Unraveling the Mysteries of Alzheimer’s
Recognizing Alzheimer’s Disease and the Need for Early Diagnosis and Treatment
by Diana Price
Did you know that every 66 seconds someone in the United States develops Alzheimer’s disease, and nearly half of them are already in the moderate-to-severe stage at the time of diagnosis?1 Despite being the sixth leading cause of death in the U.S., Alzheimer’s disease has gained a reputation as an illness we can’t do anything about.2 As someone who has made this disease his life’s work, I’m calling for an end to the under-diagnosis and under-treatment of this disease.
Lack of attention to early Alzheimer’s disease is a tragedy, because there are things we can do to help people who are starting to experience memory loss, as well as the people who care for them. Although a cure does not exist, there are treatment options for people living with Alzheimer’s disease that can help to slow down the severity of their symptoms, especially if they are diagnosed early.
Barriers to Diagnosis
Unfortunately, people with Alzheimer’s disease are often not diagnosed early enough. A common barrier to early diagnosis is that primary care physicians often feel that their medical training left them inadequately prepared to diagnose Alzheimer’s disease early in its course, leading to missed diagnoses and, in turn, delayed treatment. By the time Alzheimer’s has been diagnosed, patients have often progressed into more severe stages of the illness, and this lost ground is impossible to regain.
It is critical that primary care doctors be trained to recognize the early stages of Alzheimer’s disease, since effective treatments at the onset of symptoms are patients’ and their caregivers’ best hope for living a high-quality life despite their disease. We also need to educate the general public to look out for and detect early signs of Alzheimer’s disease, so that they can seek a diagnosis from a healthcare professional as early as possible.
Available Treatment Options
Many of my patients and their caregivers are eagerly waiting and hoping for a cure to become available, but with each passing day, patients’ mental states continue to deteriorate. Less than one percent of drugs developed for Alzheimer’s disease have successfully advanced to FDA approval, and many people living with Alzheimer’s disease are not using treatments that are currently available on the market.1, 3, 4 This is time that Alzheimer’s patients simply cannot afford to waste. While there is no cure for Alzheimer’s disease, current treatments have been shown to help slow the progression of symptoms for a while. Early diagnosis and treatment could help many of the 5.5 million Americans, and the 50 million people worldwide, who are currently living with Alzheimer’s disease.
The Impact of Alzheimer’s Disease on Caregivers
It’s important to recognize that Alzheimer’s disease has a profound effect not only on the people living with the condition, but also on more than 15 million people in the U.S. who are caring for them.1 These caregivers often neglect their own health needs and incur substantial emotional, financial, and physical difficulties in order to provide close attention to their loved ones. They are faced with a multitude of obligations – from tracking medications and balancing checkbooks to assisting with bathing needs and other everyday functions. The emotional and economic burden of caregiving is enormous, with one out of every two primary caregivers developing major depression, and the annual cost of care estimated at $230 billion in the U.S. alone in 2016.5
Properly diagnosing individuals as early as possible and making sure they take adequate doses of medication — and stick with them — can help preserve and maintain cognitive function. Sadly, these relatively simple measures are too often not applied because of the misconceptions surrounding the treatment of Alzheimer’s. It’s time to put aside such mistaken beliefs and take action to alleviate the burden imposed by this terrible disease, before it’s too late for patients and their caregivers.
Unraveling the Mysteries of Alzheimer’s Among Women
An Interview with Maria Shriver
Did you know there are more than five million Americans are living with Alzheimer’s disease, and that number is estimated to jump to 16 million by 2050 as people live longer and baby boomers reach the age when they are more at risk of the disease. What is perhaps even more disturbing is that this brain disease discriminates against women, yet the reason for this discrepancy between the genders is not well understood. Two out of three people with Alzheimer’s are women, and women in their 60s are twice as likely to develop Alzheimer’s as they are to develop breast cancer in their lifetime.(1,2)
“Genetics is part of the equation when calculating who is at risk, but studies are also starting to show that lifestyle changes in early to mid-adulthood may be a factor,” says Joshua Grill, co-director of University of California at Irvine’s Institute for Memory Impairments and Neurological Disorders (UCI MIND). “Data from new studies suggests that smoking, obesity, hypertension and high cholesterol might be linked to the disease.”(3)
Scientists are starting to investigate how physical exercise, getting enough rest, eating a healthy diet and staying cognitively active may be critical not only for body health but also brain health. The brain—the most vascular organ in humans—uses 20 percent of the body’s blood oxygen, and healthy lifestyle choices increase blood flow and decrease inflammation, says Grill. This may shed light on why today’s aging female population is more at risk.(4,5)
“Women in previous generations may not have had the same opportunities as women today for a college education, challenging careers, and physical exercise, and those lifestyle differences could increase the risk of developing the disease,” Grill says.
