Alzheimer’s disease:
Beyond memory loss
George Credle, 72, is doing his part to keep his mind sharp.
“It’s one thing to lose your keys,” he said. “But when you have keys and you don’t know what they belong to, that’s not good.”
For the last three years, he has participated in a federally funded study where participants aged 65 and older undergo tests on memory and concentration.
“They tell you stories,” Credle explained, “and you have to tell them back to show how much you remember. They show you pictures and then you have to draw what you’ve seen.”
Credle said he doesn’t mind the tests, but is concerned that others may find them a bit scary.
After all, no one wants to lose their mind.
“In my opinion,” Credle said, “It’s good to be [tested]. They can catch it early on.”
The “it” is Alzheimer’s disease (AD), a progressive condition that slowly deteriorates the brain’s ability to reason or remember. It is the most common form of dementia, and while the exact cause is not known, what is known is that it is now the sixth leading cause of death across the nation.
Roughly 5 million people in the U.S. are living with Alzheimer’s. The National Institute on Aging, part of the National Institutes of Health, estimates that 5 percent of men and women aged aged 65 to 74 have AD, while almost half of those aged 85 and older may be affected.
AD’s impact within the minority community is the subject of ongoing debate and concern. The Alzheimer’s Association calls it the “silent epidemic” of African Americans, attributed in part to its correlation with certain vascular disorders common among blacks — stroke, diabetes and high blood pressure.
It’s not just memory that concerns Credle. He has high blood pressure. “It’s in my family,” he said. But he has been able to avoid diabetes and high cholesterol, and, as far as he knows, has no heart disease. And he wants to keep it that way.
He eats lots of fruits and vegetables. “I don’t eat fried foods, though,” he said. “I try to stay away from trans fats.” He’s learned to substitute soy milk for whole milk, and even has acquired a taste for soy ice cream. But he does confess to a few weaknesses: “I will eat butter instead of margarine and I like my sweets.” He’s a member of a gym and works out regularly.
There is no guarantee against AD, but a healthy lifestyle can minimize the cardiovascular risks associated with the disease.
“I need to stay alive,” he said.
Dr. Martin Samuels is chairman of the Department of Neurology at Brigham and Women’s Hospital. He said there is no concrete evidence that Alzheimer’s is more prevalent in blacks or any other ethnic group.
“It’s an equal opportunity disease,” he explained. Nor does he believe that there is an epidemic of the disease spreading across the country.
What Samuels does believe is that more people are living longer and growing older, and as a result, more cases of Alzheimer’s are being reported. “This is not a new disease,” Samuels said. “It’s always been there. Even Shakespeare made reference to it.”
“We don’t know yet what triggers it,” Samuels said before quickly offering his opinion on the causes — “chance and aging.”
The disease was first made public in 1907 by Dr. Alois Alzheimer, a German doctor who had a 51-year-old patient that he diagnosed with what he termed at the time pre-senile dementia. After the patient died, Alzheimer made an unusual finding during the autopsy.
In healthy brains, a system of communication of neurons, or nerve cells, and chemicals called neurotransmitters enable humans to have intellectual capacity and function. In AD, some of these neurons and chemicals begin to die and leave abnormal clumps and knots — plaques and tangles — in their place and thus rob its victims of memory, reason and coherent thought.
It was Alzheimer’s discovery of these plaques and tangles that led to his name being attached to the disease.
The most significant risk for Alzheimer’s is age — it gets more common as people get older. There is a familial component, especially if a first-degree relative — a parent or sibling — has had it. Early-onset Alzheimer’s, a rare form that occurs before the age of 65, is usually hereditary.
It is more common in women, but probably because women live longer than men.
AD can be accurately diagnosed up to 90 percent of the time by means of a medical history, basic medical tests, evaluation of mental status, neuropsychological testing and brain scans. But the only precise diagnosis can be made during an autopsy, when the plaques are clearly evident.
