Jennifer Pauldurai, MD, is a board-certified neurologist who specializes in cognitive and behavioral neurology at Inova. Dr. Pauldurai’s areas of interest include memory disorders, dementia syndromes, behavioral disruptions including hallucinations and delusions, and mood disorders in the setting of neurodegenerative disease.
You lose your keys and find them in your fridge hours later. Your spouse forgets a colleague’s name or the way to a restaurant you haven’t been to in a while. Words that were once at the tip of the tongue are now hard to remember. Is it normal aging, or could it be the first signs of Alzheimer’s disease?
Alzheimer’s disease is one type of memory disorder caused by the buildup of a sticky plaque called amyloid. That amyloid plaque builds up in the brain and disrupts cognitive networks. The resulting disruption can present as forgetfulness, but this can also change mood, alter how people make decisions and change an individual’s ability to reason. Eventually, it progresses to a point where individuals need more and more help with day-to-day activities. This defines a state of dementia. Alzheimer’s disease is the most common kind of dementia (although it’s not the only one).
Alzheimer’s is common today, affecting about 7 million people in the United States, and it is projected to grow to 13 million by 2050, according to the Alzheimer’s Association. Fortunately, researchers are making strides toward solving the Alzheimer’s puzzle, and there are exciting developments in both diagnosis and treatment.
New Frontiers in Alzheimer’s Diagnosis
It used to be impossible to diagnose Alzheimer’s definitively, other than through an autopsy after the individual passed away. But thanks to advancements in neurology, healthcare teams now have a number of tools that use biomarkers to diagnose Alzheimer’s with certainty:
- A “spinal tap” (also known as a lumbar puncture)
- Positron emission tomography, better known as a PET scan
- Note: there are many types of PET scan, but the PET scan used to diagnose Alzheimer’s disease specifically highlights the amyloid plaque.
- Blood tests that look for a certain ratio of tau proteins to amyloid, which indicates Alzheimer’s
These biomarkers, combined with a detailed clinical picture that includes a patient’s history, examination of the patient’s symptoms and data from neurological tests, can drive an Alzheimer’s diagnosis.
Redefining Alzheimer’s Treatment by Slowing Down the Disease
As recently as five years ago, the medical community had no FDA-approved disease-modifying treatments for Alzheimer’s disease. We used, and still use, many tools to address symptoms and to increase quality of life such as:
- Antidepressants and antianxiety medications
- Medications to improve sleep and appetite
- Physical therapy
- Cognitive rehabilitation
- Healthy diet
- Exercise
- Social connection
Now, after many decades of research, the FDA has approved two medicines that target and remove amyloid from the brain. These medications (donanemab and lecanemab), given as IV infusions every two or four weeks, enable our immune systems to identify, break down and remove amyloid in our brains. While these medicines cannot do anything to repair the damage that has already happened, they can slow the disease’s progression – a leap forward in the fight against Alzheimer’s.
These medicines are only suitable for people who have mild cognitive changes caused by the early stages of Alzheimer’s, and there can be serious side effects. If you’re noticing memory, mood or behavior changes in yourself or a loved one – or if you or a loved one already has a diagnosis of Alzheimer’s – talk with your healthcare provider about your options.
Looking to the Future: Treating Alzheimer’s
The two new treatments have one thing in common. They both treat the end phase of the Alzheimer’s disease process by removing amyloid that has already built up. But is it possible to intervene earlier on – and stop amyloid from building up in the first place?
There are many reasons for amyloid buildup, and correspondingly, there is a range of therapies that aim to target those imbalances. Two particularly promising factors are inflammation and glucose dysregulation. For example, research is currently underway to test whether using medications to better balance glucose and insulin can prevent the buildup of amyloid. In the next few years, we’ll see more medications that directly target metabolic risk factors like hypertension, diabetes and obesity, with the goal of reducing the metabolic and energy burden on the brain.
What Can I Do Today to Keep My Brain Healthy at Any Age?
The three-legged stool of brain health as you get older is physical activity, cognitive engagement and social connection. Keeping the brain active across the physical, psychological, and social domains is not new advice, but it is backed by hundreds of research studies. In short, for a healthy brain as you age, do what stimulates you and provides you with joy in life, make it challenging, and do it every day.
Here are some other important ways to protect your brain:
- Aim for seven to eight hours of quality sleep each night
- Take steps to deal with any untreated medical conditions such as diabetes, high blood pressure, cholesterol issues or thyroid trouble
- Talk with your primary care doctor to get your health evaluated, and get regular follow-up care
- Quit smoking
- Minimize alcohol, which is a stressor on the brain
- Add more movement to your day
- Add brain-healthy foods to your diet such as blueberries, walnuts, salmon and leafy green vegetables
- If your brain already has cognitive stressors – if you have had concussions or a stroke, for example – take extra care to protect it
Alzheimer’s research is continuing to progress at a rapid pace. In the meantime, it’s good to know that by taking a few steps to optimize wellbeing – and by making small choices each day that support brain health – you can give your brain the best chance of long-term health.
Learn more about the Inova Memory Disorders Program.
Feature image, stock.adobe.com
