Firstly, forgetfulness does not occur as a result of ageing and decline should never be excused as “just getting older”. Secondly, stress, anxiety, depression and drugs can cause memory impairment but memory change due to these things should not get progressively worse over time.
The changes in the brain that produce Alzheimer’s symptoms begin 20 to 30 years beforehand. There is opportunity starting within this timeframe to prevent the silent damage to the brain. The earliest symptoms are collectively called Minimal Behavioral Impairment (MBI) and include increased irritability, mild anxiety, mild apathy, decreased mood and other mild psychological changes. Then comes the Mild Cognitive Impairment (MCI) stage with difficulties paying attention or concentrating, problems with short term memory (“What did I come to this room to get?”), difficulty finding words or names of people or places, and perhaps, even getting lost. The MCI correlates with the damage seen to the very small arteries bringing blood flow to brain cells particularly in the frontal lobe. Eighty percent of people with MCI will progress within six years to clinical Alzheimer’s dementia. In the dementing stage, decline in thinking and behavior will be significant enough to effect one or more areas of day-to-day functioning. It is subdivided into mild, moderate and severe. In the UK Alzheimer’s is the number one cause of death, surpassing death from heart disease and cancer.
According to Statistics Canada, people age 65, have a life expectancy greater than 85. By that age, one in three can expect to have a dementia, seventy percent of which will be Alzheimer’s dementia. Fortunately, there is an ongoing international study for Metformin, the first line drug for Type 2 Diabetes and a very safe and cheap drug, as the world’s first anti-ageing medication.
Increased risk occurs in people who have a family history of a close relative with Alzheimer’s, those who have a “pot belly”, and are physically not very active, have high blood pressure (greater than 120 systolic) or have high cholesterol or borderline or worse high blood sugar, who have high inflammatory blood markers, or who are known to have fatty liver, or who have had a heart attack or mini-stroke. People are also at high risk if they are smokers, have low education level, or have had a concussion. Those who snore and do not feel rested after a night’s sleep are likely to have obstructive sleep apnea and are at greater risk of memory impairment and earlier onset of Alzheimer’s. By far the biggest risk of all is age. Just as “diabetes of the old” now occurs in nine year olds who are having their heart attacks in adolescence, Sporadic Alzheimer’s is now more commonly seen and is referred to as “younger onset Alzheimer’s”. I have several patients with Sporadic Alzheimer’s in their late thirties.
Fortunately, scientific studies have shown that there are a number of things you can do to reduce your risk of getting Alzheimer’s.
Alzheimer’s disease is recognized as a disease of metabolism (the chemical processes that occur within a living organism in order to maintain life.) Although genetically predisposed Metabolic diseases like Alzheimer’s is mostly caused by lifestyle. More importantly, its risk of occurrence can be reduced through lifestyle changes such as weight reduction, diet composition, physical exercise, intellectual stimulation, stress reduction, and social stimulation. Medication can also modify your metabolism especially with the medical treatment of high blood pressure, diabetes and high cholesterol.
In fact, sufficient evidence exists to support the name change proposed in 2003 from Sporadic Alzheimer’s to “Type 3 Diabetes” or diabetes of the brain. In my opinion, the most exciting advance in the fight to prevent Alzheimer’s is the recognition that far from being an untreatable, relentlessly deteriorating, ultimately fatal disease of the brain, Sporadic Alzheimer’s (aka Type 3 Diabetes) can be prevented after identifying those at risk for developing Alzheimer’s, and then treating their risk factors, using a multi-pronged approach, individualized for each person.
Dr. J E Lessard, BSc.,BMedSc.,MD.,FRCPC,