Alzheimer's Disease update: Mayo Clinic Radio

welcome back to Mayo Clinic radio I'm dr. Tom shives and I'm Traci McCray Alzheimer's disease you know the Alzheimer's Association estimates that there are nearly 6 million people in the United States who have the disease now here are some sobering statistics one in 10 people over the age of 65 have Alzheimer's one in 3 people aged 85 and older have Alzheimer's it's predicted that the number of people with Alzheimer's disease in the United States could more than double by the Year 2060 and Alzheimer's is now the sixth leading cause of death in the United States talk about a disease that's not only affecting more and more people it's also a condition that despite researchers best efforts it's still hard to diagnose and even harder to treat joining us in studio with an Alzheimer's update is the director of the Mayo Clinic Alzheimer's Research Center dr. Ron Petersen welcome so much welcome to the program it's great to see you well thank you so much for having me back dr. peterson nice to see you I doubt that there is anyone in the world who has spent more time more effort trying to unravel the mysteries of Alzheimer's disease than you is that your way of saying I'm a bit long in the tooth I just remembered that you and I have been talking about this disease for nearly 30 years on the right that's correct that's right what has changed in 30 years well as you were saying Tracy I think our ability to diagnose the disease is much better than it was 10 20 30 years ago because we can be more precise now not only on the clinical side but on what we call a biomarker side that biomarkers would mean blood tests imaging tests that in fact tell us this person has Alzheimer's disease in his or her brain I would think that something else that changed as much like cancer where it used to be don't say the c-word Alzheimer's disease is actually something that people talk about now it's okay it's okay to talk about it it's getting better we're not there yet it's a good analogy with cancer because as Tom and I know years ago you'd say the c-word rather than saying cancer but to be honest I think part of that progress has been driven by the fact that we can now treat some of these diseases Alzheimer's disease still remains an enigma do you ever get frustrated that we haven't made more progress in the treatment of Alzheimer's yes I do I mean really when you think about it we have some symptomatic drugs that we offer people when we make the diagnosis of Alzheimer's disease but we don't have that disease modifying therapy and by that I mean something that gets at the underlying biologic process itself stops it reverses it so tell us the difference between Alzheimer's and dementia and what we mean by the term dementia well dementia means that this is an overriding condition where the person no longer remembers as well as he or she used to probably affects other aspects of thinking and it impacts their daily function so cognitive function cognitive failure now impacts your daily function so that's dementia then you ask the question what's causing the dementia so is it due to Alzheimer's disease which is a degenerative disease of the brain the nerve cells aren't working as well as they formerly did could it be due to small strokes could it be due to the side effects of medications you're taking for your other conditions could it be depression anxiety so kind so dementia is a syndrome a clinical picture and then it's caused by something now in fact in aging up in a way Alzheimer's disease is the most common cause of dementia what do we know about cause it seems like for many years we had no idea what caused it and now it seems like there may be a multi maybe multiple factors well if you define the disease by the presence of these plaques and tangles in the brain plaques made up of the protein amyloid tangles made of the protein tau we think there's a genetic susceptibility so it tends to run in families there are rare but real genetically caused forms of the disease but in terms of environmental factors where there's some associations but no real definitive causes of the plan some tangles in the brain it seems to be more common in women is that because it is more common in women or women just because women live longer well that's a controversial topic right now I think it is true women do live longer and the biggest risk factor for Alzheimer's ease is age so there are more women with it but there are also some biologic predispositions it could be hormonal it could be some of these genetic characteristics like Apple lipoprotein II that may behave differently in women than they do in men tell us about the symptoms you mentioned memory loss I presume that that's the most common symptom but what are some others the most typical symptom is in fact forgetfulness and now we all get a little more forget I don't know about you Tom but I'm a little more forgetful than I used to be and so I think forgetfulness is part of it but it's beyond the forgetfulness of aging so when people start to forget information that they formerly remembered quite readily those around you who know you well start to realize hey Dad you're forgetting that thing you used to remember quite readily previously it's a repeated pattern we get concerned but then it goes beyond memory so now we have trouble problem-solving we have trouble word finding we have trouble maybe finding our way around the community getting lost in areas that we formerly knew quite well and so those are the symptoms as they come on very gradually and very insidiously over years that lead us to be concerned this might beyond be beyond what we would expect for normal aging I think one of the first times that I ever sat in on an interview with you I heard you say you know Alzheimer's is not I can't find my car keys or I can't find where I parked my car Alzheimer's is do I have a car I mean is it also that you don't realize that you're forgetting these things I mean I've got so many friends that get so upset that they forget things and I'm like from what I understand that's not Alzheimer's well what you're describing Tracy is perhaps Alzheimer's disease and it's more advanced stages so one thing that's happened over the years is we do pick up these earlier signs now so right where are my reading glasses where are my car keys that's virtually everybody everybody has