To support women-based Alzheimer’s research, UCI MIND recently announced a partnership with The Women’s Alzheimer’s Movement (WAM), a non-profit organization founded by Maria Shriver, the award-winning journalist and former First Lady of California. Historically, studies about Alzheimer’s disease have not focused specifically on men or women. The initiative will enable researchers from UCI MIND to apply for funding to collect preliminary data about the role of sex and gender in the disease. “This will give researchers the start they need to apply for larger grants from the NIH,” Grill says.
UCI MIND is one of only 30 NIH-funded Alzheimer’s Disease Research Centers in the United States, and Shriver talked to Women about why she’s dedicated herself to supporting gender-based research in this field and why her non-profit is committed to supporting partnerships like the one with UCI MIND.
How did you become interested in Alzheimer’s disease?
My father was diagnosed with the disease, and as a result, he passed away in 2011. Since then, it’s been my mission to advocate for the millions of families affected and do everything I can to demand answers about this disease that robs people of their minds. I’ve spent the past 14 years fighting on the front lines as an activist and as a journalist, using my voice to raise awareness and to push researchers, scientists, politicians, and other influential leaders to make this issue a public health priority.
What are some common misconceptions about the disease?
Most people don’t understand their risk for Alzheimer’s disease. We did a national survey in November 2017 with the Bipartisan Policy Center and it revealed that there is a huge crisis of awareness in America. The survey showed that the majority of Americans think that if they don’t have a family history of Alzheimer’s, then they are not at risk of getting the disease. That’s just not true. We also found that many Americans believe that if Alzheimer’s runs in their family, then they are guaranteed to get it and think there is nothing they can do to avoid it. That’s also not true. Your genes are not your destiny. We’re coming to learn more and more that lifestyle choices can, in fact, improve your brain health. No one thing is a “cure all,” but leading a healthy life—which includes a nutrient-rich diet, exercise, meditation, sleep and social connection—is important to keeping our brains healthy as we age. Through my work with my nonprofit, The Women’s Alzheimer’s Movement, we are doing everything we can to make people aware of brain health and the issue of Alzheimer’s. I am really excited about the number of people who are waking up to this issue and beginning to recognize that caring for their brains is just as important as caring for their bodies. The two are definitely connected.
What are some things you do personally to promote brain health?
I have certainly taken steps to exercise more frequently, to avoid sugar in my diet, to get enough rest, and to meditate every morning. It’s not always easy—especially putting down the sweets—but I’m definitely aware now of the importance of making these changes. My children are very aware of it now as well, and they’re often the ones reminding me to keep up this brain-healthy lifestyle.
Why do you feel it’s important to study women with Alzheimer’s disease?
Every 66 seconds, a new brain develops Alzheimer’s in America. Two-thirds of those brains belong to women, and no one knows why that is. That’s unacceptable to me, and that’s why it’s important to make gender-based research a priority. This partnership aims to do research that helps us get closer to answering the important question of why more women get Alzheimer’s than men. By figuring this out, my hope is that we will get closer to a treatment or cure for all minds.
What are some of the things we already know about gender differences related to the disease?
Researchers who are focused on this issue are looking at a number of different factors, including hormones and the X chromosome, as well as how depression, stress, and inflammation affect women differently than men. That’s just to name a few things. There’s a lot we still don’t know about what makes women more vulnerable to Alzheimer’s, but that’s why I’m pushing for scientists and researchers to make women’s brains a focal point of their research.
What is your hope for the future related to Alzheimer’s disease?
I hope we find a cure and wipe it out for good. I’m optimistic we can do that within our lifetime. This is the only major disease for which there is no cure. And it’s one of the most expensive diseases. It’s set to bankrupt our country if we don’t make tackling it a national priority. My goal for the future through The Women’s Alzheimer’s Movement is to make more women aware of their increased risk for this disease and to educate everyone—men and women—about what they can do to lead a brain-healthy life. This June, we will be hosting Move For Minds, a month-long initiative in the U.S., Canada and the U.K. that aims to teach people how to make their minds and their cognitive health a priority. Funds raised from Move For Minds will go toward supporting gender-based research and advancing our understanding of this mysterious and complex disease.
How can women help spread awareness surrounding Alzheimer’s disease?
We have to serve as reporters of this vital information. We have to pass it forward to our families, to our communities, to our schools, to our churches, to our workplaces—anywhere we have an audience. Too many people just don’t know the facts. Many women don’t know that they are more likely to develop Alzheimer’s than men, and most Americans don’t realize that the disease starts to form in the brain 20 to 30 years before symptoms appear. That’s why it’s so critical we start taking action to better our health now. That’s why time is of the essence to wipe out this mind-blowing disease. Get educated and spread this knowledge to others.
