Alzheimer’s looking like a mix of genes and lifestyle

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Glen Finney, MD, Neurology, Geisinger Medical Center, GMC, Danville, GWV, Wilkes-Barre

By Dave Gardner

As medical science strives for a game-changing breakthrough, families across the nation are in a battle against exploding care costs and heartbreak resulting from various forms of dementia, including Alzheimer’s disease.

Care for the victims of Alzheimer’s is placing a tremendous financial burden upon the already stressed Medicare and Medicaid systems. The specific cost of caring for Alzheimer’s patients in the nation, according to the Alzheimer’s Association, was estimated to be $236 billion in 2016, and may rise to a crippling $1.1 trillion by 2050.

The deadly consequences of Alzheimer’s are also mounting. The Centers for Disease Control reports a 55 percent increase in deaths resulting from the disease, with no family or individual immune to the affliction.

Other staggering data reported by the Alzheimer’s Association indicates that at least five million Americans are now afflicted with the disease. This total is expected to increase to a potential 16 million by 2050.

Scientists generally agree that obesity, a lack of physical activity, decreases in intellectual exercise, high blood pressure, elevated cholesterol, diabetes and an overall poor diet all contribute to Alzheimer’s risk. These are all manageable, although certain inherited gene variations may also play a role.

EARLY ONSET?

Glen Finney, M.D., director of the Geisinger Health System’s Aging Brain and Behavioral Neurology department, explained that Alzheimer’s can actually begin when a person enters his or her 40s. Data also indicates that by their mid-80s, up to half of the population will battle some sort of dementia-related cognitive decline.

Alzheimer’s onset actually creates an ongoing physical degeneration of the brain, while vascular forms of dementia deprive the brain of blood producing cognitive difficulties. A third form of dementia and brain destruction, recently in sports news, involves repeated head trauma.

“Primary care is usually where the diagnosis of Alzheimer’s occurs,” said Dr. Finney. “For Alzheimer’s, the greatest risk is generated by living long enough for the disease to occur.”

According to Dr. Finney, studies clearly suggest sociability can be a vital tool to curb the onset of Alzheimer’s. Withdrawal from social activities with an entrance into isolation increases risk, while the inverse of keeping the brain engaged and intellectually active produces benefits for people of all ages.

“Social activity and intellectual exercise clearly benefit the brain, and even online exercise can reduce cognitive declines,” said Dr. Finney. “But, these must involve more than just a crossword puzzle.”

Vascular dementia is also a big problem for physicians, and Dr. Finney often recommends the Mediterranean-Dash Intervention diet for these patients. This is a modified medical nutritional system that allows limited red meat, fried foods, cheeses and sugars, but emphasizes brain-healthy foods including greens, vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil and potentially wine.

DRUG CONNECTIONS?

With Americans liberally using alcohol and recreational drugs, questions have surfaced about connections between these and the onset of Alzheimer’s. Dr. Finney commented that marijuana and alcohol use in adolescents has been proven to cause brain damage, but it is unknown if these substances play a role in the later onset of Alzheimer’s.

“However, recreational drugs and the elderly are a particularly bad combination,” said Dr. Finney. “They impair thinking, add to aging side-effects, and overall spell trouble.”

At the heart of science’s roadblock in the treatment of Alzheimer’s lies the reality that mankind does not understand how complex electrical activity between brain cells creates consciousness. Alzheimer’s actually causes a progressive death of brain tissue, and although the brain can regrow some cells this ability is limited, and “re-connecting” brain cells to create a functional neuro network still is not possible.

“The fundamental process of thought will eventually be understood,” said Dr. Finney. “A huge breakthrough will occur.”

According to a study associated with the National Academy of Sciences and reported by CNN, new hope is on the horizon in the difficult task of diagnosing Alzheimer’s. An experimental blood test that can accurately diagnose the disease and potentially other degenerative brain disorders has been developed, with relevant data indicating the test can reveal Alzheimer’s patients with up to 86 percent sensitivity and specificity.

This would contrast with the current situation, in which most Alzheimer’s diagnoses are made by a primary care physician utilizing different types of mental status exams. Only a microscopic study of brain cells after a patient’s death, such as is the case with former NFL players suffering from trauma-induced dementia, can produce direct evidence of brain tissue loss.

DNA CONNECTIONS?

Vithalbhai Dhaduk, M.D., an independent NEPA neurologist, is in complete agreement that many of the risk factors for Alzheimer’s can be controlled. These include blood pressure problems, diabetes, heart and vascular disease issues, high cholesterol, obesity, smoking and sedentary behavior.

However, he is also quick to point out that genes which are inherited as part of a family genetic history conclusively raise the risk for an early onset of dementia. Several medications are currently in use to slow or even delay the onset of Alzheimer’s, but no effective treatment or cure exists to stop the destruction of the brain.

Dr. Dhaduk agrees that, to really tip the balance with dementia-related illness, science is in need of a big breakthrough that will create fundamental changes to the way physicians approach care for dementia.

“It is very important to understand that Alzheimer’s is very hard on the patient’s caregivers, and right now there is no cure on the horizon,” said Dr. Dhaduk. “This is a terrible disease that dissolves both the minds of people and their family.”

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