trouble coming up with the name of that person with whom I used to work some in the grocery store who is he three aisles later of course that's bill how could I forget bill but when that advances to now you're forgetting information that you formerly should know that becomes a little more problematical you're like your wife's name is it because does Alzheimer's always first affect the memory part of the brain is that why that's the most common symptom or do we know it's it's the most typical presentation and the part of the brain that gets involved initially with Alzheimer's disease is the memory part the temporal lobe of structure called the hippocampus that's usually the beginning but there are some atypical forms and actually in individuals with younger onset disease the presentation may be quite atypical what I mean by that there's a rare form called posterior cortical atrophy or the visual variant where people really have difficulty with visual spatial relationships they may go to the eye doctor first hi doctor says gee your vision is fine but I'm not processing visual information that's because that part of the brain becomes involved initially in those individuals there's a language form for where the the word finding problems the understanding language the communication really gets impaired out of proportion to say the memory part there's even a frontal form a behavioral form where people's personality start to change they become a different person to the family and rarely that can be a presentation of Alzheimer's disease as well there's it ultimately in fact that affect the entire brain it will and as it progresses I mean there are certain parts of the brain that are relatively preserved motor functions sensory function usually hangs in there pretty far into the disease process but ultimately it affects everywhere so what about life expectancy it does shorten your life correct and what's the average life expectancy following diagnosis well it's very variable and we sometimes see people who have an aggressive form of the disease who may pass away a few years after diagnosis we have those who go out 20 years after the diagnosis but in general eight years plus or minus from the time of diagnosis till the time of death if it's diagnosed say in the early 70s or in the eighties is that the same as it was 30 years ago eight years basically it is that is frustrating what do these people die of well usually if if people go to the later stages of the disease motor function swallowing some basic autonomic functions will become impaired a person may aspirate get pneumonia and die of a medical complication of the brain not handling our motor functions very well all right our guest is the director of the Mayo Clinic Alzheimer's Research Center dr. ronald peterson time for short break when we come back we'll talk about what's available for treatment and will also tell you what you can potentially do to prevent the disease welcome back to Mayo Clinic of radio I'm dr. Tom shives and I'm Tracy McGrady we are with the director of the Mayo Clinic Alzheimer's Research Center dr. Ronald Peterson we've talked in general about Alzheimer's disease it's a devastating disease for a large number of people some six million in the United States we want to talk a little bit about not only what's available for treatment and prevention but also a little bit more about diagnosis because you did say dr. Peterson that we're better now at diagnosing it than we used to be and what did you mean well now we have the availability of these biomarkers that actually characterize the underlying biology of the disease grooming by that Alzheimer's disease is plaques and tangles in the brain plaques are made of this protein called amyloid the tangles are made of the protein called tau we can now see those proteins in the brain we can do PET scans that actually light up those regions of the brain if in fact they have plaques and tangles there we can do a spinal tap and we detect proteins in the spinal fluid that give us an index of what's going on in the brain so if a person becomes forgetful later in life you think it might be Alzheimer's disease we can now clarify it is in fact Alzheimer's disease as opposed to some other conditions small strokes other proteins that may be missed processed in the brain so we can get much better with regard to the specific diagnosis now but first of all a PET scan is an expensive test several thousand dollars so is it important to know and is it worth spending the money for that test well I think it's important to know if the person really wants to find out it's very important for the design of clinical trials so we're testing out some new experimental medicines it's very important for us to know what in fact exists in the brain but you're quite right Tom the the cost of these tests is many thousands of dollars clearly not the way to go on a population-based but for research it's important all right what about a blood test we saw a headline just today sent to us by one of our colleagues that said Alzheimer's blood test quote one step closer unquote so as you were saying these PET scans which are quite definitive with regard to the diagnosis of Alzheimer's these are expensive and certainly not available everywhere around the country what these recent studies have indicated is that there may be measures in the blood now that do in fact tell us whether somebody has amyloid in the brain it's not a yes/no yet but it helps us at least narrow down the general population as to which individuals might benefit from these more expensive more invasive tests like PET scans spinal fluid so for example here in Olmstead County we're doing the study called the Mayo Clinic study of Aging and we draw blood on individuals who participate in the study and we follow them every year those blood samples now that have been frozen away for years are being sent to these laboratories to tell us who in fact in the population might be more susceptible to having these proteins in the brain do you want to know obviously the sooner you can know this the better off it is but is that because you can tailor the treatment a little bit better if you know exerts on symptoms that they have got a possible wish exactly that's the hope for the field tracy and and and we haven't done very well on the therapeutic side thus far but that is in fact the thinking that if