Cox News Service
ATLANTA -- My father, John Foskett, turns 89 next month, though
you'd never know it from his baseline volley. He plays tennis twice
a week, competes in senior tournaments and is trimmer today than
when he graduated from college in 1947 (six years late because of
World War II).
Recently, however, my father confided a nagging concern: his
memory. He forgets names, or tasks he intended for the day. He
organizes his desk, only to do it all over again because he can't
quite recall where things are.
Could it be, my father wondered, a sign of Alzheimer's?
According to doctors, millions of older Americans are posing the
same question. Many, like my father, have dodged serious disease
and illness only to find that age is beginning to dull their mind.
Health officials predict that 16 million Americans will develop
Alzheimer's by 2050, as American baby boomers live longer.
Statistically, the odds of developing Alzheimer's are 50-50 for
those older than 85.
Risk remains low throughout middle age but begins to increase
steadily after age 65.
So, what's a person to do?
Although Alzheimer's has been around since 1906, the medical
advice about how and when to test for the disease is still
evolving. A generation ago, many doctors considered testing for
Alzheimer's a waste of time because no one knew how to treat it.
But new drugs, combined with the difficult care decisions that
accompany an Alzheimer's diagnosis, have prompted more doctors to
urge older patients to have themselves evaluated for cognitive
problems as soon as they appear.
"We still have this notion that you get old, you get senile,"
says Dr. Paul Solomon, clinical director of the Memory Clinic in
Burlington, Vt. "But senility and cognitive deficits are not
typical of the aging process. They signal a disease process."
Doctors argue that older people need to think of the function of
their mind as they would the condition of their heart or the
stability of their blood pressure.
For the moment, however, the onus to seek testing is on the
patient. Doctors will not test for Alzheimer's or other cognitive
disorders unless asked, which has resulted in huge numbers of
undiagnosed cases.
"The number of patients diagnosed early is abysmally small,"
says Dr. Allan Levey, chairman of neurology at Emory University and
director of the Alzheimer's Disease Research Center. "We need to
be identifying people even earlier on."
Basic screens to test for cognitive function can take as little
as five minutes. Most involve a person's ability to immediately
recall names or words given to them a few minutes earlier, since
one indication of Alzheimer's is a decline in short-term memory.
Another test involves having the patient draw the face of a
clock and indicate a specific time of day. Alzheimer's also
interferes with the brain's problem-solving ability, so a patient
with Alzheimer's often has trouble placing the clock hands in the
right sequence or drawing the numbers in the proper order.
Such screens do not by themselves lead to a diagnosis of
Alzheimer's. But low scores could suggest the need for more
detailed testing. (A more accurate assessment of brain function,
administered by a neurologist, takes 90 minutes or more.)
Even if the simple screens show no problems, doctors say they
can be helpful. An annual cognition screen, just like a regular
blood pressure reading, can show what's happening to someone's
mental function over time.
Moderate declines in cognitive ability also can be treated with
several drugs. They do not cure Alzheimer's, but they can slow
worsening symptoms and improve memory function. All are covered by
Medicare.
Other, more promising drugs are in the research pipeline,
including several vaccines that may actually reverse the deadly
progress of Alzheimer's through the brain. Those diagnosed with
Alzheimer's are eligible to participate in clinical trials testing
the new drugs. The government lists clinical trials by region at
www.clinicaltrials.gov.
Health care professionals also believe older people - and their
families - are better off if they confirm an Alzheimer's diagnosis
sooner rather than later. Alzheimer's is an irreversible,
degenerative disorder that slowly causes brain cells to die.
Patients can do well cared for at home in the initial phases,
but they require increasing levels of care and supervision as the
disease progresses. Patients also lose the ability to make
financial decisions, so an early diagnosis means it's time to get
their affairs in order.
James Abercrombie, 86, learned he had Alzheimer's in 1998. For
many good years, he stayed home with his wife. The couple moved to
an assisted-living home two years ago because Ruth Abercrombie
could no longer manage alone. James Abercrombie said he misses his
garden, although he's started one at his new residence. He's also
two miles from his son, Jon, who can visit his parents more often
now.
"We were afraid we would lose him in the first few years or
so," said Jon Abercrombie. "But he's done real well."
TRUTH AND MYTHS
-- Only older people can get Alzheimer's.
Actually, Alzheimer's can strike people in their 30s, 40s and
50s. Of the estimated 5 million Americans living with the disease,
some 500,000 under age 65 have Alzheimer's or a related dementia.
-- Memory loss is a natural part of aging.
Severe memory loss is a symptom of serious illness. It's still
not clear whether memory naturally declines as a person grows
older.
-- Alzheimer's disease is not fatal.
Alzheimer's disease will kill you. It destroys brain cells and
eventually results in a loss of body functions.
-- Drinking out of aluminum cans or cooking in aluminum pots and
pans can lead to Alzheimer's disease.
During the 1960s and 1970s, aluminum emerged as a possible
suspect in Alzheimer's disease, leading to concerns about exposure
to pots and pans, beverage cans, antacids and antiperspirants. But
experts haven't confirmed any link between the disease and
aluminum, and few believe that everyday sources of aluminum pose
any threat.
-- The artificial sweetener aspartame, marketed under the names
Nutrasweet and Equal, causes memory loss.
As of May 2006, the Food and Drug Administration had not been
presented with any scientific evidence that would lead it to change
its conclusions on the safety of aspartame for most people. The
agency says its conclusions are based on more than 100 laboratory
and clinical studies.
-- Flu shots increase risk of Alzheimer's disease.
A theory linking flu shots to a greatly increased risk of
Alzheimer's disease has been proposed by a U.S. doctor whose
license was suspended by the South Carolina Board of Medical
Examiners. Several mainstream studies link flu shots and other
vaccinations to a reduced risk of Alzheimer's disease and overall
better health.
-- Silver dental fillings increase risk of Alzheimer's disease.
According to the best available scientific evidence, there is no
relationship between silver dental fillings and Alzheimer's.
Source: Alzheimer's Association, www.alz.org
WHAT IS DEMENTIA?
Dementia is a general term for loss of memory and other mental
abilities severe enough to interfere with daily life. It's caused
by physical changes in the brain. The term senile pertains to the
mental decline once associated with old age but now known to be due
to dementia.
Alzheimer's disease is the most common type of dementia,
accounting for 50 percent to 70 percent of cases. A small
percentage of Alzheimer's disease is inherited, and is usually
characterized by early onset of symptoms, often before the age of
50. The vast majority of Alzheimer's is characterized as sporadic,
and generally occurs after the age of 65.
Other types of dementia include:
-- Vascular dementia: Arteries feeding the brain become narrowed
or blocked. The onset of symptoms usually is abrupt, frequently
occurring after a stroke. It develops when impaired blood flow to
parts of the brain deprives cells of food and oxygen.
-- Lewy body dementia: Characterized by abnormal deposits of a
protein called alpha-synuclein that form inside the brain's nerve
cells.
-- Frontotemporal dementia: A rare disorder that affects the
front (frontal lobes) and the sides (temporal lobes) of the brain.
Because it affects the areas of the brain that are responsible for
judgment and social behavior, frontotemporal dementia can result in
socially inappropriate behavior. Symptoms of this form of dementia,
which runs in families, usually appear between the ages of 40 and
65.
Sources: Alzheimer's Association, Mayo Clinic, medicinenet.com
Ken Foskett writes for The Atlanta Journal-Constitution. E-mail:
kfoskett AT ajc.com.