When did Mrs. Dell initially begin developing Alzheimer’s? Most people think Alzheimer’s is something that starts around age sixty-five and progressively becomes worse as a person ages. Did Mrs. Dell’s problem with her memory and thinking and planning begin within a few weeks?
Or months?
Or did it start twenty years earlier?
Or even thirty?
Reports and studies now reveal that the initial cellular damage in the brain begins twenty to thirty years before the first symptoms start to show. Recent advances in brain-imaging technology give us new ways to see what is going on inside a person’s brain. A basic understanding of what these studies show will make it easier for you to realize there are certain factors you can control to help prevent Alzheimer’s.
Stick with me. We will stay with the basics, but understanding them will help convince you that there are certain lifestyle choices you will emphatically want to embrace, as well as certain factors you will run from as fast as you can.
Could anything have been done in the twenty-plus years before Mrs. Dell had symptoms that could have prevented Alzheimer’s from stealing her life? Was there anything she could have been doing earlier in life that would have significantly lowered her chances of developing Alzheimer’s?
The medical literature thinks so. You can’t prevent what your genes do, but there are harmful causes you can counteract by simply making some lifestyle changes. An article in the medical journal Lancet stated that up to half of Alzheimer’s cases can be attributed to preventable factors.
Back in Mrs. Dell’s younger years, I wish we had known two things. First, that Mrs. Dell had deposits of beta-amyloid plaques beginning to form in certain areas of her brain before any symptoms ever showed their faces. Second, that there were lifestyle changes she could have made that would have lowered her risk of Alzheimer’s.
But we didn’t know. Back then there were no brain-imaging studies that showed what was going on in her brain years before she had symptoms. Little was known about certain lifestyle changes that can reduce the risk of such symptoms. And little was known about actions that can reduce the progression of the disease after symptoms appear.
If only Mrs. Dell could have known. Perhaps she could have changed some of her lifestyle choices. But she didn’t know the damage to her brain was already happening. Her doctors didn’t know. Now, more and more studies show that action can be taken; many things can be done to help with prevention. More risk factors are being identified that are associated with people who have Alzheimer’s. Specific brain-imaging studies now show, even prior to any symptoms, the plaques and tangles that are the hallmark of Alzheimer’s. And even more important, the same brain-imaging studies reveal that certain individuals who live specific healthy lifestyles end up not having the plaques and tangles of Alzheimer’s dementia.
Stage 1
In stage 1, even though individuals have no symptoms of Alzheimer’s, they have measurable changes that can be seen with special imaging studies of the brain. Today, changes can be detected in cerebrospinal fluid taken by a needle placed through your back into the area of fluid around the spinal cord. Some changes can be detected by specific markers found in the blood of Alzheimer’s individuals.
Most people will not get these studies performed on themselves, but everyone can develop a preventive lifestyle, whether there is any problem within your brain or not. You need to begin with prevention because no drug slows or stops the damage to dying brain cells in Alzheimer’s disease.
Controlling your lifestyle is the only “preventive medicine” available.
The medical studies we will look at use two terms almost interchangeably. They are cognitive decline and Alzheimer’s. Both are relevant to each other and interrelated. Take a minute to register the difference between cognitive decline and Alzheimer’s.
Stage 1 of Alzheimer’s is the period before an individual shows problems with memory or mental acuity, similar to the “normal” day I took Mrs. Dell flying. The process of Alzheimer’s has started in the brain, but neither the person nor anyone else knows it because they haven’t started exhibiting symptoms. There is no cognitive mental decline because enough good neurons are continuing to work in order for the person to carry out their everyday activities.
If you are over forty, the process could already have begun in your brain. There are no symptoms, and the diagnosis is called preclinical or presymptomatic Alzheimer’s. This stage can begin twenty years prior to any symptoms. Some reports say even thirty.
In an Alzheimer’s Association study, researchers studied 672 participants who did not have any symptoms of Alzheimer’s. These individuals were studied using a special brain-imaging test that measured the thickness of different parts of the brain. As the plaques that are the hallmark of Alzheimer’s begin to appear in the brain, the cells begin to die off and that area of the brain becomes thinner and less dense. The tests detected these specific changes where damage had already happened.
The conclusive finding of the study was that even though these individuals were asymptomatic, the damaging process that leads to the symptoms of Alzheimer’s was already in progress.
