importance of social interaction (visit alz.org/mind).
“I can actually divide my patients into the ones who follow this workbook and are physically active, socially active, cognitively active and the ones who don’t do those do these activities. It almost seems like there is a slower progression among those who do. But there’s more work to be done to actually prove that,” Rosenbloom said.
Lifestyle is just one element to managing the disease. There is a whole psychosocial component, Rosenbloom said. “If neither the patient nor the family has insight into the memory loss and they continue to live life normally, there can be catastrophic results. These patients end up in car accidents; they end up losing their homes because they forget to pay their mortgages; they end up losing their jobs and being accused of negligence, whereas it’s actually an organic brain disorder that is underlying it. You can make a huge impact on the quality of life of the patient, the family and, where driving is involved, on innocent parties, by making an early diagnosis.”
People who are obese, have diabetes, smoke, eat a poor diet and engage in limited mental and physical exercise have an increased risk. So it’s not surprising that dementia patients are often dealing with more than one medical condition — and doing so poorly. “If someone can’t remember what happened yesterday, he may not remember to take his medication,” Rosenbloom said. “By identifying this disease process in the early stages, you can get that supervision that’s necessary to ensure that these patients are correctly taking their medications.”
Typically, diagnosis occurs three to five years after the onset of symptoms. There are efforts under way to expedite the diagnosis by screening patients who are asymptomatic and have no history of memory disorders. A result of work at the Minneapolis Veterans Administration Hospital, the “mini-cog” is a brief but generally accurate diagnostic tool that can be administered in less than three minutes. Patients are asked to repeat three words and to draw a clock. If the patient fails the mini-cog, there is a protocol for follow up that involves additional cognitive tests. If the patient fails the second screening the next step could involve lab tests or brain scans.
With the incidence expected to triple by 2050, it’s impossible for neurologists like Rosenbloom to diagnose all dementia patients. The goal is to introduce a standardized approach that obeys best practice measures and increases early diagnosis, Rosenbloom said. Primary care providers can train nurses to administer the mini-cog during annual exams just like they take blood pressures or update medical histories. The way we are going to most efficiently deal with this disease is by empowering the primary care physician, Rosenbloom said.