I recently watched a movie that I intentionally avoided when it premiered some years ago,Still Alice. It’s the story of a young career woman and mother in her mid-40s who is diagnosed with Alzheimer’s, and how this early onset drastically changed her life and the lives of her loved ones.
The film takes viewers through the process of this degenerating disease affecting more people worldwide, including younger generations.
Research shows there is a 50 percent chance that if we reach 85 years old, we will be diagnosed with some sort of dementia. Data from Biomed Central tells us that “every three seconds, someone in the world is being diagnosed with Alzheimer’s.” These numbers are terrifyingly high.
Is being affected by this dreaded condition a throw of the dice? A matter of luck or genetic predisposition? And can awareness and lifestyle choices help change the odds in our favor?
The Alzheimer’s International Conference of 2018, has acknowledged, for the first time, that 1/3 of dementia cases may be preventable —an important statistic published in The Lancet, one of the top medical journals in the world. A sliver of hope.
Wanting to get a better understanding, I approached Dr. Donnabelle Chu, a neurologist and dementia specialist from Makati Medical Center. She is part of the core group of the Dementia Society of the Philippines. Dr. Chu kindly agreed to answer some questions on Alzheimer’s.
THE PHILIPPINE STAR: What is Alzheimer’s disease (AD)?
DR. DONNABELLE CHU: AD is a neurodegenerative disorder caused by an accumulation of an abnormal protein in the brain, eventually leading to cell death and shrinkage in the size of the brain.
There seems to be a fine line between memory loss and Alzheimer’s onset. What would be a clear way to determine the difference?
Memory loss is most often the initial and predominant symptom of Alzheimer’s disease. Memory loss can also be part of normal aging. In normal aging, one can have forgetfulness occasionally, but not severe enough to forget what needs to be recalled. If you forget the names of people that you don’t usually see or are just casual acquaintances, it may still be part of normal aging. If you forget where you put your keys but can recall after a few seconds or minutes, this may also be normal. But if the memory loss is severe enough that it is noticeable by other people and it affects your day-to-day functions at work or at home, as well as other activities, then this may be an early sign of Alzheimer’s. Alzheimer’s disease is the most common cause of dementia. Dementia, on the other hand, is a general term for cognitive loss including memory, language, problem-solving and other thinking abilities that are severe enough to interfere with a person’s daily living. It is not a specific disease, but rather a group of disorders. Alzheimer’s accounts for about 50 to 80 percent of dementia cases.
Late-onset Alzheimer’s is the more common type of Alzheimer’s. However, AD may also affect younger individuals, as early as in their 40s, and is called early-onset Alzheimer’s disease.
How early on can one start testing for signs of Alzheimer’s?
The more common type of AD, which is the late-onset type of Alzheimer’s or the sporadic type of Alzheimer’s, mostly affects individuals aged 65 years and above. For this type of Alzheimer’s, a routine cognitive assessment or screening test by around the age of 60 years (whether with or without any symptoms of cognitive impairment) may be done by a physician trained to perform such assessments. An annual cognitive assessment may be subsequently performed to monitor and identify any deterioration in cognition that may lead to Alzheimer’s disease.
What are the latest tests available to diagnose this disease?
Tests such as a clinical neurocognitive evaluation, routine blood examinations, and brain imaging such as an MRI have been the tests routinely undertaken to help diagnose AD. Measuring the presence of the abnormal proteins involved in Alzheimer’s disease (amyloid-beta and tau) in the blood and cerebrospinal fluid may also be done. An FDG-PET scan and an amyloid PET scan are also available. Most recently, tau-PET has also been utilized in clinical trials.
In the Philippines, amyloid determination in the blood is being utilized more and more in recent years. FDG-PET is available only in selected tertiary hospitals. Most recently, the amyloid-PET scan was made available but only in very few selected institutions and at a much higher cost.
Most of us believe that Alzheimer’s is an old age disease, but younger generations are being affected as well. Why is this?
Late-onset Alzheimer’s is the more common type of Alzheimer’s. However, AD may also affect younger individuals, as early as in their 40s, and is called early-onset Alzheimer’s disease. This type of Alzheimer’s disease most often affects young individuals with mutations in the genes associated with Alzheimer’s disease. Early-onset AD is also known as the familial type or the hereditary type of AD, but note that it affects only around five percent of all Alzheimer’s cases and that the majority of Alzheimer’s disease is that of the late-onset or sporadic AD.
So genetics does play an important role in AD?
Yes, mutations in certain genes are associated with an increase in an individual’s risk to develop AD. Early-onset AD is hereditary and genetic. Late-onset AD can also be genetic if an individual possesses the AD susceptibility gene, which also increases his risk of having AD. However, having these genes or having a parent or siblings with Alzheimer’s disease only increases the risk but it doesn’t mean you will surely develop AD.
What type of profile could predispose one to be diagnosed with Alzheimer’s?
