Healthy Brain Aging:
Alzheimer's Disease Risk and Protective Factors
May 29, 2013:
for general public
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“When It’s Not Just Memory”
Thursday afternoons in June 2013
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About Memory Disorders
On this page:
The term “memory disorder” means different things to different people. For some it could be just age-related memory loss. For others it could be a memory disorder caused by a medical condition, many of which are often reversible with the proper treatment. These conditions include but are not limited to:
medication interaction or incompatibility
Dementia refers to memory disorders that are not due to medical conditions or normal aging. The most common type of dementia is Alzheimer’s disease, a memory disorder that usually occurs in an older person, worsens with time, and is incurable at the present time. Alzheimer’s disease is one of more than 50 causes of dementia. Other common causes include stroke, Lewy body dementia, and Parkinson disease.
In some cases, people may experience two or more memory-related problems at the same time, such as Alzheimer’s disease and anxiety or depression.
When is a memory problem actually a marker of a more serious condition like Alzheimer’s disease or another type of dementia?
In order to know the type of memory problem that may be present, a thorough evaluation is necessary. At the SIU Memory and Aging Clinic, all known possibilities are considered in our evaluation in order to provide the best diagnosis and treatment plan for each individual.
Why do we use the term “memory disorder”?
Because there is no way of knowing the type of memory problem that may be present until a thorough evaluation is completed, in general we use the term “memory disorder,” and avoid terms that suggest a specific diagnosis (such as “dementia” or “Alzheimer’s”).
Similarly, we recommend that the family of an individual with memory symptoms encourage the person to come in for a "memory evaluation." In doing so, avoid words that may prematurely suggest a specific diagnosis, such as Alzheimer’s disease or dementia.
Memory loss that impairs the usual activities of daily living is a warning sign that needs attention. However, there is no single guideline that works for all people. If we recommended that a person or family watch for one specific symptom, we could easily miss other symptoms that might be more significant for that person. We therefore recommend that people with memory concerns and their families “keep eyes and ears open” for changes in memory and behavior that could warn of problems.
The Alzheimer’s Association publishes a list of Ten Warning Signs of Alzheimer’s Disease, but we emphasize that the list does not cover all possible changes. Even if a person may seem to be displaying one or more of the signs, it does not prove that the person has Alzheimer’s.
What to do if there are concerning symptoms or changes:
Why is it Important to Evaluate a Memory Problem Early?
A primary goal of a memory evaluation is to seek out and treat conditions that may be reversible. An accurate diagnosis is imperative, and the earlier a diagnosis can be made, the better. Additionally, therapies are available for the symptomatic treatment of Alzheimer’s disease and other common forms of dementia. When a problem is identified early, the chances are better for more treatment choices and more effective outcomes.
Steps to Evaluating a Memory Problem
As stated above, a primary physician should provide the first opinion about concerning symptoms. The individual’s medical status should be reviewed to make sure the problem is not due to medications, new or worsening medical conditions, or substances such as alcohol. The primary physician, in consultation with the person with memory complaints (and in some cases, the family), should then decide if additional tests or appointments are recommended. These could include laboratory tests, a scan of the head (such as a head CT scan or head MRI scan), or referrals to specialists.
If the person is eventually seen in the SIU Memory and Aging Clinic, we may recommend additional laboratory tests, head imaging studies, neuropsychological testing, EEG, or recommendations to see additional specialists.
Note that a referral from a primary physician is not required to be seen in the SIU Memory and Aging Clinic. However, some insurance plans have such requirements. Be sure to check first if there are questions.
Memory Problems Due to Medical Conditions
Treatment options depend on the diagnosis. Medical, psychological or other conditions that may be causing or worsening an individual’s memory can and should be promptly treated if possible. Some conditions, such as vitamin deficiency or hydrocephalus, are even reversible.
In some cases, complicating conditions, such as depression or anxiety, are present along with a dementing illness like Alzheimer’s disease. Many times these conditions are treatable, and sometimes are reversible. Even though treatment of these complicating conditions may not affect the primary problem of Alzheimer’s disease, it may result in a marked improvement in quality of life for both the individual and the family.