An article published in the medical journal Alzheimer’s and Dementia stated that a consensus has emerged in the Alzheimer’s research field that strategies of prevention should be initiated as early as possible before symptoms begin. The focus of prevention, therefore, has shifted to the stage 1 period. If you don’t have any symptoms concerning your memory or thought processes, congratulations—now is the time to start defeating dementia.
Because a medical cure for Alzheimer’s seems unlikely or even impossible, prevention aimed at the asymptomatic individual is the most powerful weapon we presently have against Alzheimer’s. Symptoms usually happen after midlife, so if you are between forty and sixty years of age, this is the time to work on avoiding risk factors that can lead to Alzheimer’s. The good news is that most of the risk factors related to Alzheimer’s are modifiable with lifestyle changes.
Stage 2
Stage 1 Alzheimer’s disease occurs before any noticeable symptoms such as memory loss are evident to the individual or anyone else. During this time period, damage is happening, but the healthier sections of the brain are able to compensate for the ongoing injury happening in other areas.
Stage 2 is the period between the time a person begins having symptoms and they become dependent on someone else to carry out their daily routines. Stage 2 is the transitional stage between the initial symptoms and the loss of independence. In stage 2, symptoms are apparent, and now the person or someone else can recognize what is happening. Beta-amyloid plaque has built up enough in a particular portion of the brain to impair the normal function of that area. With Alzheimer’s, this impairment usually involves memory.
Stage 2 is called MCI or Mild Cognitive Impairment Alzheimer’s. The word cognitive means reasoning. Individuals experience a loss of their reasoning ability. This can include memory, rational thinking, or perception of what is going on around them.
MCI Alzheimer’s is not full-blown Alzheimer’s dementia in which a person is dependent on someone else to assist them in their everyday life, but it is on the road to that stage of Alzheimer’s dementia. In MCI, there is a continual, progressive decline in mental acuity.
At this point, even though they remain independent, a person begins having memory problems or judgment difficulties that affect their daily life. They can’t remember where they left their keys or where they put something they meant to take with them. They have trouble planning their day or experience difficulty with something they commonly do, such as writing checks and balancing their checkbook. They get confused as to which day it is or which month. They stop in mid-sentence trying to think of a word or a place or someone’s name. Activities may be more difficult to do and may take greater effort, but people in stage 2 can still do them and can get through the day on their own. Yet a report in the European Journal of Pharmacology pointed out that “persons with mild cognitive impairment progress to Alzheimer’s disease at the rate of nearly 10% to 15% per year.”
Once symptoms are present in stage 2, standard mental tests can measure how much a person’s thinking process is declining. If the scores are decreasing, the person is considered to be in cognitive decline. Cognitive decline simply means the person’s reasoning, rational thinking, perception, and overall intellect have declined. They don’t think and reason as well as they did earlier. Of course, they don’t have to take a test to determine this. Usually their spouse or friends notice a decline in how they are behaving mentally.
According to the Alzheimer’s Association, as many as 10 to 20 percent of Americans who are sixty-five and older have MCI. This is why it is so important to learn all you can about slowing down the process or even preventing it from proceeding to full-blown Alzheimer’s dementia. Just because someone has MCI doesn’t mean they will eventually not recognize their spouse or children. There are things that can be done to help. Controlling the LDL cholesterol that is getting into your arteries that causes problems to the normal flow of blood to your brain, managing high blood pressure, getting to an ideal weight, especially if you have diabetes, and exercising are all lifestyle habits you can control that can reduce the likelihood that MCI will progress to that much-dreaded next stage of Alzheimer’s dementia. The best time to develop the proper lifestyle habits to deter Alzheimer’s is before symptoms appear. The next best time to commit to lifestyle changes is during stage 2. Just because the process has begun doesn’t mean a person is destined to lose their independence. Just because they are becoming a little forgetful and have developed stage 2 MCI doesn’t mean stage 3 is imminent.
A study published in the journal Alzheimer’s Research and Therapy reported that 87 percent of individuals who developed MCI had at least one modifiable risk factor. That means a great majority of people with stage 2 Alzheimer’s can lower their risk of the disease progressing by changing certain lifestyle factors.
An article in the Journal of the American Medical Association concerning stage 2 MCI Alzheimer’s warned of the acceleration of the progression of Alzheimer’s from the time of the initial symptoms to the time of full-blown Alzheimer’s. Several risk factors lead to this acceleration process, and these factors are controllable by how a person lives. A person actually has some control over the speed of progression of symptoms and should do everything possible to take their foot off the accelerator of this disease. For anyone who may have even the initial symptoms, this article gives encouragement regarding how to prevent the progression or at least slow down its acceleration by combating the risk factors you will learn about later in this book. You may be wondering, what can I do? What changes should I make? Here they are in a nutshell.
