Early Symptoms of Alzheimer’s Disease
January 1, 2012
Appeared in the print version as "What Do 'Senior Moments' Really Mean?”
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.
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.
http://www.bottomlinepublications.com/content/article/health-a-healing/early-symptoms-of-alzheimers-disease
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Worried About Your Memory? What’s Normal…and the Signs of Real Trouble
September 1, 2012
With all the media coverage of Alzheimer’s disease and other forms of dementia, it’s easy to imagine the worst every time you can’t summon the name of a good friend or struggle to remember the details of a novel that you put down just a few days ago.Reassuring: The minor memory hiccups that bedevil adults in middle age and beyond usually are due to normal changes in the brain and nervous system that affect concentration or the processing and storing of information. In fact, common memory “problems” typically are nothing more than memory errors. Forgetting is just one kind of error.
Important: Memory problems that are frequent or severe (such as forgetting how to drive home from work or how to operate a simple appliance in your home) could be a sign of Alzheimer’s disease or some other form of dementia. Such memory lapses also can be due to treatable, but potentially serious, conditions, including depression, a nutritional deficiency or even sleep apnea. See your doctor if you have memory problems that interfere with daily life—or the frequency and/or severity seems to be increasing.
Five types of harmless memory errors that tend to get more common with age…
MEMORY ERROR #1: Absentmindedness. How many times have you had to search for the car keys because you put them in an entirely unexpected place? Or gone to the grocery store to buy three items but come home with only two? This type of forgetfulness describes what happens when a new piece of information (where you put the keys or what to buy at the store) never even enters your memory because you weren’t paying attention.
My advice: Since distraction is the main cause of absentmindedness, try to do just one thing at a time. Otherwise, here’s what can happen: You start to do something, and then something else grabs your attention—and you completely forget about the first thing.
We live in a world in which information routinely comes at us from all directions, so you’ll want to develop your own systems for getting things done. There’s no good reason to use brain space for superfluous or transitory information. Use lists, sticky notes, e-mail reminders, etc., for tasks, names of books you want to read, grocery lists, etc. There’s truth to the Chinese proverb that says, “The palest ink is better than the best memory.”
Helpful: Don’t write a to-do list and put it aside. While just the act of writing down tasks can help you remember them, you should consult your list several times a day for it to be effective.
MEMORY ERROR #2: Blocking. When a word or the answer to a question is “on the tip of your tongue,” you’re blocking the information that you need. A similar situation happens when you accidentally call one of your children by the name of another. Some patients are convinced that temporarily “forgetting” an acquaintance’s name means that they’re developing Alzheimer’s disease, but that’s usually not true.
Blocking occurs when the information that you need is properly stored in memory, but another piece of information is getting in the way. Often, this second piece of information has similar qualities (names of children, closely related words, etc.) to the first. The similarity may cause the wrong brain area to activate and make it harder to access the information that you want.
My advice: Don’t get frustrated when a word or name is on the tip of your tongue. Relax and think about something else. In about 50% of cases, the right answer will come to you within one minute.
MEMORY ERROR #3: Misattribution. This is what happens when you make a mistake in the source of a memory.
More than a few writers have been embarrassed when they wrote something that they thought was original but later learned that it was identical to something they had heard or read. You might tell a story to friends that you know is true because you read about it in the newspaper—except that you may have only heard people talking about it and misattributed the source.
Misattribution happens more frequently with age because older people have older memories. These memories are more likely to contain mistakes because they happened long ago and don’t get recalled often.
My advice: Concentrate on details when you want to remember the source of information. Focus on the five Ws: Who told you…what the content was…when it happened…where you were when you learned it…and why it’s important. Asking these questions will help to strengthen the context of the information.
MEMORY ERROR #4: Suggestibility. Most individuals think of memory as a mental videotape— a recording of what took place. But what feels like memories to you could be things that never really happened. Memories can be affected or even created by the power of suggestion.
In a landmark study, researchers privately asked the relatives of participants to describe three childhood events that actually happened. They were also asked to provide plausible details about a fourth scenario (getting lost in a shopping mall) that could have happened, but didn’t.
A few weeks later, the participants were given a written description of the four stories and asked to recall them in as much detail as possible. They weren’t told that one of the stories was fictional.
What happened: About 20% of the participants believed that they really had been lost in a shopping mall. They “remembered” the event and provided details about what happened. This and other studies show that memories can be influenced—and even created—from thin air.
My advice: Keep an open mind if your memory of an event isn’t the same as someone else’s. It’s unlikely that either of you will have perfect recall. Memories get modified over time by new information as well as by individual perspectives, personality traits, etc.
MEMORY ERROR #5: Transience. You watched a great movie but can’t remember the lead actor two hours later. You earned an advanced degree in engineering, but now you can hardly remember the basic equations.
These are all examples of transience, the tendency of memories to fade over time. Short-term memory is highly susceptible to transience because information that you’ve just acquired hasn’t been embedded in long-term storage, where memories can be more stable and enduring.
This is why you’re more likely to forget the name of someone you just met than the details of a meaningful book that you read in college—although even long-term memories will fade if you do not recall them now and then.
My advice: You need to rehearse and revisit information in order to retain it. Repeating a name several times after you’ve met someone is a form of rehearsal. So is talking about a movie you just watched or jotting notes about an event in a diary.
Revisiting information simply means recalling and using it. Suppose that you wrote down your thoughts about an important conversation in your journal. You can review the notes a few weeks later to strengthen the memory and anchor it in your mind. The same technique will help you remember names, telephone numbers, etc.
Source: Aaron P. Nelson, PhD, chief of neuropsychology in the division of cognitive and behavioral neurology at Brigham and Women’s Hospital and an assistant professor of psychology at Harvard Medical School, both in Boston. He is coauthor, with Susan Gilbert, of The Harvard Medical School Guide to Achieving Optimal Memory (McGraw-Hill).
http://www.bottomlinepublications.com/content/article/health-a-healing/worried-about-your-memory-whats-normal-and-the-signs-of-real-trouble
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