Dementia: The Growing Epidemic by Catherine Madison, M.D.
Over the past century, life expectancy in this country has almost doubled. Advances in medicine, prevention and technology have greatly reduced death and debility to achieve this. But with this gain, we have observed a parallel growth in dementia, as aging remains the primary risk factor for this condition. Among the top 10 causes of death in the United States, Alzheimer’s disease remains the only one that cannot be prevented, cured or even slowed. Research to understand dementia is active, but progress with amyloid vaccines or tau modulation has been challenging. A recent paper from the Proceedings of the National Academy of Sciences describes the amyloid beta protein involved in Alzheimer’s disease having prion-like spread. Growing evidence suggests a similar process in other neurodegenerative conditions such as Parkinson’s disease and amyotrophic lateral sclerosis (ALS). The spreading of disease is further supported from functional connectivity studies showing differences between patients with Alzheimer’s disease and dementia with Lewy bodies (See reference 1). The desire for treatments is strong, and there is much anticipation and excitement building for the upcoming release of results from passive immunotherapy trials. Recent news reported positive results in a small number of mild cognitive impairment patients treated with intravenous immunoglobulin (IVIG), but given that the estimated mean annual cost of using IVIG for a chronic condition like myasthenia gravis is more than $20,000 per year, this intervention should be viewed with caution (See reference 2).
Alzheimer’s Association International Conference
At the most recent Alzheimer’s Association International Conference on Dementias, numerous scientific studies and strategies for treatments were shared. There are no medical breakthroughs, but attention is being focused on the mixed pattern of changes that can be seen in the brain with cognitive loss. Specifically, the role of vascular disease and inflammation is becoming more apparent. Microvascular changes in the brain do not typically lead to obvious memory loss, the hallmark of Alzheimer’s disease, but can impact executive function, leaving episodic memory intact. It is now being suggested that if left unattended, hypertension, high cholesterol, diabetes, depression and smoking can serve to be a very long fuse to the ignition of cognitive decline (See reference 3).
A good model of prevention and improved outcomes is available through our many years of reduction in debility related to better treatments of heart disease and stroke. Long-range studies looking at how aggressive treatment of these modifiable risk factors can influence the development of dementia are well underway. In addition, calcium channel blockers are being studied to see how they may influence signaling and inflammation in the brain, while new insulin delivery methods to improve brain function are also being examined. Recent FDA approval of an in-vivo amyloid imaging agent, Amyvid, allows researchers to add this tool in trying to predict cognitive decline. But we are not seeing it widely used until the presence of amyloid in cognitively normal individuals with aging is better understood. Some estimate this could be as high as 30 percent in cognitively normal 70- to 80-year-olds.
With all of this information exploding across headlines, it is easy to see why in the course of daily life, many overlook the growing numbers related to dementia. But becoming familiar with healthy lifestyle strategies and recognition of more individuals with impairment can help all of us. Persons with cognitive impairment are at greater risk for complications with chronic illness and hospitalizations, self-neglect, financial abuse and malnutrition. Lack of diagnosis and planning can have dire effects on an entire family.
Brain Health Center
Recognizing this need, a generous donor has emerged and partnered with us to develop a new Brain Health Center at CPMC that will open its doors this fall. This center is designed to promote brain heath by focusing care on patients and their families. A unique collaboration with the Alzheimer’s Association allows access to more extensive resources and support. The Brain Health Center will be offering caregiver training and community education while continuing compassionate care for individuals and families with memory concerns. The center will also be involved in research around improving the culture of care while helping to remove stigma from the diagnosis. We are all at risk, and we can move closer to finding treatments for this epidemic and improving lives of those affected by working together.
- Kenny ER, Blamire AM, Firbank MJ, O'Brien JT. Brain, 2012 Feb;135(Pt 2):569-81. Epub 2011 Dec 20; Functional connectivity in cortical regions in dementia with Lewy bodies and Alzheimer's disease.
- Guptill JT, Sharma BK, Marano A, Soucy A, Kruegar A, Sanders DB. Muscle Nerve, 2012 Mar;45(3):363-6. doi: 10.1002/mus.22327 Estimated cost of treating myasthenia gravis in an insured U.S. population.
- Carnevale D, Lembo G. Biochem Soc Trans 2011 Aug;39(4):939-44. Alzheimer-like pathology in a murine model of arterial hypertension.
California Pacific Medical Center
- Neuroscience Institute -
The California Pacific Neuroscience Institute in San Francisco features some of the top-rated neurology physicians and neurosurgeons in the San Francisco Bay Area. This issue of the CPNI Bulletin features our wide array of general neurology consultative services, physicians and programs, neurology research, and the new Brain Health Center at CPMC.