Initially, I was excited to see a review article titled, “Efficacy and safety of cognitive enhancers for patients with mild cognitive impairment: a systematic review and meta-analysis” (Canadian Medical Association Journal, 2013, September 16).   However, I was disappointed after carefully reading the paper.  I had hoped to gain insight into whether cognitive enhancing medications (Aricept/donepezil, Exelon/rivastigmine, and Razadyne/galantamine – there were no cognitive data for Namenda) help those with Mild Cognitive Impairment but there are too few studies with too many limitations to get a clear answer to the question of benefits. Mild Cognitive Impairment is usually characterized by mild memory/cognitive deficits in those without functional decline in everyday skills.  These are persons who do not meet the criteria for Alzheimer’s disease but are clearly at greater risk of obtaining the diagnosis in the future.  The question is whether treating […]

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I have had a number of clients over the years that have come to me with concerns about their memory that seemed just fine.  For example, there was the 82-year-old woman who was a Smith College graduate in physics.  I evaluated her four times over the course of ten years.   On the first evaluation, she tested among the highest I have ever seen – including short-term memory.  However, on each of four subsequent evaluations, her short-term memory scores declined even though the word list was the same.  She obviously was aware of changes before testing could detect decline. Clients such as this are referred to as the “worried well.”  Professionals dismiss them as if they are not aware of their own bodies.  I find this particularly disturbing as progressive neurological conditions such as Multiple Sclerosis, Parkinson’s disease, and Alzheimer’s disease […]

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Alzheimer’s disease unfolds over the course of decades.  Despite the intensive search, there are no accurate and reliable biological markers for Alzheimer’s disease.  Diagnosis is based on a combination of factors including details of course and history gathered from the person who has memory loss as well as family and/or friends.   There must also be a medical work up searching for treatable causes of memory loss such as thyroid function, status of diabetes, anemia, and imaging studies.  The standard of care also requires cognitive evaluation to map out strengths and weaknesses and stage the disease.  Finally, diagnosis requires clinical judgment. There is a push for a new set of criteria that diagnoses Alzheimer’s disease into three stages and is based on the fact that Alzheimer’s disease begins well before symptoms emerge (Practical Neurology, 2013, March/April, 34-35)).  The first stage is […]

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I am often asked about potential treatments for Alzheimer’s disease.  The intention behind the question is to solicit my assessment of whether there are any medications that show promise for the future.  Anyone who has talked to me or followed my columns knows that I am frustrated by the rigid commitment and inflexibility of many clinical trials that focus on treating brain proteins called amyloids that cause the build up of plaques in the brain.  This strategy has channeled so many intellectual and financial resources into a collective tunnel vision despite many failures of the concept. There are two recent studies that merit attention in that they each add intriguing findings that are not directly connected to amyloid pathology.  They focus on slowing progressive diseases as well as suggest new strategies in the search for disease modifying treatments of Alzheimer’s […]

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I keep hoping for more useful research on treatments and management techniques that may potentially benefit those with memory loss and their caregivers.  There are three recent studies that caught my attention as examples of movement in the right direction. First, “The effect of stimulation therapy and donepezil on cognitive function in Alzheimer’s disease” (BMC Neurology, 2012, 12, 59).  The study compared the effects of stimulation therapy, treatment with donepezil (Aricept), or to combined treatment during the first year after diagnosis with mild to moderate Alzheimer’s disease.  Stimulation therapy consisted of multiple elements including physical activity (e.g., dancing, walking, fitness training), as well as cognitive and social activities (e.g., reading, listening to music, crossword puzzles, reminiscence) for at least 30 minutes each day 5 times per week.  Donepezil (or placebo) was started at 5 mg and increased after four weeks […]

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Alterations in short-term memory are the hallmark of Alzheimer’s disease as well as a whole host of other brain changes that can, in time, erode our ability to make complex decisions such as handling finances or making legal documents.  The changes are subtle in onset and slow in progression.  Neither our own self-evaluation nor that of competent professionals can detect the changes by observation in the very early stages.  Despite our personal beliefs about our selves, most will not “know” when to give up the finances or when to stop driving.  Changes in memory are not the province of medicine.  Medical screenings are insensitive to early changes in memory and brain scans produce too many false positive results.  Verbal learning tests used to assess short-term memory are better at detecting risk than are biomarkers such as PET scans. We need […]

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“Alzheimer’s epidemic puts advisers – and their practices – at risk” (InvestmentNews.com, February 26, 2013).  “Clients with Alzheimer’s pose “scary” legal risks” (InvestmentNews.com, February 13, 2012).  “Money woes can be early clue to Alzheimer’s” (New York Times, October 2010).  The worry has been there for some time.  The problem of risk management is as clear as is the solution.  Alzheimer’s disease unfolds over the course of 30 or so years, progresses slowly, and does not produce disability until well advanced.  Progressive dementias unfold like reverse development.   First in, last out.   We learn walking and talking very early.  Managing technology and complex decision-making comes much later.  It’s no wonder that complex decision-making, like investing and managing money and legal decisions, are the first signs of decline.  It appears to sneak up on us – but it does not. Alzheimer’s disease gives […]

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“The research is out there that you can cure all of it by diet!” Not so fast.  One of the most popular theories of aging is that aging results from accumulation of damage from oxidative stress – destruction of tissues by free radicals.  Hence oxidation creates havoc on cells over time and causes tissues and organs to age as a result.  The theory suggests that consuming antioxidants is the key to anti-aging and curing disease. Last March, I wrote an article based on several findings that puzzled me. “There are small but consistent findings that vitamins and supplements may cause harm – even use of a multivitamin in those who are well nourished may slightly increase the risk of premature death.”  Additionally, taking more than 400 IUs of vitamin E may pose health risks including premature death.  Vitamin A may increase […]

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You make careless errors.  You are easily distractible, have poor concentration, and are forgetful.  You are disorganized and often misplace items.  You interrupt others, are easily frustrated, and have poor follow through on what you start.  These symptoms interfere with your ability to work or engage in activities you enjoy.  Do you suffer from Attention Deficit Disorder or do you have early Alzheimer’s disease?  Or do you have something else? I have several cases a year where I am consulted by someone with these symptoms and asked about both the diagnoses and what to do to help. If you are older than 15 and the symptoms are new (were not present before the age of 12), you don’t have Attention Deficit Disorder and are very unlikely to have Alzheimer’s disease. If you are between 30 and 60, you probably do […]

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A headline in The New York Times (November 16, 2012) announced that “For Alzheimer’s, detection advances outpace treatment options.”  We are given the example of a family who sought out a new brain scan technology that is heralded as a diagnostic breakthrough for detecting Alzheimer’s disease.   These scans show plaques in the brain.  Plaques, in turn, are composed of deposits of amyloid proteins in the brain that are associated with Alzheimer’s disease. These scans are currently available at over 300 hospitals throughout the country.  But there are a number of dilemmas resulting from this technology and its use. Are we creating a tautology between Alzheimer’s disease and plaques?  A tautology is a logical fallacy that constrains our thinking by circular reasoning.  Alzheimer’s is plaques and plaques are Alzheimer’s.  The real issue is diagnosing dementia, which is disability from cognitive decline.  […]

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