Facing The Inevitable: From Lost Keys To Dementia

I recently turned 50 and, on cue, my AARP card came in the mail and my doctor told me to schedule my first colonoscopy.

Also on cue, I’ve noticed what seems to be my own increased mental scattered-ness — misplaced keys, sluggish name recall. As a catastrophizer, I immediately link this apparent (but my doctor assures me normal) ever-so-slight decrease in cognitive sharpness to full blown Alzheimer’s and the start of a bleak, diminished future.

I am slightly comforted by two factors. First, I’m hardly alone. As Michael Kinsley eloquently reports in his recent New Yorker piece, “Have You Lost Your Mind?” we baby boomers are the first generation to have witnessed our parents cognitive decline and know in terrifying detail what’s in store for us; but at least we’re all on this sinking ship together. Second, there’s a lot of genetics behind Alzheimer’s and cognitive decline, and in that department, I’m not in bad shape. My parents kvetch, but they’re both nearly 80 and my mother, in particular, lives an incredibly active life on her own in Brooklyn: she recently learned chess, ushers off-Broadway with friends most weekends and walks and does yoga everyday.

joeduty/flickr

joeduty/flickr

Also, researchers are busily trying to tackle this problem on numerous fronts. On Sunday, for example, Harvard scientists reported what felt like a breakthrough: a new protein that in mice seems to have a rejuvenating effect on brains and muscles.

And a fairly technical study just out in Biological Psychiatry also hints at the possibility of future fixes: using something called “imaging genetics” researchers at the Lieber Institute for Brain Development and the National Institute of Mental Health are trying to identify “key molecular switches that control age-related memory impairment” and are specifically looking at a protein known to play a role in human memory, called “KIBRA and the gene responsible for its production.”

Here’s more, from the news release:

Scientists are seeking to identify key molecular switches that control age-related memory impairment. When new molecules are identified as critical to the process of memory consolidation, they are then tested to determine whether they contribute to the memory problems of the elderly…

Using imaging genetics, a method that combines genetics with brain imaging technology, the team [led by senior author Dr. Venkata Mattay] explored the effect of a variant in the WWC1 gene on age-related changes in memory function. The particular WWC1 variant under investigation has three potential forms – CC, TT, or CT.

They recruited 233 healthy volunteers, who ranged in age from 18-89 years. The volunteers completed a battery of cognitive tests, underwent genotyping, and completed a memory task during a brain imaging scan. They found that individuals who carry the T allele, as either CT or TT, performed better on the memory task and showed more active engagement in the hippocampus, a vital brain region for memory, with increasing age.

More hope: according to report in Kaiser Health News, the Affordable Care Act now requires Medicare to cover cognitive impairment screening at annual wellness visits. The downside, of course, is that there’s no cure for Alzheimer’s, nor any truly astounding treatment, so while screening might alert you to potential problems, there’s little you can do about them. As KHN reports:

The Alzheimer’s Association recommends seniors undergo cognitive impairment screening and evaluation to establish a baseline for comparison, and then have regular follow-up assessments in subsequent years.

There is no cure for Alzheimer’s disease. Some drugs, such as Aricept, may improve memory or other symptoms temporarily, but no medical treatment halts or reverses the disease.

That is a key argument against large-scale routine screening of people older than 65, says Ariel Green, a geriatrician at Johns Hopkins Bayview Medical Center. “We don’t have studies that show that such a screening program improves the care of people with dementia,” she says.

And if all else fails, there still may be ways to dampen the terrible blow of dementia. A small study suggests that elderly patients with Alzheimer’s might benefit from, of all things, hanging out with horses. From the Ohio State University news release:

…people with Alzheimer’s were able to safely groom, feed and walk horses under supervision—and the experience buoyed their mood and made them less likely to resist care or become upset later in the day.

The small pilot study, which appears in the journal Anthrozoös, suggests that equinetherapy—a treatment used today for children and teens who have emotional and developmental disorders—could work for adults, too.

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