A Lifetime of Quality Care That’s Convenient & Complete Alzheimer’s Disease Robert Grimshaw, MD FACP A Lifetime of Quality Care That’s Convenient & Complete

Dr Alois Alzheimer Dr Alois Alzheimer described the disease which carries his name in It is now the most common cause of memory loss in the U.S.: 4 million have it now 14 million are expected to have it by in 10 people over 65 has it half of those over 85 have it US costs are estimated to be at least $100 billion yearly average lifetime cost per patient is $174,000

A Lifetime of Quality Care That’s Convenient & Complete What is Alzheimer’s Alzheimer’s Disease (AD): is not yet clear what the cause or causes of AD are. Autopsy studies show dense "neurofibrillary tangles"and "senile plaques" in brain specimens. Beta-amyloid and tau proteins are strongly implicated, as are some nerve transmitter deficiencies. At least 4 genes are suspected.

A Lifetime of Quality Care That’s Convenient & Complete Warning Signs Include: Memory loss at work Problems with familiar tasks such as forgetting you made a meal Problems with simple words Getting lost in your own neighborhood or home Poor judgement such as not dressing properly Abstract thinking issues such as inability to work numbers Misplacing things bizarrely such as putting an iron in the freezer Unexplained mood swings Changes in personality Profound loss of initiative

A Lifetime of Quality Care That’s Convenient & Complete How is Alzheimer’s Diagnosed? No one test (except brain biopsy!) is diagnostic. History & physical exam, a brief memory test and lab tests to rule out other diagnoses (such as low thyroid and vitamin B-12 deficiency) are done. MRI or CT scan of the brain may be needed to rule out multiple small strokes.

A Lifetime of Quality Care That’s Convenient & Complete Non-Drug Treatments: Mental Activity: A study by Dr. Robert Friedland and colleagues at Case Western Reserve in Cleveland found that the more you do (mentally), the more you can do. Those who were more active mentally in early and midlife had 1/4th the chance of AD. Exercise reduced the risk of AD in senior women in 1 study by 13% for every extra mile walked daily. Antioxidants: Vitamin E (2000 units daily) was shown to reduce the risk of AD in the Alzheimer Prevention Study; in the Rotterdam Study beta-carotene and vitamins C & E reduced AD, especially in smokers. Alcohol: in a Boston study, 1-2 daily drinks led to less AD. Low-fat Diet: Another Cleveland study showed high-fat diet increased AD 5-6 fold in susceptible patients.

A Lifetime of Quality Care That’s Convenient & Complete Non-Specific Drug Treatment: Diabetes: control of type 2 diabetes reduced dementia in a Dutch study. Blood Pressure: control of blood pressure also reduced dementia in several studies. Statins: anti-cholesterol drugs (lovastatin, etc). Reduce AD Anti-inflammatories: Aspirin, ibuprofen and similar drugs have been associated with reduced AD in several observational studies. Anti-Alzheimer Drugs: Tacrine (Cognex) was the first; little used now due to liver risks. Donepezil (Aricept) is now the most used, working by increasing the neurotransmitter acetylcholine. Rivastigmine (Exelon) is a similar drug, with perhaps a bit more improvement in memory, but with higher rates of stomach trouble here. Galantamine (Reminyl) is the newest drug (derived from the daffodils), acting similarly, but with a 16% drop out rate due to side effects. There are no head-to-head studies. On these drugs, avoid Ditropan, Levsin, Atrohist, Bentyl; they counter the effect.

A Lifetime of Quality Care That’s Convenient & Complete Future Vaccine? Elan Pharmaceutical has a vaccine trial underway against one of the proteins in the amyloid plaques.