June 13, 2012
Dr. Michael Brant-Zawadzki
Today’s title from Glen Campbell’s hit, “Gentle on My Mind,” highlights this country music legend’s battle with Alzheimer’s. How can he perform on his current “Farewell Tour” while slowly losing his mind to the devastation of Alzheimer’s? Interestingly, this disease initially preserves the “back roads” – longstanding memories supporting well-learned tasks like song lyrics and the ability to play an instrument. It’s the fresh road construction, the brain’s ability to store new memories, that’s affected first.
Alzheimer’s has a 14-year course, with multiple predispositions: genetics, behavior (lack of exercise, poor diet, and smoking), etc. Recognition of the disease’s early stage is difficult. Normal performance of well-learned tasks like driving, writing, is misleading. Only accurate tests of memory function can suggest a problem. Brain MR and PET scans, now with a newly approved injected molecule that shows the gunk associated with the disease that shackles our brain’s nerve cells, together with memory testing, can provide a more specific diagnosis of early Alzheimer’s. This is a crucial change in our approach to the developing epidemic currently afflicting one of eight septuagenarians. Recent research contradicts the medical and urban myths that one needn’t diagnose Alzheimer’s because nothing can be done. Indeed, assessing for the earliest stages of Alzheimer’s, and treating it appropriately, can slow the disease course by as much as 50%, which means that people can lead normal lives much longer, avoiding loss of self sufficiency and institutionalization.
For instance, recently a 50ish man was concerned about his eroding executive skills. Co-workers commented that he was “slipping” on new assignments. His spouse did not notice changes, but his concern and parental history of Alzheimer’s prompted an evaluation in our Orange County Vital Aging Program (ocvitalaging.org). A subnormal memory test and further evaluation established the diagnosis of very early Alzheimer’s. Appropriately treated, he dramatically improved and he continues to work normally today.
Proactive intervention in the earliest stages of this insidious disease not only improves the quality of life for the patient and his family, but could dramatically impact healthcare expenses. Annual Medicare spending averages approximately $3,800 per person. However, in patients with Alzheimer’s disease, that cost quadruples to almost $16,000. Why? Patients with unrecognized, unmanaged early dementia forget to take other medication, are less attentive to early signs of treatable illness such as bladder infection which then erupts to a serious infection requiring hospitalization. More frequent emergency room visits and hospitalizations occur in such people. Earlier recognition by primary care doctors, and appropriate management of their patients’ cognitive disorders improves medical compliance, quality of life and saves money.
Some memory loss (forgetting car keys, name block) is normal with aging. A formal memory test can be reassuring, as the large majority of concerned individuals will be normal. Use it as a tool to learn about prevention. Given the “boomer” aging of our population, prevention cannot be overestimated. Physical exercise, were it bottled, would be the best selling drug ever. Its effectiveness for preventing Alzheimer’s and related dementias is proven. Brain exercise, is also “vital.” Learning new tasks, a musical instrument, a language, is the best brain exercise there is. Do it.
After all, we want to continue enjoying life and our loved ones, keeping them ever smiling, ever gentle on our minds.
Dr. Michael Brant-Zawadzki is the executive medical director of the Hoag Hospital Neurosciences Institute.
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