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Rehab Insights is a blog written by Burke Rehabilitation professionals to offer practical information for patients, families and the community. Its goal is to educate the reader on relevant topics in rehabilitation, general health and wellness.

Aging and Alzheimer’s Disease: What’s Normal, What’s Not

June 3, 2014
Pasquale Fonzetti, M.D., Ph.D.

brochure_frontIn late adulthood—65 years and older—most people are relatively healthy and independent, though they may start to notice changes in their health. Chronic illnesses can develop, but often (and thankfully!) these can be treated by medical intervention.

Alzheimer’s disease (AD) is the most common and the most feared neurodegenerative disorder among the aging population. AD affects approximately 15 million people throughout the world. An estimated 5.1 million individuals in the United States have AD, and by 2050 the prevalence is projected to be 13.2 million. Since the risk increases dramatically with age, an increase in longevity means that more people will be at risk of AD.

In most cases, the initial symptoms are forgetfulness and personality changes. But memory dysfunctions are not always related to Alzheimer’s disease. Although memory may deteriorate in some areas as we age, most people continue to live a normal life. Here’s what to know about what’s
normal and what’s not as it related to AD:

Normal forgetfulness in late adulthood:

  • Tip-of-the-tongue phenomenon—failure to retrieve a word from memory, combined with partial recall; the feeling that retrieval is imminent, and sense of relief when the word is found.
  • Effortful recall—the person is aware of difficulty, and is usually ultimately successful (after a delay)
  • Speed of processing steadily slows and affects all cognitive domains:
  • In terms of vocabulary, performance on reading irregular words (part of the National Adult Reading Test) is preserved. (This happens even in early stages of dementia.)

Risk factors for AD:

Primary risk factors:

  • Advanced age: after age 65, prevalence almost doubles every 5 years
  • Family history of dementia
  • Genetic factors (eg, apolipoprotein E4 polymorphisms, TOMM40, CLU, PICALM) that have cumulative effects.

Modifiable risk factors:

  • Cardiovascular disease and its associated risk factors, such as diabetes, hypertension, hypercholesterolemia, obesity and atherosclerosis
  • Educational level: people with fewer years of education have a greater risk of AD

Other possible risk factors:

  • Depression
  • Micronutrient deficiencies (vitamin B12 or folate)
  • Head injury

Early Warning Signs of AD:

  • Memory loss affecting job performance
  • Difficulty performing familiar tasks
  • Language difficulties
  • Disorientation to time and place
  • Poor judgment
  • Misplacing things
  • Mood or behavior changes
  • Personality changes
  • Loss of initiative

As with other types of dementia, the diagnosis of Alzheimer’s disease is clinical. This includes a detailed history, physical and neurological exam, evaluation of functional abilities (ADLs), screening for depression, mental status testing and/or a neuropsychological assessment, laboratory testing, and head CT or brain MRI studies to rule out other brain or systemic disorders causing the symptoms. This allows doctors to make an accurate diagnosis.

Once a clear diagnosis is made, a family conference is arranged to discuss the natural course of the disease, implications and treatment with the patient and family members.

While there is no medical intervention that can stop the disease progression at this time, there are therapies that can help keep memory functioning longer.

Current FDA-approved AD therapies:

(All target neuronal signaling)

  • -Cholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine): These prolong cholinergic brain activity in AD—cholinergic neuronal pathways are involved in many cognitive processes, including memory, attention and learning. In AD, brain levels of acetylcholine are reduced.
  • NMDA receptor antagonist (Memantine): Overstimulation of NMDA receptors by glutamate can lead to neuronal death

Nonpharmacological interventions:

  • Exercise, recreation, day care (Remember: What is good for the heart is usually good for the brain)
  • Environmental modification, if needed
  • Healthy diet
  • Simplify routine
  • Caregiver support

Emerging therapies:

  • Nutraceuticals
  • Neurotransmitter-based therapies
  • Neuroprotective/metabolic therapies
  • Amyloid-modulation therapies
  • Tau-modulating therapies
  • ApoE-modifying therapies
  • Glia-modulation therapies

Along with exploring treatment options with the patient and family, your doctor will encourage caregivers to make plans for future financial, legal, and medical issues. For access to health care team and support services, both The Alzheimer’s Disease Assistance Center of Hudson Valley (ADAC-HV) and the Alzheimer’s Association Hudson Valley/Rockland/Westchester, NY Chapter are great options.

What can you do to help prevent AD? When it comes to prevention, research in Alzheimer’s disease has focused on modifiable risk factors. Here’s a look at some lifestyle changes that may help:

Possible protective factors and preventive measures for AD:

  • Caloric restriction
  • Mediterranean diet
  • Physical activity
  • Social activities, mental stimulation
  • Education
  • Learning new skills
  • Modification of risk factors with pharmacological intervention: Antihypertensive drugs, dyslipidemia medications, hormone replacement therapy. Note: Although evidence exists to support some of these approaches, randomized trials have yielded inconsistent results.

The most important thing to keep in mind: Regardless of your age, keep busy—always be mentally and physically active.

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Burke's Rehab Insights blog is intended to provide general information about rehabilitation and other health care topics. It should not take the place of medical care. Burke staff cannot comment on individual medical cases or give medical advice.

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