The Science of Alzheimer’s - summary from public talk

The McMaster Health Forum, with support from the Labarge Optimal Aging Initiative, recently hosted a public talk to examine the latest research into risks, prevention and treatment of Alzheimer’s disease.

Jay Ingram, one of Canada’s best-known and most popular science personalities, and Dr. Christopher Patterson, an expert on the diagnosis and treatment of dementia, delivered an engaging and informative talk. This public talk was hosted in collaboration with the Alzheimer Society of Canada, Alzheimer’s Disease International, Alzheimer Society of Brant Haldimand Norfolk Hamilton Halton, and MedicAlert Foundation Canada.

“My experience is that when you talk to people about Alzheimer’s, they have three questions,” said Ingram. “The first one is always ‘am I going to get it.’ The second is ‘If it looks like I’m likely to get it, what can I do to lower that risk?’ And the third question is ‘if that doesn’t work and I do get it, what are the prospects?’”

Jay Ingram and Dr. Patterson provided a brief history of Alzheimer’s disease, following which they addressed these, and other questions. Watch the video or read the summary below:

Click here for information on upcoming talks (and live-webcasts) on optimal aging issues.

How we think about ageing
“The way we think about ageing today is very different from the way that people thought about ageing 160 years ago. At that time, religion was what everybody looked to when they were getting older,” said Ingram. “Today, very different. If we get ill in late life, a large percentage of us appeal to medicine.”

In the 1850s, life expectancy was in the mid 40’s. Now, in the countries with the highest rate it’s in the mid-to-late 80’s. In the last 20 years, life expectancy is increasing at the upper end as well.

“Life expectancy in humans has risen one year for every four years that pass ever since the 1840’s,” said Ingram. “It’s absolutely extraordinary, and it casts a completely different light on what medical issues might arise in late life because so many more people are getting there.”

History of Alzheimer’s
“What is the definite diagnosis of Alzheimer’s in 2015? The presence in the brain, after death, of plaques and tangles. So Alzheimer had it exactly right. And yet, from 1906 when he first publicized this, till practically the mid-1970s nobody took any notice of it,” said Ingram.

‘This created a huge delay in acknowledging that Alzheimer’s is actually a disease, and it’s an important disease. It underlies 75% of people who have dementia.”

Why didn’t people pay attention to Alzheimer’s findings? At the time, there weren’t very many people getting dementia. Populations were much smaller and the number of people reaching the susceptible age was correspondingly smaller. It was also assumed that becoming a little bit forgetful and disorganized was just part of normal aging.

What exactly is dementia?
Dementia is an acquired disorder, usually much later on in life. Dementia affects cognition (thinking) and/or behavior and interferes with daily activities. Dementia is not due to another problem (such as depression or delirium) and is detected by history and cognitive testing.

Alzheimer’s in Canada
Alzheimer’s disease is one of the causes of dementia. Today, 700,000 Canadians have Alzheimer’s disease. This number is predicted to reach 1.5 million by the year 2031.

“In Canada, about 50% of people who have a dementia, have Alzheimer’s disease. Another one-third have Alzheimer’s disease, plus some other pathology – usually strokes. We call that mixed dementia. If you add that up, about 80% of people with dementia in Canada actually have Alzheimer’s disease,” said Dr. Christopher Patterson.

10 warning signs of dementia
The Alzheimer Society of Canada has developed a list of ten warning signs of dementia

• Memory loss that affects day-to-day function
• Difficulty performing familiar tasks
• Problems with language
• Disorientation of time and place
• Poor or decreased judgment
• Problems with abstract thinking        
• Misplacing things
• Changes in mood and behaviour
• Changes in personality
• Loss of initiative

How do we diagnose dementia?
“If you are concerned, the way we approach making a diagnosis of dementia is, first of all, listening to the story. We listen to the person’s story. We listen to the story as given by their caregivers and family members. That’s the most essential part,” said Dr. Patterson.

The next step is to perform a physical examination to see if there’s any evidence of a disease that might mimic dementia. A neurological examination is then performed to see if there’s any evidence that might suggest strokes or some other disease. Lastly, cognitive testing is undertaken, which includes things like memory, language, orientation, abstraction, visual-spatial, and executive function.

“If we find that there are significant deficits in more than two of those domains, then we realize there’s a problem that’s likely a dementia,” said Dr. Patterson.

Will I get Alzheimer’s?

Early-onset familial Alzheimer’s
“There are two kinds of Alzheimer’s disease – early onset familial Alzheimer’s, which you do inhert and is a dominant gene. If you had a parent with this kind of Alzheimer’s, you have a 50/50 chance of getting it yourself,” said Ingram.

