Perspective on "A Cure for Alzheimer's"

Contributed by: Dennis Fortier, President, Medical Care Corporation

_____________________________________________________

Sometimes the facts are very misleading.

For some reason, when Alzheimer's Disease is discussed in the popular press, the discussion often includes a reference to the fact that "there is no cure" for this disease. This is a true statement, but somewhat misleading.

This is misleading because it establishes "a cure" as the appropriate frame of reference for evaluating our ability to fight against this disease.

However, in medicine, we know this is not true. For example, we have no cure for hypertension, but we treat it effectively for most people. Clearly, the "no cure" frame of reference is not the most meaningful perspective on hypertension.

Also, we have no cure for diabetes, but like hypertension, we control it to a large extent for very many years.  We have no cure for the common cold, eczema  asthma, allergies, migraine, anxiety, heartburn, cancer, osteoporosis, depression, lupus  or a thousand other common, and sometimes deadly, medical ailments.  The truth is, cures are very rare in medicine.

To be clear, everyone would love to have a cure for Alzheimer's. It would greatly improve the world and eliminate much tragic suffering  But "no cure" is not the same as "no treatment", and we should not allow the "no cure" label to fill us with pessimism.

In fact, with an early Alzheimer's diagnosis (prior to the dementia stage), doctors can often delay disease progression through a robust regimen of proper diet, physical activity, tight control of chronic conditions, and poly-therapy with approved drugs.

At present, we should not despair that there is no cure. Rather, we should keep searching for a cure while embracing the reality that, like so many other medical conditions, Alzheimer's must be vigilantly diagnosed in its earliest stages and treated to the best of our current abilities.

The cure may or may not come, but initial treatments have arrived, and better treatments will follow.

Straight Talk: Mild Cognitive Impairment

Contributed by: Dennis Fortier, President, Medical Care Corporation

Mild Cognitive Impairment (MCI) is a term we are seeing more and more frequently in the general press.  Unfortunately, efforts to clarify its meaning often serve to further confuse the issue.

Case in point is a lengthy discussion about MCI, with an associate professor of psychiatry, published recently in the New York Times "New Old Age" blog.  While lots of important ground is covered in the interview, most of the information is geared toward MCI caused by Alzheimer's disease, without proper emphasis and clarity about other, arguably more common causes of MCI.  Population-based studies suggest that prevalence of MCI cases caused by depression, poorly controlled diabetes, sleep-disorders, thyroid conditions, alcohol/drug abuse, medications, and cancer treatments, far exceed the number of cases caused by early stage Alzheimer's disease.

That oversight, that most MCI is caused by common, treatable, medical conditions and not early Alzheimer's disease, undermines the clarity of the piece.  Most of the discussion is geared toward understanding MCI caused by Alzheimer's disease, as opposed to MCI caused by the many other, more common, medical conditions that impair cognition.

This confusion about MCI and the proclivity to attribute MCI to Alzheimer's disease are not new phenomena.  I wrote about it more than three years ago in a post about MCI converting to Alzheimer's disease. In the years since, increased interest in cognitive health has brought increased coverage of these issues.  Unfortunately, much of the coverage is poorly presented and does not aid clarity.

Here is a constructive way to understand the term MCI: While some decline in cognitive function is normal with aging, MCI refers to changes that are more severe than would be expected at a given age, but not so severe as to prevent a self-reliant lifestyle. When cognitive decline is severe enough to prevent self-reliance, we use the term "dementia".  In this way, cognitive health can be viewed as a continuum from "normal aging" to "MCI" to "dementia". One crosses from MCI into dementia when the cognitive decline is severe enough to prevent effective self-care.

Depression and Aging

Contributed by: Dennis Fortier, President, Medical Care Corporation

This is a great overview on common triggers for depression as you age, including a few life-style choices that effectively keep depression at bay.