Alzheimer’s Prevention - What You Need to Know
by David Borenstein MD, Medical Editor
It is sad to lose a family member or a close friend to a disease, and it may even be worse when you lose them when they’re still alive. They’re living, but their mind is gone: this is the reality of dementia. The toll it takes on the individual is devastating, but it is also disheartening for the people who care for that person.Alzheimer’s disease has the potential to become an epidemic. We need to find ways to prevent this disease. Luckily, clinical trials are under way to find ways to stop this illness in its earliest phases. Here, Laurie Ryan, PhD, provides background about the disease and answers questions about Alzheimer’s disease risk, lifestyle factors, and clinical trials.
Q&A with Laurie Ryan, PhD Chief of the Dementias of Aging Branch in the Division of Neuroscience National Institute on Aging
What is Alzheimer’s disease?
Alzheimer’s disease is the most common form of dementia, which is a progressive loss of cognitive motor function that occurs as the brain—the central nervous system— deteriorates. Alzheimer’s disease predominantly affects adults over 65 years of age.
What causes Alzheimer’s disease?
Alzheimer’s is a complex disease, and there are genetic, cardiovascular, and many other risks factors that can put a person on the pathway to potentially developing the disease. Though we have come to understand a lot more about what those risk factors are, and we can pinpoint some of the changes that occur over a decade or more in the brain before the dementia starts, we don’t know absolutely what the cause is at this point. We have a much better understanding now, but we don’t have a specific cause.
Can you provide an example of a current topic of research sponsored by the National Institute on Aging related to Alzheimer’s prevention?
One focus of current research is amyloid, which is a protein that builds up in the brain and causes plaques to develop. The development of these amyloid plaques is an early indication of Alzheimer’s—it builds up as much as a decade before dementia sets in. It has become a target of prevention trials, to see if we can stop the buildup of this protein before it progresses to cause dementia. Prior research has shown us that targeting amyloid later in disease progression has not been effective in slowing Alzheimer’s, but current studies are aiming to discover if early intervention might be able to stop the buildup of the protein and slow progression. Several prevention trials are ongoing related to anti-amyloid therapies.
The media often reports on research into how lifestyle factors may affect brain health—and Alzheimer’s, in particular. What do we know about the impact that lifestyle factors might have on the development of dementia?
The impact of lifestyle factors on brain health is an ongoing area of research; there have been observational and animal studies related to the role these factors may play in prevention, and other, larger trials are also under way. Some of these results are encouraging. For instance, studies have shown that exercise and maintaining physical activity as we age is good for brain health; information is also emerging about the role that sleep plays in cognitive function; diet can also be a factor, as can remaining mentally active as we age. Although there is also some information available about the potential benefit of specific foods—caffeine and chocolate, for example—we don’t yet have enough information to know the extent of the impact. As with all lifestyle recommendations, moderation is key; a healthy lifestyle is certainly a benefit in many ways.
What should we know about the role that clinical trials play in Alzheimer’s research?
We cannot make these important discoveries into the causes and potential treatments without clinical trials, wherein volunteers—individuals and families—commit to participating in research studies. There are great resources to learn more about clinical trials, which offer opportunities to contribute to research for both healthy people and those already diagnosed with Alzheimer’s.
More Information About Alzheimers
- More About Alzheimers
- National Institute on Aging website (nia.nih. gov/alzheimers)
- The Alzheimer’s Association website (alz.org).
- “What is Alzheimer’s?” Alzheimer’s Association. . Accessed April 18, 2017.
- Centers for Disease Control and Prevention. Deaths from Alzheimer’s Disease – United States, 1999-2014. Morbidity and Mortality Weekly Report. 26 May, 2017.
- Cummings JL, Morstorf T, Zhong K. Alzheimer’s disease drug-development pipeline: few candidates, frequent failures. Alzheimers Res Ther. 20 14;6(4):37.
- Blutstein T, Kumar N, Searles JW; for the Decision Resources Group. Alzheimer’s disease: analyzing and forecasting the commercial outlook of drugs on the market and in research and development. Burlington, MA: Decision Resources Group; 2015.
- “2017 Alzheimer’s Disease Facts and Figures.” Alzheimer’s Association. . Accessed April 18, 2017.
- The Alzheimer’s Association. Available at:
- The Alzheimer’s Association. Available at:
- Gottesman, RF, et al., Association between midlife vascular risk factors and estimated brain amyloid deposition, Journal of the American Medical Association, 2017 Apr; 317(14):1443-1450. doi: 10.1001/jama.2017.3090. Available at:
- Morris MC, et al., Nutrients and bioactives in green leafy vegetables and cognitive decline: Prospective study, Neurology, 2018 Jan 16;90(3):e214-e222. Available at:
- Sprecher, KE, et. al., Poor sleep is associated with CSF biomarkers of amyloid pathology in cognitively normal adults, Neurology, 2017 Aug 1;89(5):445-453. Available at .
