Doctors Look To Prevent Alzheimer's Disease Decades Before Symptoms or Diagnosis

Apr 5, 2017

Healthcare providers are focusing more on prevention, given recent discoveries into this degenerative neurological condition. Meanwhile, treatment and management remain challenging, as families and caregivers often struggle to find appropriate and affordable care. 


GUESTS:

  • Melissa Grenier - Regional manager for the New Hampshire Alzheimer's Association Chapter, and licensed social worker with experience in cognitive and memory impairment. 
  • Dr. Jonathan Jackson - Cognitive neuroscientist and instructor of neurology at Massachusetts General Hospital, where he specializes in Alzheimer's Disease.
  • Dr. Lyn Lindpaintner - Internist and geriatric specialist at Concord Hospital.
  • Dr. Daniel Seichepine - Lecturer of Psychology at UNH Manchester, and clinical neuropsychologist with a specialization in dementia and sports-related traumatic brain injury. 

What is Alzheimer's?

Dr. Jonathan Jackson: "Alzheimer's Disease is the buildup of amyloid plaque and neurofibulary tangles, or tau tangles, in the brain, that leads to the destruction of brain cells. It tends to start off in parts of the brain that are responsible for the assembly of memory, and then it spreads throughout the brain over about eight to twelve years. Dementia is frequently attributed to Alzheimer's Disease...so for older adults over 65, the leading cause of dementia is Alzheimer's Disease."

Dr. Lyn Lindpaintner: "Dementia is not only to be thought of as problems with thinking and cognition and memory, it also implies that there's been a sufficient functional decline, problems in getting things done in your daily life that you need to do, to really cause impairment. That's the distinction between dementia and these early stages of both Alzheimer's disease and other dementia-related diseases."

Where do we stand with treatment?

Dr. Jonathan Jackson: "One of the big challenges we've had to overcome with Alzheimer's disease is figuring out where it starts, figuring out where to intervene. For many years, we thought of Alzheimer's disease as this problem with memory loss. We tried to fix that by looking at the brain where memory was, and trying to intervene there, only to find that the cures and treatments we developed weren't effective enough...so we looked a bit earlier. We tried to wait until people were first diagnosed with the disease and intervened at that stage, and we found that we had a little bit more success, but still not quite enough. 

"So nowadays, our treatments and our options are looking more at the prevention stages of the disease, so before someone is diagnosed with Alzheimer's disease. Even before someone is diagnosed with mild cognitive impairment, we try to intervene then."  

Dr. Daniel Seichepine: "Alzheimer's disease probably starts decades before we see any symptoms, as Dr. Jackson mentioned, these plaques likely build up two, maybe three decades before we diagnose it, so we don't even know people have the disease yet. We have to wait a decade or more before they start to see symptoms and by that time it's probably too late, at least in the way we've been trying to treat it currently. 

"Currently, we don't have any disease modifying treatments. We have treatments that can help with some of the symptoms, but we have nothing that is going to change the course of the disease, stop the brain from shrinking."

Dr. Jonathan Jackson: "The most promising diagnostic technique that our group is working on relies on PET (positron emission tomography) imaging. So basically, we can put a radio tracer into your blood stream, it will go into your brain, and if you have any of the amyloid plaques, in theory, it's supposed to bind to them and fluoresce (light up)...one of the things we recognized is that it is less about amyloid and more about amyloid and tau and where tau is in the brain."

What is "early-onset" Alzheimer's disease?

Dr. Daniel Seichepine: There is a genetic mutation version of Alzheimer's disease in which if you have this gene, you will get this disease. It is incredibly uncommon, and represents less than one percent of all cases of Alzheimer's. But in those people, with those genes, they will get the disease...we find them in pockets around the world where there isn't a lot of genetic diversity, so we see big groups in Colombia, there are some in this area, Greater Boston...but again, this type is very unusual. 

How might diet, exercise, and other behaviors help prevent or slow Alzheimer's disease?

Producer's Note: A caller and several e-mailers were curious about a study known as the "Nun Study," in which over 600 elderly Catholic nuns had their genes analyzed for fifteen years to determine what risk factors might lead to Alzheimer's and other illnesses related to aging.  This is the study referenced by our guests. 

Dr. Jonathan Jackson: One of the things we learned from that study that we didn't really understand before is that a lot of these nuns had enough amyloid in their brains to meet the criteria for Alzheimer's disease, but they didn't show a lot of the cognitive and clinical symptoms we associate with Alzheimer's...we realized that the pathology of the disease is more than just how much amyloid is present. 

Dr. Lyn Lindpaintner: We are learning how important our social networks are, it's not just that our cognitive stimulation...but we get emotional stimulation, we practice being empathetic, we practice functions of our brain that are deeply human...there are some things that each person can do: not smoking, controlling blood pressure, controlling blood sugar, looking at diet.

Further reading:

Visit the New Hampshire Alzheimer's Association Chapter website.  

The Telegram in Worcester, MA, spoke with guest Dr. Jonathan Jackson, in "Alzheimer's research shifts to prevention, with diet as latest 'darling'."

Science Daily reports on "Therapies that target dementia in early stages critical to success."

Science Daily also reports on "Link found between concussions, Alzheimer's Disease." 

Alzheimer's News Today reports on the connection between sleep and dementia in "Prolonged Sleep May Predict Future Risk of Dementia, Study Shows."