The link goes to a WebMD presentation of 21 slides that can be viewed and read in about 5 minutes.  For anyone over age 40, or with an interest in depression, I highly recommend clicking through and reading; it is very well done and informative.

Memory Loss More Common in Men?

Contributed by: Dennis Fortier, President, Medical Care Corporation

There is much press this week about a study published in Neurology that measured the incidence of mild cognitive impairment (MCI) in an aging population.

MCI is a subtle loss of thinking ability, such as impaired memory or judgment, that is not severe enough to interfere with the person's normal activities of living.  The study showed about a 20% incidence rate which is squarely in line with previous estimates.

The press has been largely focused on the fact that, in this study, men between the ages of 70 and 89 years had a higher incidence of MCI than women of the same age.  This is probably true.  It is also probably easy to explain.

MCI is not a disease, it is merely a descriptor term for a certain level of cognitive impairment.  It refers to the degree of impairment that falls between normal cognition and the severe loss of function that we call dementia.  Asking "why" a person has MCI is a whole different question with a host of common answers including depression, thyroid disease, stroke, sleep disorder, Alzheimer's disease, and anxiety, to name just a few.  

The question of "why" a person has MCI was not adressed in this study, but may shed some important light on the observed gender differences.  For example, sleep disorders and certain cardiovascular conditions, like hypertension and stroke, are common causes of MCI and are somewhat more prevalent among men than women.  Clearly, conditions that impair memory and are also more common in men, could fully explain the observed gender differences in this study.  In that respect, these results are hardly surprising and, in fact, make perfect sense.

It would be truly worthy of a media frenzy if researchers controlled for each cause of MCI and still found that one gender was more susceptible than the other.  But despite many misleading headlines, that was not the case in this study.

Can B-12 Vitamins Prevent Memory Loss?

Contributed by: Dennis Fortier, President, Medical Care Corporation

_______________________________________________________
Can B-12 vitamines prevent memory loss?  As with so many questions, the answer to this one is "it depends".

Remember, there are many causes of memory loss, including depression, anxiety, diabetes, medications, thyroid disorders, head injuries, strokes, Alzheimer's disease, Parkinson's disease, tumors, sleep disorders, and drug use, just to name the most common. Vitamin deficiency is also on the list of common causes, especially for older adults who become less proficient at absorbing B vitamins from the foods they eat.

According to a recent study conducted at Rush University Medical Center and published in Neurology, research subjects who had markers for vitamin B deficiency, such as brain shrinkage and high homocysteine levels, also performed worse on cognitive tests compared to subjects without vitamin B deficiency.  These findings are consistent with other studies linking vitamin B deficiency to poor cognition.

So, it would be a stretch to conclude that taking a B-12 supplement will protect a person from all causes of memory loss or cognitive decline.  However, the evidence suggesting that proper intake of B-12 is important to ongoing brain health is quite strong.  In that regard, think about including fish, meat, poultry, eggs, milk, and cheese in your diet as good sources of B vitamins.

Want a Healthy Brain? Stay Physically Active.

Contributed by: Dennis Fortier, President, Medical Care Corporation
_______________________________________________________

There are no guarantees, but this is our current best bet.  The evidence linking physical fitness to good cognitive health in later life continues to roll in.

At the International Conference on Alzheimer's Disease in July, researchers from the University of California, San Francisco presented data showing the high correlation between physical fitness and brain health.  Their research on "modifiable risk factors", or lifestyle changes we are all free to make, showed that regular activity was the most likely to reduce the risk of cognitive decline.

Importantly, several of the other risk factors that are highly correlated with cognitive decline, may also be reduced through physical activity.  Hypertension, obesity, diabetes, and even depression, all of which confer higher risk of cognitive decline, can be managed to some degree through regular physical exercise.

We have known for some time that staying active is good for our hearts and it has always made sense that a regular supply of oxygen-rich blood is probably good for our brains.  This latest research is more evidence that it is likely to be true.

