alzheimer's patients not going without a fight_26jul07

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Alzheimers patients not going without a fightFaced with early-stage diagnosis, more people are prepping brain for battleBy L inda Carro l l

MSNBC contributorUpdated: 9:44 a.m. ET July 26, 2007

LONG ISLAND, N.Y. - Alzheimers disease is inexorably robbing Phyllis Blais of her memory and mind. But the 79-year-old grandmother has decided

to fight back.

Each week, she tests wits with a group of people like her whove received a diagnosis of early-stage Alzheimers. They come to the Long Island Alzheimers

Foundation to work puzzles, play word games and compare memories of current events. The hope is that this mental activity will help short-circuit the

disease and keep brain wiring intact as long as possible.

Blais and her classmates, whose ages range from the mid-50s to the 90s, listen to clues and questions and then vie to be the first with the right answer.

And those answers come in rapid fire. Surrounded by others with fading memories, no one feels self-conscious.

So far, there's no proof that mental exercises can stave off Alzheimers, but growing evidence suggests that it might be possible to slow down the

diseases impact.

Blais thinks the classes are making a difference, and that makes her all the more determined. Im not completely gone, she says. Im gonna fight it and

make sure I dont get that bad.

Around the country, other early-stage patients are grasping at this possibility. They flock to Alzheimers centers that offer support groups and

opportunities to tune up aging brains. This may be another path paved by boomers. The oldest of that generation are beginning to show signs of the

disease and they want to take more control of their destinies.

There is a changing landscape when it comes to Alzheimers, says Dr. Peter Reed, senior director of programs at the national office of the Alzheimers

Association. The baby boomers are more vocal and more interested in playing a greater role in their experience. Those in the early stages have a lot more

remaining ability and capacity to be involved in their own decision making.

Patients with early-stage Alzheimers account for about half of the estimated 5.1 million Americans afflicted with the disease. Increasingly, Reed says,

Alzheimers is being diagnosed early when symptoms are subtle and patients still have the promise of several years of relatively normal life.

People in the early stages, he says, are not so much dying from the disease as they are very much living with it.

Bracing for a decline

Seated in a semicircle, Blais and 10 others listen intently as Alana Rosenstein asks them to supply the word that will finish the two phrases: Buster ____

and ____ v. the Board of Education.

An elderly man says, Brown. And the answer becomes a springboard for a history discussion. What was Brown v. the Board of Education about? asks

Rosenstein, director of Early Stage Programs at the Long Island Alzheimers Foundation.

Moving on to the next word game, Rosenstein gives a clue to prompt for a word that can be made from the letters in conglomerate: When people get

married, theres a bride and a

Groom! several voices call out. Blais playfully elbows the man next to her. Hopefully, she says with a sly smile.

A few seats away, Gertrude Rothenberg carefully scrawls each answer down so shell be able to test her daughter with todays brain teasers.

At a very early stage of Alzheimers, Rothenberg, 84, shows a face of the disease at odds with the public perception. The only change in her life since her

diagnosis a year ago is a bit more attention from her adult children. Rothenberg still l ives on her own. She drives. She does her own shopping, pays her

own bills and volunteers at a hospital near her Mineola, N.Y., home.

Dr. Ronald Petersen isnt surprised at how normal Rothenbergs life is post-diagnosis. People in the early stages of Alzheimers can function at a very high

level, says Petersen, director of the Mayo Clinic Alzheimers Disease Research Center. They may still be driving and handling their own daily activities, he

says. But there needs to be frequent contact by someone who knows them well family members and the like.

The extra scrutiny is needed so that any decline will be spotted quickly, he adds.


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Rothenbergs diagnosis did bring a prescription for the medications Aricept and Namenda. Aricept works by boosting the availability of a neurotransmitter,

acetylcholine, which sharpens signaling in the brain. Namenda helps by blocking a different neurotransmitter glutamate which can be toxic to brain

cells.

Studies have shown that while these medications dont stop or slow the disease, they can tune up the brain, improving memory and helping Alzheimers

patients think more clearly. The drugs help a deteriorating brain much in the same way that high-octane gas boosts the performance of an old car engine.

The gas doesnt fix the problems with the engine, but it can make it run more efficiently.

The diagnosis also provided the impetus for Rothenberg to look into the cognitive-stimulation class. Its part of her plan to keep her independence as long

as possible.

Simple acts, not-so-simple science

Until recently, doctors assumed there wasnt much to be done once a person was diagnosed with Alzheimers. Patients were sent home with kind words,

drugs that had a mild impact on symptoms and perhaps some advice on how to deal with the inescapable changes in their brains and the inevitable

changes in their lives.

But over the past few years, studies have hinted that lifes tyle changes might have an impact. Most of the evidence comes from population and animal

studies, which, scientists are quick to point out, are not definitive. But the results have been promising.

Take, for example, the studies in mice engineered to carry the human gene for Alzheimers. One, published earlier this year in the Journal of Neuroscience,

showed that the simple act of learning could have a profound impact on the buildup of the distorted proteins that cause memory loss in both humans and

mice afflicted with the disease. Researchers found that mice that had periodically been forced to learn to navigate a maze ended up with fewer plaques

and tangles of protein than intellectually idle ones.