Get at least thirty minutes a day of aerobic exercise that increases the workload on your heart, the organ that pumps oxygen and nutrient-rich blood to every one of those one hundred billion brain cells.
Learn which foods to eat and which to avoid. Fish will become the basic “meat” in your diet, along with olive oil and nuts. All three of these foods are healthy in the mono and polyunsaturated fats that protect the smaller arteries within as well as the larger ones leading to the brain. You will avoid the saturated fats in red meat and dairy products like cheese, cream, and butter. You will develop the habit of eating more fruits and vegetables, whole grain fiber, peas, and beans. Your eating lifestyle will develop into better eating habits. Foods you never thought you could live without will become foods you don’t want. You will lose a desire to taste them because you know the role they play in harming your brain.
These lifestyle choices will become easier and easier as you remember how they impact what is going on inside your brain. If you smoke, you will think differently when you realize smokers face a 45 percent greater risk for developing dementia than someone who does not smoke. The same is true when someone who is a heavy drinker realizes that too much alcohol can have significant negative impacts on your brain.
I wish we had known these things when Mrs. Dell was diagnosed with “probable Alzheimer’s.” Perhaps she would have done something to change the path she was on. But we didn’t know then what we know now.
At the end of stage 2, it becomes clear that the individual can’t continue carrying out their daily activities without some help. Their memory problems increase, and their symptoms become more significant. There are noticeable changes in their personality and behavior. They become confused as to time or place. They forget where they are going or lose their ability to think things through. They can’t operate the stove or the microwave properly. They begin to suspect that something or someone is out to get them. They can’t carry on normally. They have to be helped. Yet they argue that they can carry on without help. They usually do not realize anything is wrong.
I hated to hear what Mrs. Dell’s doctor had to say about Alzheimer’s, but I was thankful it awoke me to a medical realization. It made me realize that prevention is the answer. Those initial twenty years when it is developing are the prime time to go to battle. But even if you find yourself in the next stage, when you realize you are not remembering a name, or forgetting where you placed something, or not being able to reason or process something you used to do—that is also the time to commit to prevention. That is also the time to learn what you can do to decrease your chances of ever being told, “Take this medicine—it won’t cure it or prevent it from progressing but it may help with your symptoms.”
Fight to prevent any beta-amyloid plaque formation. Fight even if there is some plaque but no symptoms—yet. And yes, fight it even if symptoms have arrived. Fight its progression all the way to the ground.
Stage 3
Stage 3 is called dementia due to Alzheimer’s disease. Stage 3 involves noticeable memory problems, and a person’s thinking and reasoning affect their behavior to the point that they have to depend on someone else to help with everyday activities. When we speak of dementia, we are talking about stage 3 Alzheimer’s.
On the dreadful day a person goes from stage 2 MCI to stage 3 Alzheimer’s dementia, they are no longer able to perform the activities of a normal day without assistance from someone else. The day they are told they can no longer drive is a common initial realization of Stage 3. They soon will not be able to make breakfast, decide what to wear, or even dress themselves. All their familiar habits, previously enjoyed, will become foreign to them.
The Scary Numbers
Have you visited a nursing home recently? If not, I suggest you visit one and walk down the hallway. As you do, think about some of the statistics from the Alzheimer’s Association’s publication “Alzheimer’s Disease Facts and Figures.” Seventy-five percent of nursing home admissions for people over age eighty are due to Alzheimer’s. Two-thirds of those who die of dementia do so in nursing homes. Once the diagnosis of Alzheimer’s is made, 40 percent of a person’s remaining life will be spent in a nursing home setting. The contributing causes of death for people with Alzheimer’s are most often pneumonia and urinary tract infections. They get pneumonia because they have a slight stroke that affects their swallowing, and some of their saliva incorrectly goes down their trachea into their lungs rather than down their esophagus. According to Medicare data, one-third of all seniors who die in a given year have been diagnosed with Alzheimer’s dementia. About half of all people who visit a doctor for memory symptoms will develop stage 3 dementia in three to four years.
Most people know that heart attacks and strokes kill more Americans than any other cause. But few realize that dementia is the second largest contributor to death behind heart failure.
The last of the scary numbers is that most people who develop Alzheimer’s live four to eight years in stage 2 and stage 3 of the disease.