we can identify people who are at risk even before they become symptomatic before they become forgetful we may be able to intervene with a disease modifying therapy if and when hopefully when we develop these if that's the future what is treatment now well right now we talk about some symptomatic drugs that can alter certain chemicals in the brain that may help us with our remembering keep us stable for a little longer but they don't get at the underlying disease process itself we still talk about lifestyle modifications because believe it or not things like exercise physical aerobic exercise may be beneficial i won't go as far as to say prevent alzheimer's disease but it may slow down the course delay the onset a little bit much as we do in heart disease we don't necessarily prevent heart attacks heart failure if we can push that back by two three five years that's a big deal we're hopeful that we can do that with Alzheimer's disease as well you didn't talk at all about the drugs that you have available and I think there's a reason for that isn't there I mean they're not all that effective and are they expensive also they're not very expensive now because they're generic by and large but believe it or not we've not had a new drug approved for Alzheimer's disease by the Food and Drug Administration since 2003 16 years despite billions of dollars being spent on the development of therapies why is that that you're is it that you're not looking in the right spots or well it's it's a tough nut to crack actually so we talked about these two proteins MO and tau getting at them getting in the brain getting the drug into the brain removing the protein or stopping from being miss processed is an important target but we've really not been able to demonstrate we can get drugs in the brain now to remove that protein the amyloid protein but we haven't been able to demonstrate that it makes any difference clinically now there are a lot of reasons for that and it's a much more complex situation than just amyloid and tau itself there are other proteins that get Mis processed in the brain something protein called alpha synuclein that causes Lewy bodies associated with Parkinson's disease another protein called tdp-43 which in and of itself can cause memory impairments in the brain we have vascular disease small blood vessels get closed off and in most people in Aging in their 70s and 80s it's a combination of those factors so amyloid and tau are important components but they're just components of a complex process all right let's talk about prevention because all of us want to do what we can to not get Alzheimer's disease so tell us about the World Health Organization guidelines for risk reduction of all kinds of dementia actually right so the World Health Organization came out with a paper earlier this year that were was describing certain lifestyle factors that may in fact deter the ants have demand now I must clarify and say they were talking more about dementia in general than they were specifically about Alzheimer's disease nevertheless that's very important because it may be that these lifestyle modifications again aerobic exercise staying intellectually active a heart-healthy diet remaining in your social network social connectedness may actually defer the onset of mild cognitive impairment or dementia or slow down their progress so these are important findings and in particular the World Health Organization speaks to everyone but to low and middle-income countries in particular and that's where the rate of dementia is increasing most rapidly because these countries are experiencing an increase in aging again the biggest risk factor so it's a really important document doctor shives earlier said you know you've been working in this for 30 years do you get frustrated that you're not farther ahead in this I want to know the opposite is there something that is exciting obviously you have been working on this for so long what excites you about coming in and finding a cure well I think we're getting close I I do it and I don't mean we have the magic drug around the corner but I think we're learning so much about the underlying disease the biology of the disease the characteristics what may modify its onset delay its progression that I think we're getting very very close and I would suspect that we will be able to come up with a combination of disease modifying therapies with lifestyle recommendations that may in fact have a real impact so those w-h-o guidelines are also indicated that smoking wasn't good and I guess that doesn't surprise anybody an alcohol in moderation one other thing I want to ask you is there any evidence that there are any over-the-counter vitamins or supplements that will help prevent Alzheimer's disease the short answer tom is no there's a recent report by the by AARP on this very issue if you want to google the global council on brain health just reviewed this whole area and came to the conclusion that if a person does not have a deficiency state meaning they're low in b12 the low in vitamin D the low in calcium if all those levels are normal taking supplements will not help you will not mend your performance make you live longer anything of the sort it's a forty billion dollar industry out there right now and there's really very little data to support any of it hopefully you have just saved our listeners a lot of money dr. Ron Peterson director of the Mayo Clinic Alzheimer's Research Center there are six million Americans living with Alzheimer's disease it affects one in ten people over the age of 65 and the older you get the more likely you are to be affected there are now better ways to diagnose Alzheimer's disease but there is still no definitive inexpensive test that can confirm the diagnosis treatment a few drugs that can possibly slow the progression but so far nothing that will stop it but researchers like dr. ronald peterson are optimistic our thanks to one of the world's Alzheimer's experts dr. Ron Peterson thanks ty Matt Tracy I appreciate it

Channel: Mayo Clinic

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Keywords: Mayo Clinic, Health Care (Issue), Healthcare Science (Field Of Study), Mayo Clinic Radio, Dr. Ronald Petersen, Alzheimer's disease research, Alzheimer's disease

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Length: 20min 2sec (1202 seconds)

Published: Tue Sep 17 2019