I think you need to look at the mouse studies with a cautious optimism, Petersen says. I think its probably a modest effect.

Studies in humans have also suggested that increased mental activity might protect the brain. One study, for example, followed more than 800 Catholic

nuns, priests and brothers for four years. Ultimately, researchers determined that the most mentally active people were the least likely to develop the

disease.

This doesnt necessarily mean that the mental activity prevents Alzheimers. Its always possible that the people with the healthiest brains were able to

stay more mentally active. Still, experts say, the research does suggest that mental activity might help slow the symptoms.

In general, I think the use it or lose it admonishment is true, says Dr. Jeffrey Cummings, director of the Alzheimers Disease Center at the University of

California, Los Angeles.

But mental stimulation isnt the only factor thats been found to have an impact on Alzheimers. Studies have found that people with active social networks

are less likely to develop the disease. In a 2006 study, researchers examined the brains of people who had recently died for the characteristic plaques and

tangles of distorted protein. The researchers also had data on cognitive symptoms and how sociable people had been during their lives. What the

researchers found was surprising: Even among those with extensive plaques and tangles, Alzheimers symptoms were less severe if people had many

friends.

So, this makes the mental stimulation class a twofer because it also gives seniors more of a social life.

Experts suggest another lifestyle change that may help stave off symptoms: physical exercise. Both mouse and human studies show thatphysical exercise

may slow the disease, says Brian Christie, an associate professor in the division of medical sciences at the University of British Columbia in Victoria.

Christies research on Alzheimers mice has shown that regular workouts on an exercise wheel block the buildup of plaques and tangles. He and others

suspect that exercise works by increasing the flow of blood, nutrients and other substances that improve brain-cell survival. So exercising is like keepingthe garden watered, Christie says.

The mouse research has been backed up by studies that followed healthy seniors.

There is a very powerful dataset on exercise, says Cummings. One large study showed that exercising 30 minutes three times a week diminished the

risk of developing Alzheimers by 50 percent.

This still isnt proof. Theres a difference, experts say, between showing that people who exercise are less likely to develop Alzheimers and showing that

exercise actually slowed mental decline in those who already have the disease.
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Patients like Rothenberg arent waiting for the definitive studies, though.

Im doing whatever I can do, medication-wise, doctor-wise, health-wise, she says. I walk because I know its good for you. I do my exercises in the

morning. I try to stay fit.

Byways in the brain

Other researchers are looking for strategies that might allow people with Alzheimers to live independently for longer by rewiring the brain to circumvent

areas damaged by the disease. Its like choosing a side road when a major freeway is blocked.

As it turns out, there are different types of memory, explains David Loewenstein, a professor of psychiatry and behavioral sciences at the University of

Miami School of Medicine.

Information stored in episodic memory is like the narrative of a short story. This kind of memory depends on the hippocampus, a part of the brain hit

hardest by Alzheimers. The brain regions involved in another kind of memory procedural memory are less affected by the disease. Procedural

memory is what allows us to learn a foreign language or to ride a bicycle.

You dont have to think about it. It becomes automatic, explains Loewenstein, who is also director of research and neuropsychology at the Wein Center

at the Mount Sinai Medical Center in Miami.

In a pilot study, Loewenstein and his colleagues showed that you could teach Alzheimers patients skills that capitalize on procedural memory, bypassing

brain regions affected by the disease. The Miami researchers are now working on a larger study funded by the National Institutes of Health.

One example of a way to use procedural memory is by adding up the change received from a store clerk, Loewenstein explains. Normally a person would

try to do the math in her head, but that can be difficult for someone with Alzheimers. Theres an easier way, Loewenstein says. If you get change from a

$20 bill and count the bills you receive back to yourself, making sure it adds up to the original $20, you only have to remember how much money you

gave the clerk.

Loewenstein points to another example of using a side road in the brain to access information. People with Alzheimers often have problems remembering

names, he says. You teach them to associate the name with a facial feature that begins with the same first letter as the name, and it can make a huge

difference. So, if you met me you might say to yourself, this is David and he has dimples, Loewenstein explains. Then the next time you met me youd

say, Theres the guy with the dimples. Thats David.

Loewenstein also encourages patients to keep a memory notebook in which they write down names of people and places and review the events of the

day.

If this kind of training kept patients functional a year longer, the impact on people and the health-care system would be tremendous, Loewenstein says.

The effects of mental stimulation are obvious to Phyllis Blais and her family.

Blais is happy and alert when she comes back home, says her daughter, Susan Cuoccio. She always looks forward to going there, says Cuoccio, 49. And

when she comes back, theres a real excitement, a spark.

Blais will bring home word puzzles and sometimes mentions a particularly engaging speaker. Ill ask her about it to see how much she retains, Cuoccio

says. Im often surprised. She remembers a lot.

Linda Carroll is a health and science writer living in New Jersey. Her work has appeared in The New York Times, Newsday, Health magazine and

SmartMoney.

2007 MSNBC Interactive

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alzheimer's patients not going without a fight_26jul07

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