Compounding the difficulty in diagnosis are other conditions that mimic AD. Thyroid problems, drug interactions, depression, excessive alcohol use and even diet and vitamin deficiencies can cause symptoms similar to those of AD. But the difference is significant. Many of these conditions are treatable and reversible. Alzheimer’s is not.
Treatments have been approved for all stages of AD, but, according to Samuels, the treatments work on the symptoms and not the disease itself, and offer temporary relief. Despite promising research, no cure is yet available.
“If a person is concerned about his or her memory loss,” Samuel said, “there’s a good chance it is not AD. AD takes away the capacity to know. It is a disease that ravages the mind but spares the body.”
For the most part, people who complain about memory loss are probably experiencing the normal aging process.
“As you age, you lose rapid recall, but this does not do anything to your life,” Samuels said. “It’s just irritating.”
“But when someone else complains about your forgetfulness, and you don’t, that does signal a problem.”
Joycelyn Warren had such a problem. Her husband, Harold, was diagnosed in 2000 with Alzheimer’s. But she noticed the deterioration years earlier.
She was working then and was often surprised by what she found — and didn’t find — after she returned home. It was clear that Harold, a retired pastry chef, had baked while she was at work. She could smell the pastries, but couldn’t find them. “He would hide them,” Warren said.
Then one morning she couldn’t find him.
“One morning I woke up at 2 a.m. and he was gone,” she said.
The car was gone as well — even though he knew he was not allowed to drive. He was eventually found hiding near the pool in their apartment complex.
It was at that point that Warren said she realized that she had a much bigger problem. “I was living in denial,” she said. “What was happening was real.”
She did all that she could. She had him tested — memory tests, neurological tests, brain scans — and when doctors determined he had Alzheimer’s, she left her job to spend more time at home.
Despite medication, he continued to deteriorate. It eventually got to the point where he didn’t even recognize her.
“Have you seen Joyce?” she said he would ask her.
“I’m Joyce,” she answered.
One night, she turned off the lights to go to sleep but he asked her to turn them back on.
“I’m waiting for Joyce,” he told her.
The stress took its toll. She began to drink as an escape — a temporary crutch — and eventually was treated for depression and anxiety, a common experience for people who assume the role of caretakers without outside help. She was hospitalized for a short time when suicide seemed the best solution.
Warren eventually participated in workshops to learn how to deal with AD and is a member of a support group for caregivers sponsored by the Massachusetts chapter of the Alzheimer’s Association.
“I thought I could make Harold better, she said. “But seeing him in that condition was the most difficult thing of all, especially knowing the kind of person he was.”
Samuels is quick to point out a startling fact — Alzheimer’s is not part of the normal aging process.
“We are not destined to become demented,” he said.
Case in point — Hanrikje van Andel-Schipper. The Dutch woman died three years ago at the age of 115 years old. She was the world’s oldest living person, and when she died, a post-mortem brain analysis revealed little signs of Alzheimer’s.
According to published reports, the then 82-year-old woman contacted the University of Groningen in 1972 to donate her body to scientific research at the time of her death. Unable to make those arrangements, she called again — she was 111.
Doctors began testing her cognitive abilities at ages 112 and 113. While they observed some eyesight problems, she performed mentally better than the average 60- to 75-year-old.
“Everybody was thinking that when you have a brain over 100 years, you have a lot of problems,” Gert Holstege, one of the scientists who tested and examined Andel-Schipper, explained in an interview. “This was the first [extremely old] brain that did not have these problems.” |
(top) George Credle participates in the Health Outreach Program for the Elderly (HOPE) study funded by the National Institute on Aging to determine the impact of aging on memory.
(middle) Joycelyn Warren is all too familiar with the tragedy of Alzheimer’s disease. It has struck twice — first her husband of 29 years, and now her mother.
(bottom) Harold Warren, a retired pastry chef at Emerson College, was diagnosed with Alzheimer’s disease in 2000, and passed away two years later. |
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(above) Martin A. Samuels, M.D.
Chairman, Department of Neurology
Brigham and Women’s Hospital
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