But, he cautioned, “That’s so not the norm. There’s really only three genes that have been absolutely identified as early onset familial genes. They represent something less than 1% of all Alzheimer’s.”

Also, not every case of early onset Alzheimer’s is genetic.

“Yes, there’s a risk but it’s a very tiny risk. For the most part, I think you could set that aside,” said Ingram.

Late-onset Alzheimer’s
“There’s really only one gene that has been unambiguously associated with late-onset Alzheimer’s (that is 65-70 years old and older),” said Ingram. “It comes in three varieties. One is bad, one is neutral and one is actually beneficial.”

“Let’s say, worse case scenario, I’m carrying two of these bad genes. APOE4. The most pessimistic of studies would say that that my risk is now 15-fold greater than it would have been. So you might think I’m terrified, but there are some other facts to consider. About half of the people who have the two bad genes never get Alzheimer’s. Plus, a good percentage don’t have those genes and do get it.”

“As far as late onset, it’s so ambiguous, for my money it’s not worth worrying about.”

What can I do to prevent getting Alzheimer’s?
“There’s this whole constellation of effects, but when you put them together I think they boil down to some pretty common-sensical things,” said Ingram. “Exercise, watch your weight, watch your blood pressure, engage socially and keep your mind active. They’re all sort of common sense things that one should do in life.”

Education
“Education has been shown to be clearly related to your risk of dementia. The further you go in school, the less likely you are to become demented,” said Ingram. “If you continue on in what is defined as a mentally stimulating job, you’re also better off.”

Exercise
The single most important thing that older adults can do to prevent getting dementia is to walk 35 or 40 minutes a day.

“Exercise. Why is that important? Cardiovascular health, the health of your circulatory system and, maybe most importantly, your blood pressure are all risk factors if they’re in decline for Alzheimer’s disease,” said Ingram.

Be social
“There have been studies that show it’s not even the kind of activities you do, it’s the number of them that you engage in and the number of people with whom you engage,” said Ingram.

Other factors

• There’s good epidemiological evidence that people who adhere to a Mediterranean-type diet are least likely to develop Alzheimer’s.
• People that watch a lot of TV were more likely to become demented
• Obesity and diabetes are risk factors for Alzheimer’s

Does having diabetes increase the risk for Alzheimer’s disease?
“If you have diabetes, your risk of developing dementia is about twice that if you don’t have diabetes. Certainly, management of blood sugars is important. Whether that actually changes the progression of the disease, I don’t think we know but we would suspect that it would because appropriate management delays other vascular complications,” said Dr. Patterson. 

Can cognition exercises help improve brain function?
“The evidence for enhancing your memory by doing those memory exercises is not nearly as solid as the evidence for physical activity,” said Ingram.

“The evidence is that, in earlier stages of cognitive impairment, you see improvements in those domains in which you practice. If you do memory tests, it may not necessarily improve executive function,” said Dr. Patterson.

How does dementia impact the quality of life for caregivers?
Dr. Patterson commented that in a research project, in which he was involved, found that the quality of life did not diminish in individuals over different stages of the disease whereas for caregivers it clearly did.

“While we talk about memory loss so much, the most disturbing change to families is not the memory loss, it’s the change of mood or affect or personality. That’s where people feel they’ve lost the person,” added Ingram.

If I do get Alzheimer’s, what can I do about it?

Education
“Understanding the disease. Understanding what’s going to happen to that person over time is extremely important,” said Dr. Patterson. “Learning how to deal with some of the behaviours that might evolve as the disease progresses.”

“This is by far the most important part of management of individuals with dementia.”

Support
Dr. Patterson highlighted that it was important to recognize “that being a caregiver for an individual with dementia is extremely stressful.”

Case management is a way of supporting families through this journey.

Medications
“Of the whole management of individuals with dementia, medications really play the least part.”

“The single medication that is commonly prescribed these days will stabilize cognition for 9-12 months,” said Ingram. “As the cells generating neurotransmitters die, to a degree you can replace them chemically. But, the cells are still dying and eventually you can’t make it up chemically.”

Patients may be prescribed medications to help with other symptoms of the disease.

“In the future, there may be medications that can literally interrupt the sequence of the disease,” said Dr. Patterson.

 “So what do we do in the meantime? We hope that with increasing general health, reduction of diabetes, slow down the obesity train, we do lots of things that make us healthier and happier people. That may be, at least in the short-term, the most effective thing we can do,” said Ingram.

For more information about healthy aging that you can trust, visit the McMaster Optimal Aging Portal.