AD Treatment Perspective #3

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Why is the press so nihilistic about the fact that there is no cure for Alzheimer’s disease and that current treatment options only manage the symptoms? We can say the same about diabetes, hypertension, and high-cholesterol. True, we are highly effective at managing these other chronic conditions and only moderately so for AD, but I am alarmed at how broadly the “nothing can be done” mantra has been embraced. Much can be done.

When will we get a cure for Alzheimer's Disease?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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There is no definitive answer to this ubiquitous question. The best we can do is to watch the advance of science through the published literature and to follow the clinical trials from which the answer will one day emerge.

While the pathology of Alzheimer's disease is still not well understood, scientists have developed a host of well-grounded theories. Several treatment agents, based on those theoretical foundations, are currently in development or in clinical trial.

Here is an excellent summary of the leading treatment hypotheses as well as the development status of the most promising treatment agents. Some of the information is a bit technical but I think the lay person can read this and get a good sense of the time frame for a meaningful advance. It should be clear that no cure is imminent but equally clear that several treatment agents are in advanced stages of clinical trial.

Predicting the results of these trials is hampered by our vague understanding of what causes Alzheimer's Disease. On the bright side, one or another of these agents may be surprisingly effective in altering the disease course and could be available in less than five years. On the dark side, they may all turn out to be ineffective in which case we would be more than five years away from a meaningful new medication. Only time will tell.

In the meantime, we all need to be proactive in identifying and managing our risk factors for cognitive decline (the topic of an upcoming blog) and physicians must be vigilant about acting on evidence or suspicion of decline among their patients. Until better treatments are discovered, we must intervene as early as possible with the current medications to maximally delay the progression of Alzheimer's disease.

Mild Cognitive Impairment 101

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Mild Cognitive Impairment (MCI) is now widely but inconsistently used to describe a broad range of cognitive states. While there may not yet be a universally accepted definition, there is adequate consensus that MCI describes the space on the cognitive continuum between "Normal" and "Demented". Recall from an earlier post (Dementia 101) that a person does not meet the clinical definition of dementia until their impairment is severe enough to interfere with their social or occupational function. From this definition, the need arose to describe the situation when a person is beginning to lose function but the deficits are still subtle and not yet severe enough to meet the criteria for "dementia". To address that need, researchers at the Mayo Clinic constructed the term Mild Cognitive Impairment which has been quickly, if not uniformly, adopted in the scientific community.

As with dementia, Mild Cognitive Impairment is not a diagnosis and not something that must be treated. It is merely a symptom of some underlying medical condition such as depression, Parkinson's Disease, Vitamin B-12 deficiency, early stage Alzheimer's Disease, etc.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

What is Normal Memory Loss?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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I see this headline quite frequently and the published answers that follow range from reasonably constructive to dangerously misleading. Here is what I believe to be a helpful perspective.

Most of the time, when a person past the age of 40 suggests that their memory is not as good as it used to be, they are actually saying one of two other things. I will describe each briefly below:

1) For those whose perceived memory loss manifests as "difficulty recalling names" or "inability to find the right word" then they are probably experiencing "slow" memory and not "broken" memory (which would indicate a medical problem). If your tennis serve has gotten slower since you were 25 and you accept that fact without fearing some underlying medical problem, then rest assured that your memory can get slower as well, even if you are completely healthy. The final proof for these people is that, once reminded of the name they could not recall, they instantly confirm it. This establishes that the information was still stored in their memory (not lost), they just hadn't been able to recall it as quickly as they would have liked.

2) For those who complain of losing track of things and not following through on details, the problem is generally one of distraction and/or overload. When you have a job, a spouse, children, bills to pay, elder parents to care for, college tuition to be met, etc., there are many things to think about in a given day. Many more, on average, than you probably had in your twenties. While you once had the luxury of concentrating on far fewer demands, you may now regularly lose track of a few details among the much greater administrative burden of your daily routine.

I contend that these are two very common descriptions of people who claim to have memory loss but actually do not. One group is correctly sensing a slow down in their retrieval speed and the other group is incorrectly attributing lack of focus to a recall deficit. Real memory loss is present when, given adequate time, one cannot store and retrieve information that they have focused on storing and retrieving.

So let's get back to the question (What is Normal Memory Loss?) with which we began. Most of the time, those asking the question don't really have memory loss, they have either slow recall or distractions that prevented them from storing the information in the first place. When neither of those explanations apply and the person truly cannot store and retrieve important information, the memory loss is real and, importantly, this is never normal.

When the memory loss is real, there will be an underlying cause of the problem that an enlightened physician can diagnose and treat. If your physician says it is "just old age" and neither of the two explanations above (slow recall and lack of focus) seem to apply, you should seek a second opinion from another physician.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

AD Treatment Perspective #2

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The fastest path to better treatment for AD is to start diagnosing the disease at an earlier stage and intervening while the brain is still somewhat healthy. On average, we currently diagnose AD about 8-10 years after the onset of symptoms when the pathology is in the end stages and massive brain damage has already occurred. The current drugs may not cure the disease but they can delay progression quite well if patients get access to them as soon as symptoms manifest.

Solution: Patients and Primary Care physicians must engage in proactive dialogue about cognitive health and be vigilant toward investigating suspicion or evidence of memory decline.