Facts and Figures
Alzheimer's Disease Facts and Figures report – get the latest statistics on the impact of Alzheimer's and dementia in the United States.
Nutrients and bioactives in green leafy vegetables and cognitive decline
Objective To increase understanding of the biological mechanisms underlying the association, we investigated the individual relations to cognitive decline of the primary nutrients and bioactives in green leafy vegetables, including vitamin K (phylloquinone), lutein, β-carotene, nitrate, folate, kaempferol, and α-tocopherol. Methods This was a prospective study of 960 participants of the Memory and Aging Project, ages 58–99 years, who completed a food frequency questionnaire and had ≥2 cognitive assessments over a mean 4.7 years. Results In a linear mixed model adjusted for age, sex, education, participation in cognitive activities, physical activities, smoking, and seafood and alcohol consumption, consumption of green leafy vegetables was associated with slower cognitive decline; the decline rate for those in the highest quintile of intake (median 1.3 servings/d) was slower by β = 0.05 standardized units ( p = 0.0001) or the equivalent of being 11 years younger in age. Higher intakes of each of the nutrients and bioactives except β-carotene were individually associated with slower cognitive decline. In the adjusted models, the rates for the highest vs the lowest quintiles of intake were β = 0.02, p = 0.002 for phylloquinone; β = 0.04, p = 0.002 for lutein; β = 0.05, p < 0.001 for folate; β = 0.03, p = 0.02 for α-tocopherol; β = 0.04, p = 0.002 for nitrate; β = 0.04, p = 0.003 for kaempferol; and β = 0.02, p = 0.08 for β-carotene. Conclusions Consumption of approximately 1 serving per day of green leafy vegetables and foods rich in phylloquinone, lutein, nitrate, folate, α-tocopherol, and kaempferol may help to slow cognitive decline with aging. BMI= : body mass index; FFQ= : Food frequency questionnaires; MAP= : Rush Memory and Aging Project
Poor sleep is associated with CSF biomarkers of amyloid pathology in cognitively normal adults
Objective: To determine the relationship between sleep quality and CSF markers of Alzheimer disease (AD) pathology in late midlife. Methods: We investigated the relationship between sleep quality and CSF AD biomarkers in a cohort enriched for parental history of sporadic AD, the Wisconsin Registry for Alzheimer's Prevention. A total of 101 participants (mean age 62.9 ± 6.2 years, 65.3% female) completed sleep assessments and CSF collection and were cognitively normal. Sleep quality was measured with the Medical Outcomes Study Sleep Scale. CSF was assayed for biomarkers of amyloid metabolism and plaques (β-amyloid 42 [Aβ42]), tau pathology (phosphorylated tau [p-tau] 181), neuronal/axonal degeneration (total tau [t-tau], neurofilament light [NFL]), neuroinflammation/astroglial activation (monocyte chemoattractant protein–1 [MCP-1], chitinase-3-like protein 1 [YKL-40]), and synaptic dysfunction/degeneration (neurogranin). To adjust for individual differences in total amyloid production, Aβ42 was expressed relative to Aβ40. To assess cumulative pathology, CSF biomarkers were expressed in ratio to Aβ42. Relationships among sleep scores and CSF biomarkers were assessed with multiple regression, controlling for age, sex, time between sleep and CSF measurements, and CSF assay batch. Results: Worse subjective sleep quality, more sleep problems, and daytime somnolence were associated with greater AD pathology, indicated by lower CSF Aβ42/Aβ40 and higher t-tau/Aβ42, p-tau/Aβ42, MCP-1/Aβ42, and YKL-40/Aβ42. There were no significant associations between sleep and NFL or neurogranin. Conclusions: Self-report of poor sleep was associated with greater AD-related pathology in cognitively healthy adults at risk for AD. Effective strategies exist for improving sleep; therefore sleep health may be a tractable target for early intervention to attenuate AD pathogenesis. Aβ42= : β-amyloid 42; AD= : Alzheimer disease; BMI= : body mass index; ESS= : Epworth Sleepiness Scale; MCP-1= : monocyte chemoattractant protein–1; MOS= : Medical Outcomes Study; NFL= : neurofilament light; OSA= : obstructive sleep apnea; p-tau= : phosphorylated tau; PiB= : Pittsburgh compound B; t-tau= : total tau; WRAP= : Wisconsin Registry for Alzheimer's Prevention; YKL-40= : chitinase-3-like protein 1