Do Pain Medications Reduce the Effectiveness of Anti-Depression Drugs?

Contributed by: Dennis Fortier, President, Medical Care Corporation

This is one of those stories with the potential to shift billions of dollars in pharmaceutical sales from one class of drugs to another, so we should all understand that there may be more than science motivating the conclusion.  However, it has been widely reported in the press and deserves discussion in this blog.

Depression is widely diagnosed in the USA.  It is also commonly treated with a class of anti-depressant drugs known as SSRI's (selective serotonin reuptake inhibitors).  Now, research from the Fisher Center for Alzheimer's Disease at the Rockefeller University suggests that the effects of these drugs can be largely negated by common pain killers such as aspirin, ibuprofen, and naproxen.

The most common SSRI's are well known by their brand names, Zoloft, Prozac, and Paxil, and they constitute the most widely prescribed class of drugs in this country.  Millions of people spend millions of dollars annually to treat depression.  However, since pain medications are also commonly consumed, this research suggests a massive potential treatment conundrum.

I think it is fair to suggest that there may be a relationship between the efficacy of SSRI's and over-the-counter pain medications.   But it is also fair to recognize that this is merely a suggestive finding at this point, with no peer-reviewed publication describing the conclusion as yet. 

If a publication follows, and others duplicate the findings, this could become a very big story.  For now, it is a point of interest, and something to discuss with your physician if you feel your anti-depressant is ineffective.

Can a Brain Scan Predict Alzheimer's?

Contributed by: Dennis Fortier, President, Medical Care Corporation

There is a lot of recent press suggesting that a brain scan may be useful in predicting Alzheimer's disease.

The excitement has been generated by a new study showing that a good read on the size and shape of particular portions of the brain, can be useful in predicting which patients, among a group with subtle symptoms of memory loss, will develop Alzheimer's disease.

The journalists at MSNBC, provide a good example of how the concept of "predicting" is frequently misused in the press, when they are actually writing about "identifying".  Almost invariably, the confusion between predicting and identifying Alzheimer's, is coupled with the misleading notion that subtle symptoms of memory loss sometimes "progress" to Alzheimer's.

I want to untangle these various notions, and offer a clear summary of what I think these journalists are trying to convey.

Mild Cognitive Impairment
When a person has mild symptoms of memory loss that are more severe than those we expect with normal aging, but not severe enough to qualify as dementia, we describe their condition as "mild cognitive impairment" (MCI).  By definition, MCI is not a part of normal aging.  This means that it is caused by some underlying medical condition such as vascular disease, a  thyroid disorder, depression or a number of other causes.  It might also be due to early stage Alzheimer's disease.

Predicting vs. Identifying
The key point is, if you have MCI due to Alzheimer's disease, then you have Alzheimer's disease.  There is no need to predict, only to identify.  There is no concept of "progression", the disease is already present.

So, the recent study that has generated much press, is a good study with a potentially valuable conclusion.  When a person has mild cognitive symptoms that we call MCI, and a physician must diagnose the correct cause of the symptoms in order to administer appropriate treatment, the ability to identify Alzheimer's disease  as the cause (or not the cause), is very important.  If a scan of brain structure is valuable in this regard, then we have gotten better at diagnosing this terrible disease.

We have not, however, found a new way to predict anything.  Only a new way to better identify a disease that is already present.

6 Ways to Keep Your Brain Healthy

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

There is some great advice in the Huffington Post regarding 6 well-validated approaches to maintaining a healthy brain.  Each of these has been covered to some extent in past posts here, but this is a nice presentation of the evidence in one article.

While I would recommend that you click through and read the full article, the 6 tips are listed here as an overview:

1. Manage chronic conditions under your control
2. Incorporate Mediterranian diet
3. Stay physically active
4. Avoid Tobacco Smoke
5. Stay intellectually and socially active
6. Watch for signs of Depression

Each of these is well within your control and proven to reduce your risks for cognitive decline.

