The largest gains in treatment of the disease have been made in the psycho-social realm — preparing the patient and the caregiver for what to expect. Dr. Jason Karlawish of the University of Pennsylvania tells guest host Lynn Neary what else researchers are learning.
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LYNN NEARY, HOST:
Dr. Jason Karlawish is a professor of medicine at the University of Pennsylvania. He says the most significant breakthrough in Alzheimer's research is that doctors no longer have to wait until after a patient has died to diagnose the disease.
DR. JASON KARLAWISH: We are beginning to be able to see the disease during life. Imaging techniques are allowing us to see things like amyloid buildup in the brain using PET scan imaging. We can also see it on MRI scanning and spinal fluid analysis. These are still emerging concepts but the notion that it can, quote, "only be diagnosed with an autopsy" is, I think, a fading notion.
NEARY: What are the treatment options that are available at this moment?
KARLAWISH: Pharmacologic treatments are certain available. They're modest in their affects in modifying the clinical symptoms of the disease for relatively short periods of time. But there are other treatments, though, that are effective. Psychological and educational and behavioral interventions have clearly been shown to reduce the burden of disease on patients as well as families.
Such as how to manage common functional disabilities like driving and financial problems, later-stage issues like bathing and grooming. And these are interventions that have been shown to do things like delay the time before someone goes to a nursing home. The sad thing is that there's not a solid business model that surrounds them like there is around drugs.
If you're a diabetic in America, you get your drugs, right? And you have access to a diabetes educator. That's standard of care. Well, my hope would be that when you get your diagnosis of Alzheimer's disease, dementia, or mild cognitive impairment, you get your drugs but you also get access to your educator to help you think about how you're going to learn to live with this disease and deal with the functional and behavioral problem.
NEARY: Now, African-Americans are up to twice as likely to get Alzheimer's as white Americans. Why is that?
KARLAWISH: Well, there's probably a number of factors at work there. One of them very well could be genes, but also some of the illnesses that associate with increased risk of Alzheimer's disease are more prevalent in some communities, such as vascular disease, such as diabetes, hypertension, hyperlipidemia. So to the extent that those diseases cluster in certain groups, and the quality of their treatment also, it can impact their increased risk of developing the disease.
NEARY: There seems to be more people with Alzheimer's now and is that just because people are living longer?
KARLAWISH: It's a mix of things. Certainly, one of them is the fact that one of the biggest risk factors for developing the disease is chronologic age. And you're right; we are living longer in the United States, as in other developed nations.
NEARY: What kinds of lifestyle choices, health choices, can people make that might reduce their chances of getting Alzheimer's?
KARLAWISH: I think there's some good take-home points that I tell my patients. Which are, number one, the evidence is pretty good that a healthy heart is a healthy brain. That if you can reduce the risk factors that lead to cardiac problems, such as high pressure, and adopt a lifestyle that is a healthy heart lifestyle, it's associated with a healthy brain.
There's evidence as well that reducing head injury reduces the risk of developing cognitive disorders later in life. There's good data that shows that chronic stress can lead to cognitive decline, and so greater attention paid to mental health and well being in the life course. Finally, we have good evidence that people who engage in cognitively engaging lifestyles even after retirement, you know, but continue on with activities they enjoy and engage them, they're less likely over time to develop cognitive decline.
So there are a number of things that can be done to maintain brain health.
NEARY: Well, thanks so much for being with us.
KARLAWISH: It's my pleasure. Thank you so much, Lynn.
NEARY: Dr. Jason Karlawish is a professor of medicine, medical ethics and health policy at the University of Pennsylvania.
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