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Early Symptoms of Alzheimer’s Disease

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Until recently, most physicians have reassured older adults that so-called “senior moments” are usually a normal part of aging.

Now, research shows that complaints of subtle memory loss—for example, not remembering the name of a longtime acquaintance as easily as you might have five to 10 years earlier—may mean more than doctors once thought.

Researchers at New York University (NYU) School of Medicine have found that people who are concerned about episodes of memory loss may, in fact, be absolutely right, and they are at increased risk of developing Alzheimer’s disease years later.

To learn more, Bottom Line/Health spoke with Barry Reisberg, MD, a renowned Alzheimer’s researcher who led this important recent research.

WHEN DOES ALZHEIMER’S BEGIN?

The warning signs of Alzheimer’s disease are now well-known and include a gradual decline of memory and reasoning skills. However, the stages that precede Alzheimer’s now are a great focus of investigation.

In the 1980s, I, along with my associates, first identified a condition that we termed mild cognitive impairment (MCI), which is generally characterized by measurable memory loss beyond the personal experiences of forgetfulness that can be associated with normal aging. With MCI, memory problems, such as forgetting recent events and frequently repeating yourself in conversations, usually are noticeable to family members and/or friends.

Research findings are mixed, but most evidence shows that about half of people who experience MCI go on to develop overt Alzheimer’s disease within about four years.

Important research: NYU investigators have found that a condition they’ve termed subjective cognitive impairment may be evident up to 22 years before noticeable Alzheimer’s symptoms manifest—many, many years before MCI.

What’s the implication of this finding?

It means that scientists can refocus their research to try to find ways to prevent Alzheimer’s by addressing it a decade or two before it surfaces—and individuals may have a crucial new clue that signals the importance of seriously following the lifestyle habits that promote brain health.

A NEW—EVEN EARLIER—SIGN

Subjective cognitive impairment is so subtle that it usually is not recognized by a patient’s doctor or his/her family. In fact, the condition is generally apparent only to the individual, although he may confide in a spouse or close friend about the self-perceived problem.

Interestingly, when people with subjective cognitive impairment are tested, they continue to perform within normal ranges on mental and psychological tests.

So, how can subjective cognitive impairment be detected—and is it important to even do so?

What researchers currently know: Up to 56% of adults ages 65 and older experience subjective cognitive impairment. Its key known characteristic is that the person believes his memory is not as good as it was five to 10 years before. Specifically, a person with the condition may complain—or simply note—that he can’t remember, say, names or where he has placed things as well as he did in previous years.

Compared with people who don’t have subjective cognitive impairment, those who have the condition are 4.5 times more likely to develop MCI or full-blown Alzheimer’s within seven years. In a recent study, more than half of people advanced to these more evident and more serious conditions after seven years.

What’s more, research shows that those with subjective cognitive impairment who progress to MCI or Alzheimer’s do so about 3.5 years sooner, on average, than those who didn’t have subjective cognitive impairment.

IS THIS JUST NORMAL AGING?

Since studies show that as many as 56% of people ages 65 and older have subjective cognitive impairment, it can be technically considered part of the normal aging process. Advanced age is, after all, the single biggest risk for dementia.

However, there are unique psychological and physiological characteristics that accompany subjective cognitive impairment.

For example, research conducted at the NYU School of Medicine found that people with subjective cognitive impairment have increased urinary levels of the stress hormone cortisol and decreased brain activity in the memory and other brain regions, compared with people who don’t have the condition. Increased cortisol levels have been shown in some studies to damage the brain.

In addition, European researchers have found that people with subjective cognitive impairment have significantly higher levels of spinal fluid markers that often accompany Alzheimer’s, compared with people who don’t have subjective cognitive impairment.

THREE IMPORTANT QUESTIONS

Here are a few of the questions that were used by the NYU researchers to help identify subjective cognitive impairment. If you answer “yes” to one or more of the following, discuss this with your physician…

  1. Am I having trouble recalling names (especially names of people) more than I did five to 10 years ago?
  2. Am I having trouble recalling where I placed things more than I did five to 10 years ago?
  3. Is my ability to concentrate lacking compared with five to 10 years ago?

WHAT YOU CAN DO

If you suspect that you have subjective cognitive impairment or MCI, your doctor can determine whether a treatable factor—such as depression…anxiety…a thyroid disorder…a nutritional deficiency (such as too little vitamin B-12)…or medication (such as anticholinergic drugs taken for conditions including allergies or overactive bladder…and painkillers)—is causing memory loss. Chronic stress also may affect memory.

If your doctor rules out a treatable cause for your memory loss, it’s crucial to adopt lifestyle habits, such as regular exercise, that promote brain health.

This includes eating a heart-healthy diet. A diet that emphasizes vegetables and fruit, lean protein and whole grains…avoids saturated and trans fats…and includes healthful fats, such as olive oil, promotes cardiovascular health and, in turn, the health of your brain.

There is no medication that is prescribed at the present time for people with subjective cognitive impairment. There are also no medications that have been approved specifically for MCI. However, medications such as donepezil (Aricept) or rivastigmine (Exelon), which are approved for the treatment of Alzheimer’s symptoms, have been studied in MCI patients. But these medications have not shown sufficient benefit to win FDA approval as a treatment for MCI.

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Source: Barry Reisberg, MD, leader of the Clinical Core of the Alzheimer’s Disease Center of the New York University (NYU) School of Medicine and clinical director of the school’s Aging and Dementia Research Center, both in New York City. He is also director of the university’s Zachary and Elizabeth M. Fisher Alzheimer’s Disease Education and Resources Program. He has authored or coauthored more than 300 articles and chapters, primarily on Alzheimer’s and other forms of dementia, in addition to books on Alzheimer’s disease. Dr. Reisberg is a 2004 recipient of the Lifetime Achievement Award for Outstanding Research from the Alzheimer’s Association. Date: January 1, 2012 Publication: Bottom Line Health
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