Myths and Facts About Depression

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

Depression is widely misunderstood by many.  For some reason, various misconceptions about its causes and its symptoms, have lodged themselves in the public psyche.

WebMD has posted an excellent slide show that sorts the facts from the myths, and provides an excellent overview of depression.  Through a series of short simple snippets, the slide show debunks 9 myths and reinforces 9 facts that everyone should understand.

I recommend you click through to view the presentation, but I will share a sampling of their message here:

• Myth: Depressed People Cry a lot
• Fact: Exercise is Good Medicine
• Myth: Depression is a Part of Aging
• Fact: Depression Imitates Dementia

In the full slide show, each of these Facts/Myths is supported with a short summary of the scientific truth behind statement.  It is an enlightening overview, well worth the 3 minutes it will take you to view it.

You should follow Brain Today on twitter here

----------------------------------------------------------------------------------
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.

Causes of Memory Loss that are Not Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation

________________________________________________

This bears repeating: Not every instance of memory loss is a sign of encroaching Alzheimer's disease.

Many common medical conditions, most of them easily and completely treatable, can impair memory. A great review of such conditions is underway online at Behavioral Health Central.

I encourage readers to click the link and read the article but here is a list of the conditions reviewed to date:

1. Chronic Stress
2. Depression
3. Medications
4. Malfunctioning Thyroid
5. Pregnancy or Menopause
6. Excessive Drinking
7. Head Injury
8. Normal Aging

I think it is important to point out that a sharp, progressive decline in memory function is not consistent with normal aging. Some aspects of one's recall abilities, such as speed of word and name recall, tend to decline slowly with age, but more serious changes are never normal and should be evaluated by a physician.

Follow Brain Today on Twitter

--------------------------------------------------------------------------------
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.

Is Memory Loss Treatable?

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

This is a common question that needs to be recast before it can be answered in any useful way.

To explore the question as posed, we must start with this other question: What is the cause of the Memory Loss you wish to treat? Once we have that information at hand, we can properly respond.

The point of this post, and of this recent article from KABC-TV in Los Angeles, is that there are many medical conditions that can cause memory loss. While many seem people to be most acutely aware of Alzheimer's disease, other common conditions such as depression, thyroid disorders, and vitamin deficiency can also impair memory.

In terms of treatment efficacy, these latter three (depression, thyroid, and vitamin deficiency) can be treated with excellent results. Alzheimer's disease treatments are less effective but perhaps not as poor as many headlines would indicate. The key to delaying progressive symptoms of Alzheimer's is early intervention coupled with a robust treatment plan that includes prescription drugs but also emphasizes good nutrition, physical exercise, social engagement, and careful management of other conditions such as diabetes and hypertension.

Not every patient responds well to this treatment but many can delay progression of decline due to Alzheimer's disease for a meaningful period of years. As such, the simple answer to the question "Is Memory Loss Treatable?" must be "Yes". The degree of treatment success depends on the cause of the memory loss and individual factors related to the patient's health and genetics.

Depression and Memory Loss

Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego.
-----------------------------------

Studies show that prolonged stress leads to elevated levels of cortisol, a "stress" hormone produced by the adrenal glands. This in turn appears to shrink or atrophy the hippocampus, the sea-horse shaped part of the brain associated with many kinds of memory and learning. The hippocampus is a part of the brain that is particularly vulnerable to stress and stress hormones.

While cortisol levels normally fluctuate over the course of a day and night, they often soar when a person is faced with a stressful situation. Many studies have shown that this affects short term memory. For example, researchers have shown that people taking cortisone pills (which metabolize to cortisol in the body) were not as good at remembering a list of words as people taking placebo pills.

For many people, depression appears to cause similar damage; their cortisol levels remain slightly elevated as long as they are depressed. This moderate, but constant elevated cortisol appears to wear down the hippocampus--and lead to memory difficulties.

