The Paradigm Shift in Alzheimer’s Disease

One of the leading U.S. researchers in vascular dementia was a guest on the Living to 100 Club Radio show last December, who discussed the latest findings on the assessment and treatment of dementia. Among other subjects, Dr. Gary Rosenberg from the University of New Mexico highlighted a growing interest among researchers on  “mixed dementia, ” a combination of Alzheimer’s disease and vascular dementia. This appears to manifest as a more damaging and rapid type of cognitive decline but also one that may be subject to modifications in lifestyle.


* Alzheimer’s disease is a slow accumulation of abnormal proteins in the brain, which finally leads to cell death. It begins with memory problems and then after a few years, begins to progress to disorientation. And toward the end, there can be changes in personality, aggressive behavior, agitation, and finally the motor system gets involved.

* Vascular dementia, formerly know as multi-infarct dementia, is usually related to vascular risk factors, hypertension being the main one, diabetes, sleep apnea, and high cholesterol. These end up damaging the blood vessels and generally, they make the brain less oxygenated, less blood flow is going to the brain, and that creates a hypoxic situation that turns on inflammation and slowly damages the deeper structures in the brain.

* Fronto-temporal dementia is similar to Alzheimer’s disease, but primarily involves the language centers and changes the personality. There’s also a Parkinson-related disease, called Lewy Body dementia where a certain protein damages cells. And there’s also Parkinson’s disease with dementia where people with this disease also begin to have cognitive problems. There are other variations in dementia that researchers are now finding pathologically, but they’re not easy to separate out clinically.

* “Mixed dementia” is where a person has both the Alzheimer’s type proteins, but also has a lot of vascular risk factors and vascular disease, and it’s actually of a more damaging type of process than either the Alzheimer’s or the vascular type because it accelerates the decline in thinking.

* Vascular disease is a disease of aging. So, a person who has high blood pressure when he or she is 40 and that can be 140/90, is at a greater risk of having vascular dementia by the time they’re 60.

* Diabetes is another major cause of vascular dementia, which is also at least controllable and related to obesity. We should be focused on lifestyle changes. Exercise, a proper diet, social contact; these are all things that will reduce the impact of vascular disease and slow the onset of dementia.

* The genetic types of Alzheimer’s disease are only present in about 5% of the patients, which means that there are 95% that are not genetic. For the families that have the genes, and the risk is raised if these abnormal proteins are present, it makes the onset earlier, though the progression is not necessarily faster. The onset can be even in the 40’s or 50’s, it is more likely to have one of these genetic defects which generally do run in families.

* People who have higher cognitive reserve tend to get dementia later. This is a difficult thing to control, but probably through educating our children better, we can provide some protection. It won’t protect necessarily against the genetic factors, but certainly the lifestyle factors. There are also instances where we lose some memory and yet it does not have an impact on our daily life.

* There are several FDA approved treatments for Dementia, and can be effective in slowing the progression of memory loss: Donepezil – trade name is Aricept and Memantine – Namenda.

* Leukoaraiosis means in Latin “white matter change”. These are patients that have difficulty walking, they’re incontinent and they have small strokes. Though this white matter change is not a disease, the more common type occurs in someone who is beginning to have problems with their memory, yet does not have Alzheimer’s disease. It does become, though, a risk factor for Alzheimer’s.

We are fortunate to have guests like Dr. Rosenberg on our program.  And we look forward to future programs to inform and entertain our listeners, and to help our audiences meet the challenges of aging with a positive spirit. As our readers know, the goal of the Club is to help members live longer, healthier, and happier lives, and if this isn’t in the cards, stay positive in the process.

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