Memory Problems Due to Dementing Illnesses
For patients who have a dementing illness such as Alzheimer’s disease, medications are available that have shown to be of benefit. Medications may be prescribed to treat the disease itself or to treat related conditions, such as behavior changes.
It is important to understand that none of the medicines currently available can cure or stop Alzheimer’s disease. However for some people, improvements can be seen, and most of the time the progression of certain problems, such as memory loss, may be delayed. Such a delay can help a person remain independent and able for a longer time.
Currently there are two general types of medications available for the treatment of Alzheimer’s disease and related disorders. The U.S. Food and Drug Administration has approved each for various stages of the disease.
- Cholinesterase inhibitors, which help to increase the amount of acetylcholine, an important chemical needed in the brain for memory and learning.
- NMDA receptor antagonist, which may help to reduce excessive glutamatergic activity, which is considered to be one of the toxic effects of Alzheimer’s disease.
Depending on the situation, sometimes a combination of medications is prescribed. The clinician may recommend one or more of these medications for other conditions as well, such as the dementia related to Parkinson’s disease. Or through discussion with the patient and family, the clinician may consider it prudent to recommend one or more of these medications “off-label,” for example prescribing a cholinesterase inhibitor for a patient who may have severe memory impairment that is worsening, but for whom the formal diagnosis of Alzheimer disease has not been committed.
Because no two people with a memory disorder are alike, medications may work differently with different people. It is important to work with your doctor or other clinician to learn which medicines to use, how much to use and when to use them.
APPROVED MEDICATIONS FOR
NMDA receptor antagonist
Experimental Treatments / Clinical Drug Trials
If both patients and family members agree, sometimes patients are referred to our study coordinators for consideration of experimental treatments. Of course, experimental programs are voluntary and are closely overseen by the SIU School of Medicine ethics committee (SCRIHS). Clinical Drug Trials at SIU CADRD.
Researchers are studying the effects of lifestyle choices (such as diet or exercise) on both the progression rate of Alzheimer’s disease and prevention of Alzheimer’s disease. There is hope that certain healthy lifestyle choices will slow down the course of the disease and/or help prevent the disease. For example, evidence is growing quickly that supports the notion that exercising and eating right throughout life is just as important to long-term brain health as it is to heart health.
While this research is ongoing and thus not yet entirely conclusive, we fortunately do not have to wait to adopt these lifestyle choices since they already are widely accepted as healthy choices for disease prevention and healthy aging in general.
Healthy lifestyle recommendations for Alzheimer’s disease include:
Treatment of Behavior Issues
Some behavior-related symptoms of Alzheimer’s disease and other dementias can cause problems both for the individual with the disease and the family. These include sleep problems, depression, restlessness, anxiety, aggitation and aggression. There are many strategies to help alleviate these symptoms as well as medications that may be recommended by your doctor or other clinician.
A Caution about Advertised Cures and Treatments:
We sometimes hear about “wonder” drugs or supplements available on the commercial market. Always check with your doctor before trying pills or other substances that promise to treat or prevent Alzheimer’s disease. They may be unsafe, may interfere with other medical treatments that have been prescribed, or simply may be a waste of money.
More on Treatment of Alzheimer’s disease
R. Zec and N. Burkett, Non-pharmacological and pharmacological treatment of the cognitive and behavioral symptoms of Alzheimer disease, NeuroRehabilitaion 23 (2008) 425-438.
Abstract: This article discusses the various pharmacological and behavioral treatments for the cognitive, emotional, and behavioral symtoms of Alzheimer’s disease (AD). The medications that are currently FDA-approved for the treatment of the cognitive/functional deficits of AD are first discussed. Next, neuropsychiatric behavioral disturbances, including hallucinations and delusions, agitiation and aggression, activity disturbances, depression, and anxiety will be described along with treatment interventions. Sleep disturbances and its treatment in AD and the issue of fitness to drive a motor vehicle are also reviewed. Principles of behavior management, tips for communication, and recommendations for caregivers are discussed. Lastly, risk and protective factors and their relevance to delaying the expression of dementia are examined.