More studies are needed to fully understand the molecular connection between stress, depression and memory, and perhaps better treatments.

Depression and Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

If and how depression is related to dementia are two questions that I hear often. A nice summary of important information is posted by Dr. Charles Raison on the CNN Health website.

Of specific importance, I think the closing point about symptoms associated with abnormal thyroid function should be noted. Thyroid disorders are fairly common, can produce a host of worrisome symptoms including memory loss, and are generally treated with success.

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.

More News on the Relationship Between Alzheimer's and Depression

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

A study published in the June 16 issue of Neurology, the journal of the National Academy of Neurology, suggests that people with memory loss who are also depressed have a greater likelihood of getting Alzheimer's disease (AD).

In a three year study of 756 subjects aged 55 to 91, those diagnosed with depression and memory loss developed AD at a higher rate than those with memory loss and no depression.

The study also had some good news about Aricept, a cholinesterase inhibitor commonly used to treat AD. Among a group of subjects with both memory loss and depression, 11% of those given Aricept developed AD during the study while 25% of those not given Aricept developed AD.

This finding suggests that Aricept may have slowed the progression of Alzheimer's pathology and prolonged high quality of life. This bodes well for our ongoing ability to treat AD in a more effective manner.

Causes of Depression

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

This site is devoted to distilling the important messages from the daily news and online content. Occasionally this means debunking aggressive treatment claims from the pharmaceutical industry but often times, it is the pharmaceutical manufacturers that provide the most useful consumer information.

Today I highlight the causes of depression posted at depression.com, a site sponsored by a major manufacturer of a popular anti-depressant.

Depression is a widespread problem that is slowly (too slowly by most accounts) shedding the stigma attributed to almost all brain-related disorders. The key to further progress in that regard is to promote further education about the causes of depression and to facilitate open discussion about its signs and symptoms.

I hope this posting will nudge us all gently in that direction.

Depression and Memory Loss

Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego.
-----------------------------------

Studies show that prolonged stress leads to elevated levels of cortisol, a "stress" hormone produced by the adrenal glands. This in turn appears to shrink or atrophy the hippocampus, the sea-horse shaped part of the brain associated with many kinds of memory and learning. The hippocampus is a part of the brain that is particularly vulnerable to stress and stress hormones.

While cortisol levels normally fluctuate over the course of a day and night, they often soar when a person is faced with a stressful situation. Many studies have shown that this affects short term memory. For example, researchers have shown that people taking cortisone pills (which metabolize to cortisol in the body) were not as good at remembering a list of words as people taking placebo pills.

For many people, depression appears to cause similar damage; their cortisol levels remain slightly elevated as long as they are depressed. This moderate, but constant elevated cortisol appears to wear down the hippocampus--and lead to memory difficulties.

More studies are needed to fully understand the molcular connection between stress, depression and memory, and perhaps better treatments.

What about Depression?

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

While I don't see daily headlines about depression and its relationship to dementia, I do get questions about it from one direction or another with great regularity.

A nice summary of important information was posted by Dr. Charles Raison on the CNN Health website today.

Of specific importance, I think the closing point about symptoms associated with abnormal thyroid function should be noted. Thyroid disorders are fairly common, can produce a host of worrisome symptoms including memory loss, and are generally treated with success.

What Causes Memory Loss?

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

This is a common question that all too many people answer incorrectly. The comprehensive answer is that there are many causes of memory loss, most of which are completely treatable, and all of which are manageable to some degree. Many, however, assume that all recall deficits are due to Alzheimer's Disease and therefore, such symptoms must indicate a dire medical condition. While it is true that Alzheimer's Disease is one of the leading contributors to memory loss, there are many other, more benign conditions such as depression, thyroid disease, and anxiety to name just a few, that commonly impair memory and can be easily treated by a physician.

There is a good summary of medical conditions that cause memory loss and their respective treatments at www.PreventAD.com (which is an educational website, supported by Medical Care Corporation).