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There are two types of risk factors that are associated with the development of dementing conditions as we age.  First, there are factors that we cannot control.  The strongest risk factor for becoming demented is not directly controllable, age.  If you live to be in your mid-80s or older, the risk is near 50%.  There are other associated risk factors that are correlated with cognitive decline with aging such as apolipoprotein gene carrier status (Apoe4 has the greatest risk whereas Apoe2 has the least), Mild Cognitive Impairment, cancer (there is an inverse association between cancer and cognitive decline), and sex (women are at greater risk than men). Second, there are also factors over which you have at least some degree of control.  These include history of head injury (hence the desire to wear seatbelts and helmets), blood pressure at midlife […]

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Notwithstanding many technological advances, there is still no fool-proof method for diagnosing Alzheimer’s disease, (avoiding the fact that the brain changes occur decades before symptoms).  There is no blood test or imaging technique that is definitive.  Even autopsy diagnosis has its problems.  Diagnosis of Alzheimer’s disease remains a clinical diagnosis based on history, symptoms, patterns, and clinical judgment.  The criteria for a diagnosis of possible Alzheimer’s disease: The afflicted individual must be demented – disabled by the decline. Symptoms appear gradually over months to years There is progressive worsening of cognition The initial and cardinal deficit is short-term memory (i.e., new learning) Less commonly language deficits (e.g., word-finding) appear early There are deficits in other skills such as planning, reasoning, judgment, sequencing The diagnosis of possible Alzheimer’s disease: There is sudden onset of symptoms Progression is not gradual There is […]

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The AARP Bulletin ran an interesting title in April, “Am I losing my mind?”  This article is in response to the growing paranoia about memory fed by the news that the rate of Alzheimer’s is rising and that many more die of Alzheimer’s than are reported in official statistics.  It’s no wonder that if I have a senior moment, I briefly consider whether I am on the slippery path to dementia.   Dementia is a generic term that refers to more than just memory loss.  Dementia is a permanent, irreversible and, in some cases, progressive decline in brain skills that interferes with independent living – hence produces disability.  There are a multitude of possible causes of dementia.  Among sudden causes are stroke and head injury.  Slow onset progressive causes include Alzheimer’s disease, Lewy body disease, and Huntington’s chorea. You can have […]

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 We are all subject to random bouts of forgetting.  Where did I park my car?  I forgot my grocery list.  Why am I in this room?  These complaints increase with age and are the source of both jokes about senior moments and serious fear of developing Alzheimer’s disease.  However, there is a huge difference between the increasing inefficiencies in memory resulting from aging and memory loss and dementia.  The fears have produced a burgeoning business in brain training programs such as Lumosity.  Lumosity has about 50 million users and is the best known of these programs.  It promises to improve attention and the capacity to learn.  Strong promises if short-term memory begins to fail.  The Centers for Medicare Services is exploring whether to pay for memory fitness training, which would create a boom market for these services. But does brain […]

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I was giving a talk last week and asked the question of whether Alzheimer’s disease can be diagnosed by means of an alpha-beta PET scan.  This refers to the use of a brain scan with amyloid markers in the detection of early Alzheimer’s disease before clinical symptoms appear.  A review by Steven Peterson (Journal of the American Medical Association Internal Medicine, 2014, 174, 133-134) concludes that it cannot.   I have already had a couple of clients who presented to me after they had obtained a PET scan with an amyloid marker and told, despite the fact that they had no symptoms or neuropsychological assessment, that they had early Alzheimer’s disease.  Of course, this was very alarming and they sought assessment and council.  After careful testing, these two clients had superb short-term memory, the loss of which is the hallmark and […]

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Although the clinically significant phase of Alzheimer’s disease is characterized as a disorder of memory, it is so much more.  There are a number of cognitive skills that become progressively compromised as it progresses.  For example, in addition to loss of memory there is a decline in attention, concentration, orientation, judgment, reasoning, visuospatial ability, executive function, and language.  The language changes present a real challenge for caregiving as we function in the world by language abilities that we take for granted.  In the mild stages (Late Confusional to Early Dementia) there are often deficits in language such as anomia (cannot name common objects) and circumlocutions (provide functions of objects rather than names) in addition to the forgetfulness.  For example, a person may look at a clock and say it’s for telling time or point to the lights rather than saying […]

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The most common question that I am asked is  “What can I do to prevent Alzheimer’s disease?”    The honest answer is that nobody actually knows.  Much of what we read or hear on the news is overstated for emphasis.  Our current beliefs are mostly based on anecdotal reports, marketing, and epidemiological studies (looking backwards to see what someone says they did) with a few prospective studies (ongoing studies of people as they age) to add intrigue.  There are few randomized control studies (the gold standard for scientific inferences of cause and effect) to guide us in answering this important question.  Epidemiological studies tell us what is correlated or associated with desired outcomes.  However, they cannot tell us root causes. It seems intuitively sensible that what we eat is important for our health and may impact the course of neurodegenerative disorders.  […]

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There are a multitude of risk factors for Alzheimer’s disease.  As I have often written, the best treatments are proactive rather than reactive.  Risk factors help you be aware that you need to evaluate and monitor your memory and incorporate external memory supports, strategic planning, and life style enhancements to better protect your future. Age is the clearest risk factor for a diagnosis of Alzheimer’s disease.  Age trumps all other factors.  Most of those diagnosed with Alzheimer’s disease are 65 and older.  The risk reaches nearly 50%by age 85.  Anyone over the age of 65 should consider a thorough memory evaluation to establish a baseline. Genetics.  If you have a first-degree relative (parents or siblings) with Alzheimer’s disease, your risk is about 3-4 times that of those who do not have a first-degree relative.  But the genetics are complex and […]

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Why do we need a new diagnostic category of “subjective cognitive decline?”  We already have a system in place to stage the level of memory loss and concerns.  The challenge of a slowly progressive disease like Alzheimer’s is that it unfolds over several decades, it has subtle beginnings (difficult to tell from senior moments early on), and it does not always lead to dementia (i.e., disability).  This means that many, but not all, will be aware that they are changing well before it can be recognized from the outside. The Global Deterioration Scale is designed to stage level of memory loss and has been available for years.  It comes in several forms but in essence the scale marks seven stages from no decline to total disability.  It serves as a guide to determine what actions need to be taken and […]

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What is the most useful way to enhance and protect my cognitive skills as I age?  Brain exercise products, “brain fitness computer programs,” have burgeoned over the last few years to the point that they have already become a $300 million industry.   The programs promise to improve memory, attention, and creativity.  They promise to prevent or delay Alzheimer’s disease and dementia.  The programs are heavy on marketing but lean on rigorous evaluation.  Are the programs worth the investment?  Is it better to work-face-to-face or to use a computer program? In an attempt to answer these questions, I just read a complicated review article “Computerized cognitive training with older adults” (PLoS One, 2012, 7, e40588, 1-13).  The intent, in part, was to compare the efficacy of face-to-face cognitive training to computer based programs in healthy older adults (those over 50).  First, […]

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