Doc: I fear losing my memory more than anything else. What can I do to not get Alzheimer's?
A: It is a fear a lot of people have and I hear it almost everyday. A recent expert in the field actually addressed this very question.
Dr. Kristine Yaffe, professor of psychiatry, neurology and epidemiology at the University of California, San Francisco gave the 2014 AAGP Distinguished Scientist Award Lecture in Orlando recently.
The AAGP is the American Association for Geriatric Psychiatry - a group that is keenly interested in the "epidemic in dementia", its causes, and its treatments. Part of the reason we are seeing such an increase is that people are living longer into their 80's and 90's. She also addressed other contributing causes.
According to Dr. Kaffe, up to half, not all, of all the cases of Alzheimer's disease are attributable to seven modifiable risk factors.
The list includes depression, diabetes, smoking, midlife obesity, midlife hypertension (high blood pressure), low educational attainment and physical inactivity. It doesn't take long to see a lot of people are at risk.
Three things really caught my attention from Dr. Yaffe that weren't actually included in the seven risk factors that she mentioned. She did not mention post-traumatic stress disorder and traumatic brain injury as risk factors, even though she has been a leader in identifying these as risks. The third point is - what about the other fifty percent of Alzheimer's cases? Is there any hint of a clue?
It has been well documented that some people with normal memories have had changes noted on autopsy that would be consistent with Alzheimer's disease. Therefore, the presence of the physical changes in the brain is not always consistent with memory changes.
Also, many of us can easily think of someone we know who was highly intellectual, extremely active, non-smoker, lean and not diabetic who succumbed to Alzheimer's disease. My grandmother comes to mind for me, along with several patients I have known over the years.
My grandmother on my mother's side of the family could work circles around most anyone well into her 80's. She would sit at the dinner table hardly eating looking around the table for something someone needed, or might need, or something my grandfather would soon command she immediately jump from the table and do.
(I still remember how he would never ask her to refill his tea glass. He wouldn't ask because all he did was tap one finger on the rim of his tea glass at the table and she would jump up to refill it in a swift blur. I tried that once with my wife shortly after we were married. Once. Not twice.)
Her diet was lean, and mostly grown on the farm. She never smoked, read whenever she sat down at night, and never complained. She was the kind of person who never saw herself when she looked in the mirror. She only saw what could be done for someone else.
But living with my grandfather was a challenge. When he died she opened up to caring for others in the community and quilting - until her own memory began failing. Her body was so healthy that she lived many years in the prison of dementia. Even then, the nursing home staff could put towels next to her and she would fold them happily for hours.
It is the unknown that is so frightening. Was it her hearing loss (a known contributor)? The chronic stress of living with a challenging spouse? Or was is something common in the world we live in that we don't even recognize?
The longer I practice medicine, the more I believe chronic stress, but especially traumatic events during the older years, contributes significantly to memory decline. It is almost as if the mind builds a wall to protect itself from further pain. Unfortunately, stress, and how a person responds to it, is difficult to measure and even more difficult to treat.
Nevertheless, the fear of the unknown causes should not keep us from changing the known causes. If a person is sitting in their worn out recliner with cigarette burns in the upholstery , hasn’t read a book in years, and is resting their bowl of ice cream on the top of their insulin injected belly, well, there are some steps that can be taken to reduce the risk of Alzheimer's disease.
But there are steps we all can take, too. We can't let the fear of the unknown causes deter us from facing the known causes and making an effort to reduce them. It is a habit we should remember to do every day.
Eric J. Littleton, M.D. is a Family Physician in Sevierville, TN. His new office is located at 958 Dolly Parton Parkway. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com.
