From the office of Robert S. Grimshaw Jr MD FACP Internal Medicine 3535 Hill Blvd Yorktown Hts NY 914 962-3180 NEWS Recognized Provider  “With Distinction” by the American Diabetes Association/National Committee for Quality Assurance 2/99-2/02

103                         June  2001

Update 2001:  Alzheimer’s Disease

Dr Alois Alzheimer described the disease which carries his name in 1906. It is now the most common cause of memory loss in the U.S.:

4 million have it now

14 million are expected to have it by 2050

1 in 10 people over 65 has it

half of those over 85 have it

US costs are estimated to be at least $100 billion yearly

average lifetime cost per patient is $174,000

What is Alzheimer’s? It is not yet clear what the cause or causes of AD are. Autopsy studies show dense "neurofibrillary tangles"and "senile plaques" in brain specimens. Beta-amyloid and tau proteins are strongly implicated, as are some nerve transmitter deficiencies. At least 4 genes are suspected.

Memory loss at work

Problems with familiar tasks such as forgetting you made a meal

Problems with simple words

Getting lost in your own neighborhood or home

Poor judgement such as not dressing properly

Abstract thinking issues such as inability to work numbers

Misplacing things bizarrely such putting an iron in the freezer

Unexplained mood swings

Changes in personality

                    Profound loss of initiative

How is Alzheimer’s Diagnosed? No one test (except brain biopsy!) is diagnostic. History & physical exam, a brief memory test and lab tests to rule out other diagnoses (such as low thyroid and vitamin B-12 deficiency) are done. MRI or CT scan of the brain may be needed to rule out multiple small strokes.

Non-Drug Treatments: Mental Activity: A study by Dr. Robert Friedland and colleagues at Case Western Reserve in Cleveland found that the more you do (mentally), the more you can do. Those who were more active mentally in early and midlife had 1/4th the chance of AD.

Exercise reduced the risk of AD in senior women in 1 study by 13% for every extra mile walked daily.

Antioxidants: Vitamin E (2000 units daily) was shown to reduce the risk of AD in the Alzheimer Prevention Study; in the Rotterdam Study beta-carotene and vitamins C & E reduced AD, especially in smokers.

Alcohol: in a Boston study, 1-2 daily drinks led to less AD.

Low-fat Diet: Another Cleveland study showed high-fat diet increased AD 5-6 fold in susceptible patients.

Diabetes: control of type 2 diabetes reduced dementia in a Dutch study.

Blood Pressure: control of blood pressure also reduced dementia in several studies.

Statins: anti-cholesterol drugs (lovastatin, etc). Reduce AD

Anti-inflammatories: Aspirin, ibuprofen and similar drugs have been associated with reduced AD in several observational studies.

Anti-Alzheimer Drugs: Tacrine (Cognex) was the first; little used now due to liver risks.

Donepezil (Aricept) is now the most used, working by increasing the neurotransmitter acetylcholine.

Rivastigmine (Exelon) is a similar drug, with perhaps a bit more improvement in memory, but with higher rates of stomach trouble here.

Galantamine (Reminyl) is the newest drug (derived from the daffodils), acting similarly, but with a 16% drop out rate due to side effects.

There are no head-to-head studies. On these drugs, avoid Ditropan, Levsin, Atrohist, Bentyl; they counter the effect.

Future Vaccine? Elan Pharmaceutical has a vaccine trial underway against one of the proteins in the amyloid plaques.