Daily Checkup: Alzheimer’s disease is a dire threat, but early action and treatment can slow its progress

Tests, exercise help in coping with debilitating disorder, says Mount Sinai's Dr. Sam Gandy

By Katie Charles / NEW YORK DAILY NEWS
Wednesday, August 15, 2012, 1:17 PM

    THE SPECIALIST: Dr. Sam Gandy

    A neurologist and director of the Center for Cognitive Health at Mount Sinai Hospital, Gandy specializes in the study and treatment of dementia, focusing on Alzheimer's disease. He has been working in the field for 25 years

    WHO'S MOST AT RISK

    As Americans live longer and longer, Alzheimer's disease has become more and more familiar.

    "Alzheimer's is the most common underlying disease that causes dementia, which literally means the loss of the ability to think," says Mount Sinai's Dr. Sam Gandy. "Half of all people over age 85 are living with Alzheimer's. It's really a disease that touches everyone."

    Of the 5.4 million Americans who have been diagnosed with Alzheimer's, 5.2 million are older than 65. "Aging is the No. 1 risk factor for Alzheimer's," says Gandy. "While early onset cases do exist, the vast majority of patients are over 65."

    Twice as many women as men have Alzheimer's, not because women are more prone to the disease, but because they have a longer life expectancy.

    Though there isn't a complete consensus, most doctors believe Alzheimer's is the result of plaque buildup in the brain. "This specific plaque, a protein called amyloid, is made everywhere in the body all throughout life," says Gandy.

    "After 60 or 70 years, some brains continue making amyloid, but can no longer process it properly, and the plaque buildup interferes with normal brain function."

    Only 3% of Alzheimer's cases are completely attributable to genetics.

    Although Alzheimer's is caused by plaque buildup in the brain, it follows a process similar to the plaque buildup in the arteries that causes heart disease.

    "The primary risk factors for Alzheimer's are the same as heart disease: high blood pressure, high cholesterol, diabetes, high blood sugar, obesity and a sedentary lifestyle," says Gandy. "Also, having suffered a head injury severe enough to lose consciousness puts you at higher risk of Alzheimer's down the road."

    SIGNS AND SYMPTOMS

    Traditionally, Alzheimer's has been diagnosed when patients present certain symptoms.

    "The three classic symptoms are loss of short-term memory, a personality change or loss of executive function," says Gandy.

    "For instance, patients might be able to tell you about their childhood but not what they had for breakfast, or a previously outgoing elder gets depressed."

    With loss of executive function, patients can look okay, but lose the ability to handle necessary duties in life, like managing finances and paying bills.

    Alzheimer's is a progressive disease.

    "Initially, the forgetfulness isn't crippling and people can remain independent," says Gandy. "But eventually, everyone will require 24-hour supervision, which means either an assisted living situation or having either a family member or outside help in place around the clock."

    One reason doctors stress having an elderly loved one assessed is to help family members plan ahead so they can avoid crises like a car accident, leaving the stove on, getting lost or financial mismanagement.

    Only very recently have doctors had a test that can confirm the diagnosis of Alzheimer's based on symptoms. "We now have two tests: We can examine the spinal fluid for changes in amyloid level, or we can use a nuclear medicine scan to image plaque buildup in the brain," says Gandy. "These tests allow us not only to confirm the diagnosis, but to see how far the disease has progressed."

    TRADITIONAL TREATMENT

    As studies increasingly show, complementary therapies can go a long way toward preventing Alzheimer's or slowing its progression. "A lot of people know that mental activity and social engagement show a lot of benefit in staving off Alzheimer's," says Gandy. "What's more of a surprise is that vigorous physical exercise is also extremely protective — right now we're just trying to figure out what kinds of exercise are most effective and what the ideal dose is."

    Gandy recommends getting at least 30 minutes of exercise three times a week. "Mental and physical activity can completely neutralize genetic factors that increase risk," says Gandy.

    There is no cure for Alzheimer's and no medication that can permanently halt its progression. "The standard medical treatment uses cholinesterase inhibitors — first tested in patients at Mount Sinai — to help the brain compensate for chemical deficiencies early in the disease," says Gandy. "While these drugs help some patients, eventually all these medicines wear off."

    The average time between diagnosis and death is 10 years.
   

Research breakthroughs

    With so many Americans affected by Alzheimer's, doctors are working to find ways to prevent and cure the disease.

    "At the Mount Sinai Alzheimer's Disease Research Center, we're doing a lot of clinical trials that are attempting to speed amyloid clearance or prevent amyloid buildup in the first place," says Gandy.

    "The lingering question is: How early do we have to start these treatments to have any effect? We know that people with genetic reductions in amyloid are protected from Alzheimer's, but they have low levels beginning from the moment of conception. Obviously we want to begin interventions later than that."

    QUESTIONS FOR YOUR DOCTOR

    For many patients and loved ones, the first question is, "What is the distinction between Alzheimer's and dementia?" There are many causes of dementia; Alzheimer's is the most common specific disease that causes it.

    Because caring for a loved one with Alzheimer's can be very demanding, relatives should ask, "What should I expect from the progression of this disease?"

    A proactive question everyone should ask is, "What can I do to prevent Alzheimer's?" "Even people with a family history can reverse their risk by getting enough physical and mental exercise," says Gandy. 'Don't feel that you're doomed.Keeping yourself in good health and maintaining physical and mental fitness can go a long way in fending off this disease."

    WHAT YOU CAN DO

    GET INFORMED.

    Stellar resources are available online, thanks to groups like the Alzheimer's Association (Alz.org) and NIH (nia.nih.gov/alzheimers).
   
    DON'T WAIT FOR A CRISIS.

    "If you're concerned about an elder, it's important to have them examined," says Gandy. "Senility isn't inevitable — there's a lot we can do to help patients preserve function, especially if they receive treatment early."
   
    GET CAREGIVER SUPPORT.

    There are many resources for caregivers, from support groups to social workers who can help with the daunting logistics.

    STAY ACTIVE.

    Both physical and mental activity are ­essential for preventing Alzheimer's and for slowing the progression of dementia once the signs of it have begun.

http://www.nydailynews.com/life-style/health/alzheimer-disease-a-dire-threat-early-action-treatment-slow-progress-article-1.1136755



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