The Specialist:
As the director of the Ronald M. Loeb Center on Alzheimer’s Disease at Mount Sinai, Dr. Alison Goate specializes in researching the disease’s basic mechanisms to improve our treatment options. November is National Alzheimer’s Disease Awareness Month.
Who’s at risk:
More than five million Americans are living with Alzheimer’s disease, the most common cause of dementia. “Alzheimer’s disease is most commonly associated with progressive memory loss over a period of years, though there can also be deficits in other cognitive areas,” says Dr. Alison Goate, the director of the Ronald M. Loeb Center on Alzheimer’s Disease at Mount Sinai. “Alzheimer’s dramatically affects the activities of daily living and, as yet, we don’t have a disease-modifying therapy for it.”
In casual speech, people tend to use dementia and Alzheimer’s interchangeably. “Dementia is the broad umbrella term for memory loss, cognitive impairment and behavioral change. But there are about 60 known causes of dementia,” Goate says. “Alzheimer’s accounts for about 70% of all dementia cases. Most people know someone who has the disease.”
Alzheimer’s is a disease most often associated with aging. “The disease usually affects older adults over the age of 65,” says Goate. “There are some relatively rare forms of Alzheimer’s that include early onset of the disease.”
What causes Alzheimer’s?
“Both genetic evidence and environmental factors contribute to an individual’s risk of developing Alzheimer’s,” Goate says. “At the moment, we understand the genetic factors better. There are familial subtypes of the disease and we have identified one gene that increases people’s risk three- to ten-fold.”
Doctors identified other risk factors as well. “Anyone who has suffered a head injury with loss of consciousness is probably at greater risk of Alzheimer’s,” Goate says. “The more education you have, the lower your risk, which might have to do with what we call cognitive reserve, which means you have more brain connections that can compensate for the loss of other cells.”
Counterintuitively, health problems that might seem unrelated to the brain are also associated with Alzheimer’s.
“We’ve found that having untreated cardiovascular risk factors like diabetes, hypertension and obesity probably also increase your risk of Alzheimer’s,” Goate says. “Because poor people are less likely to have those disorders treated in middle life, they’re at higher risk of Alzheimer’s down the road.”
While Alzheimer’s strikes both men and women, women are disproportionately affected. “Women are affected more than men, and that’s true even accounting for the fact the women are alive longer,” says Goate. “Women are also more likely to be caregivers to people with Alzheimer’s, so they are affected both ways.”
Signs and symptoms:
The classic warning signs of Alzheimer’s disease involve problems with short-term memory. “People with Alzheimer’s forget something from five minutes ago — they may ask the same questions and tell the same stories over and over again,” Goate says. “Sometimes, this can become dangerous, because someone goes to run the bath and then forgets it and it overruns the place, or sets the kettle to boil and forgets to turn it off.” In the early stages, the patient may remember events that occurred 20 or 30 years ago perfectly well, but not remember something that happened five minutes ago.
Memory problems can be accompanied by other cognitive losses. “People can become confused because they don’t have a good sense of time and place. A red flag in the early stages is when someone goes out to do something quite normal, like go to the grocery store and they get lost,” says Goate. “Any executive function can be impacted. Someone who balanced her checkbook or played bridge for her whole life can’t do it any more.” Often both the patient and a spouse and loved ones notice the early signs.
Traditional treatment:
Currently, doctors don’t have medications that can halt the progression of Alzheimer’s, but they can moderate the symptoms. “Right now there are a couple of drug classes that are on the market, including anticholinergic drugs, which can help to treat the symptoms for a short period of time for some people,” Goate says. “They don’t stop the progression of the disease, so we need more and better drugs.”
In taking care of patients with Alzheimer’s, it’s crucial to treat other health problems like hypertension or diabetes.
“For most patients, Alzheimer’s is a five- to fifteen-year progression,” Goate says. “Sometimes it depends on how healthy you were before and how carefully you’re taken care of. If you have any other illness, that’s almost certainly going to contribute to a shorter lifespan.” As the disease progresses, patients need full-time care.
Research breakthroughs:
The Human Genome Project has mapped the sequence, or order, of chemically-bonded pairs that make up human DNA like rungs on a ladder. So doctors are using this knowledge to treat Alzheimer’s.
“Twenty years ago, when we were studying families with inherited forms of the disease, we would sequence only a few people in the family. But now the cost has dropped to about $1,500 for an individual, so a large study can look at the unique gene sequences of 10,000 people,” says Goate. “We’re trying to learn more about the biology of the disease so can we develop new therapeutics to target the disease pathways.”
Questions for your doctor:
We can all benefit from asking, “What can I do to prevent Alzheimer’s?”
“Taking care of your cardiovascular health is important not only to cut your risk of heart attack, but also diseases like Alzheimer’s,” Goate says. If you’re caring for someone with Alzheimer’s, you may want to ask, “Do we know how rapidly this disease will progress?” Being a caretaker is incredibly demanding, so don’t hesitate to ask, “At what point should I start thinking about getting help?” and “What resources are available to me in the community?”
One misconception about dementia: there’s no need for a more precise diagnosis. “If someone is showing signs of dementia, it’s important to get a diagnosis, because some causes are reversible,” Goate says. “We have different therapies for different forms of dementia and sometimes what people assume is dementia can be a manifestation of depression. It’s best to figure out exactly what’s going on.”
What you can do:
Get informed.
There’s a wealth of Alzheimer’s information online. Two places to start are the Alzheimer’s Association (alz.org), which runs a free 24-hour helpline too — and Mount Sinai (icahn.mssm.edu/research/centers/alzheimers-disease-research-center).
Consider a clinical trial.
There’s a lot of promising work being done. So look for an appropriate trial near you at clinicaltrials.gov.
Find support.
“Caretakers need a respite too,” Goate says. “Talk to the doctor about resources in your community, including adult day care centers.”
Make smart lifestyle choices.
It turns out that eating a heart-healthy diet and getting exercise, the things that are good for your heart, also protect against Alzheimer’s.
By the numbers:
— An estimated 5.3 million Americans are living with Alzheimer’s in 2015.
— Almost two-thirds of Alzheimer’s patients are women.
— 1 in 3 people will have Alzheimer’s or another form of dementia at the end of their lives.
— Only 45% of patients or their caregivers have been told the diagnosis of Alzheimer’s.
Source: Alzheimer’s Association
