Dementia remains a grim diagnosis but new treatments for Alzheimer’s and other dementias are being developed and approved, bringing a glimmer of hope to the 55 million people afflicted by these diseases worldwide. There is still no cure, but scientists are figuring out ways to slow progression of the diseases.
“Medicare has just approved a new drug called Leqembi for early onset and mild Alzheimer’s which claims to have reduced the progression of the disease by up to 35 percent in clinical trials,” Vero Beach Neurologist Dr. James Shafer said. “Unfortunately, there is no evidence that this or any treatment can restore or reverse lost memories and cognitive function, but it has been shown to slow the progression, giving the patient more time to participate in life and live independently.
“There are also companies out there developing antibodies targeting both amyloid and tau proteins,” Dr. Shafer added. “Integrative and functional medicine using IV Nutrient Therapies is another avenue in caring for Alzheimer patients. Our patients receive both traditional medical care and IV nutrient therapies such as NAD+. Hydrogen Peroxide and Phosphatidylcholine are known to preserve normal cell function. There’s even an Alzheimer’s vaccine being investigated that would potentially prevent getting the disease.”
So what is the difference between dementia and Alzheimer’s and how do doctors diagnose them?
“Dementia is a descriptor of a state by which a person has cognitive difficulties to the level that they have impacted them socially, personally or professionally,” Dr. Shafer explained.
“There are many different types of dementia, and many conditions cause it, including endocrine issues, infections and other underlying causes. Alzheimer’s is an organic cognitive-dementia and the most common form of dementia, accounting for 60-to-80 percent of dementia cases.”
Dementia is not a normal part of aging. It is caused by damage to brain cells that affects a person’s ability to communicate, think and feel. Alzheimer’s is a degenerative brain disease that is caused by complex brain changes following cell damage.
“The age demographic most at risk for developing Alzheimer’s is the 65-plus group and the risk goes up with each decade,” Dr. Shafer continued. “Alzheimer’s stems from an accumulation of plaque in the brain formed from proteins. While all people have some plaque buildup, what makes it abnormal for people with Alzheimer’s dementia is that the plaque builds up faster and collects in the memory centers and in circuits of the brain that control short and long-term memory. That is why the onset of Alzheimer’s is usually in older patients as it takes time for this plaque buildup. Once you’ve hit your 90’s, about 60 percent of those people will have some degree of Alzheimer’s associated cognitive problems.”
Memory is only one component of Alzheimer’s. Language changes can occur earlier than memory issues. Naming and word finding are early symptoms but also can occur with normal aging. People with Alzheimer’s may have trouble joining in a conversation or struggle with vocabulary. They may have trouble recalling the name of a familiar object and resort to describing it in an improvised way, such as calling a watch a wrist clock.
“The four primary symptoms of Alzheimer’s are personality and behavior changes, language and communication changes, memory changes and functional changes; understanding one or all of these symptoms may be evident at presentation,” Dr. Shafer said. “Changes will become more prevalent as the disease progresses and these symptoms should not to be confused with typical age-related changes like sometimes forgetting the right word or misplacing your keys.”
In order to determine whether a new patient has Alzheimer’s or another form of dementia, neurologists conduct several standard tests. An MRI scan, for example, will be used to see if there are other reasons for the cognitive changes, like a brain tumor or previous strokes.
If no other causes are shown, an EEG will be performed giving the physician some insight into the cortex function of the brain. This test will help identify any “short circuits” in the brain.
A very thorough cognitive evaluation will be conducted with comprehensive tests for language, reasoning and thought. And lab work will be done to look for other causes of the dementia, like a low thyroid or infection.
“More advanced testing like a SPECT scan of the brain, which can identify parts of the brain with a low metabolism, and beta-amyloid ratio testing that evaluates the ratio of proteins in spinal fluid may also be used to establish a clinical diagnosis of Alzheimer’s,” Dr. Shafer said. “We will be using these tests more frequently as we look at patients who may be candidates for the new monoclonal antibody drugs just entering the marketplace.”
Alzheimer’s disease remains a major public health challenge with a growing global impact.
In the United States alone more than 6 million people are living with Alzheimer’s and by 2050 that number is expected to rise to nearly 13 million, and the disease kills more seniors than breast cancer and prostate cancer combined, according to the Alzheimer’s Association.
The economic impact is staggering. It’s estimated that in 2023, Alzheimer’s and other dementias will cost the nation $345 billion, with those costs rising to nearly $1 trillion by 2050.
While current drug treatments offer limited benefits, ongoing research into new therapies provides hope for more effective treatment.
Dr. James Shafer has practiced Adult Neurology in Vero Beach and the surrounding area since 1997. He received his medical degree from Medical School at the University of Miami at Jackson Memorial Hospital in Miami, followed by an internship in Internal Medicine at Jackson Memorial Hospital. He completed his residency in Adult Neurology at the University of Florida at Shands Teaching Hospital. He can be reached at his solo practice, Vero Beach Neurology and Research Institute, located at 1040 37th Place #201 in Vero Beach. Call 772-492-7051 or visit verobeachneurology.com to learn more or schedule an appointment.