Modifiable risk factors of Alzheimer’s disease include physical inactivity, smoking, excessive alcohol consumption, air pollution, head injury, infrequent social interaction and contact, less education, obesity, hypertension, diabetes, depression, and hearing impairment.
Is there anything we can do to curb the onset of Alzheimer’s?
As more and more individuals have these modifiable risk factors, the risk of developing them at an earlier age is also increasing. Knowing that these risk factors can be addressed and that developing AD at an earlier age can be prevented, we must engage in activities that promote a healthier lifestyle even at a younger age. These activities include engaging in regular physical aerobic exercise, eating a healthy diet rich in green leafy vegetables, fruits, nuts, and omega-3 fatty acids, participating in mentally stimulating activities such as learning new things and developing new hobbies, preventing social isolation and depression, not smoking and limiting alcohol consumption, as well as having a good educational background. Avoidance of any type of head trauma can also decrease the risk of developing dementia.
How quickly can Alzheimer’s progress once diagnosed and what does it depend on?
One hallmark of Alzheimer’s disease is its insidious onset and progressive course. It tends to develop slowly and gradually worsens over several years. The rate of progression of Alzheimer’s disease varies widely. Some reports say people with AD can live between three to 11 years or up to 20 years from the time of diagnosis. However, this depends on the stage at which the patient already is at the time of diagnosis, as well as the presence of uncontrolled or untreated vascular risk factors and the other modifiable risk factors mentioned above.
Experimental drugs like Lecanemab are being tested in clinical trials. How would it compare to the ones already in the market such as Aricept, Exelon and Razadyne?
Presently available medications such as Donepezil, Rivastigmine and Memantine are considered symptomatic treatments. They affect the symptoms of the disease and can provide an initial benefit by trying to control the progression of symptoms, but the patient will continue to decline.
Experimental drugs such as Lecanemab are classified as disease-modifying agents. Lecanemab in particular is a monoclonal antibody that targets the amyloid protein that causes AD. In general, disease-modifying agents affect the disease’s underlying pathology and would either stop or slow the progressive decline of the patient. This type of treatment shows promise as it may potentially halt or lessen the pathology of AD to stop its symptom progression. However, as this drug is still new, less is known regarding its safety and long-term effects, hence clinical trials on this treatment are still being conducted.
Would it be accurate to state that the earlier it is detected, the better chances of stalling its progress?
Yes, knowing that Alzheimer’s disease has modifiable risk factors can definitely prevent or delay the progression of its symptoms. Preventive measures should be done as early as possible. Screening for cognitive impairment, especially for those at risk, should be done to detect Alzheimer’s earlier and appropriate intervention should be undertaken to delay the progression of cognitive impairment and subsequent Alzheimer’s disease. Also, if someone has mild symptoms already and Alzheimer’s is detected early, medications may be given earlier to help slow its progression.
Reducing the risk
Eight health factors might increase our predisposition to this disease: binge drinking, depression, early hearing loss, diabetes, obesity, high blood pressure and physical inactivity. According to studies made at the University of Minnesota, the last three factors are the ones that contribute the highest to our risk of this type of disease. Solving these factors could reduce dementia prevalence.
• Maintain a healthy weight. Opt for high-density foods by consuming a dietrich in vegetables, fibre, Omega 3 and protein.
• Manage your blood sugar. Insulin resistance-related syndromes, such as diabetes and dyslipidaemia, are well-known risk factors for AD. Keep your sugar intake to a minimum including fruits and watch your intake of carbs such as baked goods, pasta and white rice. Try intermittent fasting to allow your body and brain to spend more time in a low insulin state.
• Understand your blood pressure. Blood pressure normally rises and falls throughout the day, but it can damage your heart and cause health problems if it stays high for a long time. Readings should normally be 120/80 or below; once they hit 130/80 or 140/90 you should see a doctor. Blood pressure monitors are easily available; invest in one.
• Stay physically active. Our bodies are meant to move. Physical activity can improve thinking, reduce the risk of depression and anxiety, and help you sleep better.
• Test your hearing. Studies have shown that patients with hearing loss may be two to five times more likely to develop dementia, depending on the severity of their hearing problems. An audiometry evaluation is a painless, non-invasive hearin test that measures a person’s ability to hear different sounds, pitches or frequencies.
• Avoid binge drinking. National Institute on Alcohol Abuse defines excessive drinking as consuming more than four drinks on any day or more than 14 drinks per week for males. For females, it involves consuming more than three drinks on any day or more than seven drinks per week. Lowering intake can help you. Alcohol makes it harder for the brain areas controlling balance, memory, speech and judgment to do their jobs, resulting in a higher likelihood of injuries and other negative outcomes.
Our cognitive health might be a choice that we make with every bite we take and all of us are at risk. Our brain is highly delicate and vulnerable to the many offenses thrown at it by our modern world. It is our brain that makes possible all that we love to do. We are never too old or too young to make a brain-healthy choice, so lessening the chances of dementia through awareness, knowledge and dietary changes might just help us beat the odds.