A University of Minnesota professor is touring the state, county by county to educate those afflicted with Alzheimer’s or dementia, and their caregivers.
Joseph Gaugler, PhD, spoke to more than 75 attendees over two sessions at the St. Francis Center of Little Falls, Jan. 9. Audience members who were very willing to talk about their experiences with the disease.
“The reason for doing this is number one education and outreach, sharing resources that are available to people that might need them,” said Gaugler, who started his tour in the fall of 2018.
Sister Joan Tuberty, who lives at the St. Francis Center, said she attended because she has a background as a psychiatric mental health nurse, and often visits the center’s memory care unit.
“I thought this was a wonderful opportunity to kind of get the latest compact information from a real teacher. I thought it was really just excellent,” she said.
Sister Tuberty said she was most taken aback by all that one can do to possibly prevent Alzheimer’s or at least postpone the disease’s progression.
It is estimated that Alzheimer’s disease affects nearly 5.5 million people and is the sixth leading cause of death in the United States, according to the National Institute on Aging.
Gaugler said that reducing risk factors and early diagnosis is the best defense against the disease at the moment. The first step is education, and understanding the difference between Alzheimer’s and dementia.
Dementia itself is not a disease, he said, but a group of symptoms caused by brain cell damage that interferes with someone’s daily living activities. Other illnesses may complicate dementia, which is considered irreversible and degenerative, he said.
“In the past it was always thought that memory loss had to be present in order for someone to have dementia. But in 2011, came new diagnostic criteria and really what with this new diagnostic criteria it was understood that in fact if one has two of five different clusters of symptoms related to cognition, thinking and memory and then they also have this activity of daily living impairment. They then would be thought to and should be diagnosed as having dementia,” Gaugler said.
Alzheimer’s is a cause or type of dementia, and is the most common cause or type of dementia, Gaugler said. But it is not the only cause of dementia.
Alzheimer’s disease causes problems with thinking, memory and behavior. It also has physical impacts on the brain, resulting in the build-up of plaques and tangles, which are two neuropathological hallmarks of Alzheimer’s disease.
“One thing I think is really important to note here about Alzheimer’s is that it’s not a normal part of aging. Some of you may have heard Alzheimer’s referred to as old timer’s disease, but it’s really important to emphasize to you that it is not a normal part of aging, it’s a disease,” the professor said.
Age is a major risk factor, according to Gaugler. Around 13% of people over 65 and 30% of those over the age of 85 are thought to have Alzheimer’s related dementia. He also said that it occurs more in women than men, but the main reason is that women tend to live longer.
Some behavior changes with Alzheimer’s or dementia can include: wandering, repetitive statements and questions and personality changes.
Diagnosing Alzheimer’s can be very complicated as there are various types and combinations of the disease. Gaugler said that some post mortem analysis on people who were thought to have Alzheimer’s showed that up to half of them had another version of a secondary dementia. He said it is that much harder to find a cure if a diagnosis isn’t always accurate.
He did say that identifying people with Mild Cognitive Impairment (MCI) is helping to diagnose those with Alzheimer’s disease. MCI is not a cause of Alzheimer’s, but it is a risk factor.
“So what is MCI? It’s a decline in cognitive function that is noticeable however this is what makes it different from dementia. You have this decline in cognition and thinking and maybe memory a little bit, but it’s not severe enough to impair one’s ability to do day to day activities,” said Gaugler.
It’s thought that around one in five people over the age of 65 have MCI. Gaugler said diagnosing people as early as possible ensures a better treatment outcome and may possibly delay symptoms.
Biomarkers can help to identify people who are at risk but not yet showing symptoms. However, Gaugler said that study samples are limited, and it’s undetermined how they reflect across a broad population. Even though there are genetic links to Alzheimer’s, since it’s not a causal factor, a person wouldn’t have a guarantee either way.
The Alzheimer’s Association advocates for early diagnosis because treatment options are more expansive. Many clinical trials, according to Gaugler, recruit people with MCI or in early stages of Alzheimer’s dementia as it’s been found that early treatments might be more effective.
Early diagnosis also provides an opportunity to make lifestyle changes that may increase quality of life over time.
Gaugler presented the Alzheimer’s Association’s top 10 warning signs which help to differentiate from normal signs of aging and the actual disease.
Memory loss that disrupts daily life is a widely known symptom, as well as confusion with time or place, and misplacing items that can be later found in odd areas.
Some other warning signs include: challenges planning or solving problems, difficulty completing familiar tasks, trouble understanding images, new problems with language, poor judgment and decrease in self care, withdrawal from social activities and changes in mood or personality.
“So our memory and cognition as we age, think of a chain with links. As we get older those links rust, that’s natural, but they still hang together. In Alzheimer’s disease, entire links fall off the chain. Information is not only forgotten, but you can’t retrieve it again. Those are problems in cognition and thinking that might be indicative of larger problems,” said Gaugler.
Diagnosing Alzheimer’s is a process of exclusion, Gaugler said. Sometimes different conditions can cause dementia-like symptoms or cover up a true case of dementia. Conditions like depression, vitamin deficiencies, metabolic issues, thyroid issues are ruled out before Alzheimer’s or dementia can be diagnosed.
Once other causes of dementia symptoms are ruled out, a specialist can perform a comprehensive neurological and mental status evaluation, as well as lab work, imaging studies and diagnostic interviews.
Gaugler believes a big issue in diagnosis and care comes from the lack of geriatricians in the nation. He said there are the same number of geriatricians now as there were in the 1980s. To meet today’s needs, potentially 30,000 of these doctors are needed, but there are only approximately 2,500 geriatricians nationwide, he said.
Beyond age, several risk factors for dementia include traumatic brain injuries, depression, having a genetic link, unmanaged hearing loss, hypertension, obesity, diabetes, being on multiple prescription medications and a big one, Gaugler said, is cardiovascular disease risk factors.
According to Gaugler, there is a strong link between brain and heart health so smoking, hypertension, physical inactivity and poor diet, among other things, can be problematic.
Making lifestyle changes can reduce one’s risk of developing Alzheimer’s, he said.
Engaging in cognitively challenging activities like chess, puzzles, creative writing and reading, as well as reducing stress and staying active can all improve brain health.
“By and large the type of diet that has been most linked in an intriguing way to brain health has been the Mediterranean Diet. I think we know we all need to do that,” Gaugler said.
A diet high in fruits and vegetables, particularly dark skinned fruits and vegetables, non fried fish for omega-3s, is ideal. Although Gaugler said it’s just as effective to take an omega-3 supplement. Also swapping out butter for olive oil and eating nuts and grains is part of a brain healthy diet, he said.
A 2017 study from the Lancet Medical Journal resulted in the creation of a model Alzheimer’s risk over a lifetime.
Gaugler said some of their findings show people what they can do over the course of their life to reduce dementia risk factors.
The big takeaway, he said, is that 35% of dementia risk is potentially modifiable.
“It tells you that Alzheimer’s is probably a disease of the life-course, it’s not something that just happens as we get older. The main symptoms manifest themselves later, but there are probably things we can do throughout our life that could potentially offset our risk for dementia,” Gaugler said.
Managing behaviors associated with dementia is Gaugler’s recommendation, as it can bring relief to the patient and the caregiver.
“Effective and front line treatments are acknowledging requests and listening to people. It’s less about reacting, and more about understanding why a behavior,” he said.
Often finding a creative way to direct or solve some negative behaviors of patients can be the best way to care for them, Gaugler said.
The Alzheimer’s Association has a medical trial manager that families can access for information on the latest treatments.