Learn about the differences between Alzheimer's and dementia, and how Alzheimer's disease progresses. We talk about why catching the disease early can make a big difference. Dr. Sharon Cohen and Dr. Yaakov Stern walk us through the stages of Alzheimer's disease, from when there are no symptoms to when memory issues start to show. They explain the stages of Alzheimer’s and how it develops over time. We also hear from Kelly, who explains her personal experiences and concerns about developing Alzheimer’s, and what she does about it.
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Rethinking Alzheimer’s Disease was made possible with support from Eisai Inc.
[00:03:10] What's the difference between Alzheimer's disease and dementia?
[00:07:04] When does Alzheimer’s begin to develop?
[00:09:08] What is Mild Cognitive Impairment (MCI)?
[00:10:36] What is subjective cognitive decline?
[00:11:59] What is preclinical Alzheimer's disease?
[00:13:13] Why is it important to detect Alzheimer’s disease early?
Disclaimer: The content provided in this podcast is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast. Reliance on any information provided by this podcast or its guests is solely at your own risk.
©2024 Mission Based Media Ltd • April 2024 • AD-M2059
[00:00:01] Kelly O'Brien: My dad was diagnosed at a relatively early age of onset for Alzheimer's.
[00:00:06] Dan Kendall: Meet Kelly. She was a caregiver for her dad.
[00:00:10] Kelly O'Brien: It was in his early 60s and I'm 56. And it's not lost on me that that's not that far away.
[00:00:17] Dan Kendall: Like millions of people around the world, Kelly worries that she could develop Alzheimer's like her dad did.
[00:00:23] Kelly O'Brien: I turned 50 and, as you get older, people say, oh, it's all downhill from here.
[00:00:28] Dan Kendall: Have you ever lost your car keys, or struggled to remember the name of the person standing in front of you? Have you quietly worried to yourself, am I starting to lose my memory? One of the concerns many people have as they age is whether they will someday struggle with dementia or develop Alzheimer's disease. Alzheimer's affects one in nine people over the age of 65 and in 2023, an estimated 6.7 million Americans, age 65 and older were living with Alzheimer's disease. And by 2050, that number is estimated to grow to nearly 13 million people.
These numbers may sound overwhelming, but fortunately researchers are making tremendous progress in understanding Alzheimer's disease, how it develops and its impact on the brain. Advances in diagnostics now allow doctors to detect and diagnose Alzheimer's earlier than ever before.
Emerging treatment options and empowering brain health strategies are rapidly changing the way we think about and treat this progressive neurological disease.
Welcome to the Rethinking Alzheimer's Disease Podcast. I'm your host, Dan Kendall. I'm not a medical professional, but like Kelly and millions of people all around the world, my family has been affected by Alzheimer's disease. I watched my grandparents slip into dementia. And one of my grandmothers lived her final years with Alzheimer's disease. Now, decades later, I find myself looking for signs about my parents' health as they age. I think about my brothers and sisters and my own health and I wonder if there's anything that I can do to prevent myself from getting Alzheimer's.
In the Rethinking Alzheimer's Disease Podcast, we share important information about how, and when Alzheimer's develops and what can be done about it. Throughout the series, we learn how to proactively take care of our brain health and we hear from experts, caregivers, and most importantly, we hear directly from people living with Alzheimer's disease.
I hope you'll be inspired and empowered from what they share, because, as you'll hear throughout this series, there's no time like the present to take action in your own health.
The Rethinking Alzheimer's Disease Podcast was created by Mission Based Media with support from Eisai. This series is for educational purposes only, and is not a substitute for formal medical advice, diagnosis, or treatment. The opinions expressed are the individual views of the speakers themselves and do not necessarily represent those of any organizations. If you have questions about a medical condition, talk to your qualified healthcare provider. For our list of resources about Alzheimer's disease, please visit healthunmuted.com/resources. All guests participated voluntarily and did not receive any form of compensation for their involvement.
[00:03:12] Dr. Sharon Cohen: People always ask, what's the difference between Alzheimer's disease and dementia?
[00:03:17] Dan Kendall: That's Dr. Sharon Cohen. She's a behavioral neurologist and the medical director of the Toronto Memory Program in Canada.
[00:03:24] Dr. Sharon Cohen: Dementia is a general term. It refers to a situation when a person has lost some ability and memory and thinking to the extent that they are no longer fully independent in their everyday activities.
[00:03:39] Dan Kendall: In other words, dementia isn't a disease. Dementia means that someone's thinking and memory has deteriorated to a point where their day-to-day activities are affected. Dementia is caused by diseases such as Alzheimer's.
[00:03:53] Dr. Sharon Cohen: Alzheimer's disease is a specific disease of the brain that causes dementia and it's characterized by a specific set of changes in the brain that can be identified and distinguished from other causes of dementia.
[00:04:07] Dan Kendall: There are over 100 different types of dementia.
[00:04:11] Dr. Sharon Cohen: There are many other causes of dementia, including Parkinson's disease, head injury, stroke, brain tumors, and they all have different features.
[00:04:20] Dr. Yaakov Stern: Alzheimer's, by far, is the most common dementia that people will have. Early on, it could be very subtle.
[00:04:28] Dan Kendall: That's Dr. Yaakov Stern, a cognitive neuroscientist and professor of neuropsychology at Columbia University.
[00:04:35] Dr. Yaakov Stern: As the disease advances, it just gets worse and worse. We have what we call the basic activities of daily living that start to be affected; eating, dressing and toileting. By the end stage of the disease, a person can't talk and can't walk.
[00:04:52] Dan Kendall: To understand how Alzheimer's disease causes changes in the brain, we first need to learn about two specific proteins.
[00:05:00] Dr. Sharon Cohen: There are two bad actors in Alzheimer's disease that constitute the main pathology of the disease. One is amyloid, the other is tau. Amyloid is the earliest change in the brain. This is a protein that is sticky and it forms clumps in the brain. And these clumps then are toxic to the brain, but when they reach a certain density, they also trigger another protein to become abnormal. So amyloid accumulates outside of the brain cells, within the brain, but outside of the brain cells, but tau starts becoming abnormal within brain cells, and it stops performing its important function of maintaining the structure of the brain cell and starts misfolding, forming clumps and becoming abnormal and spreading from one cell to another, causing the next cell to become abnormal. So with amyloid and tau, we have sort of double injury to the brain and we start to affect memory, language abilities, and other thinking abilities.
[00:06:09] Dr. Yaakov Stern: These pathologies are disturbing how the brain works. They tangle up the communication of the brain from one place to another. They're not the only pathologies that are there with Alzheimer's disease, but they're the two major ones. Typically plaques start first and then, sometime later, these tangles start to emerge. We typically see Alzheimer's maybe in sixties, seventies, but some people will get it younger, even in their fifties.
[00:06:35] Dan Kendall: When someone is diagnosed with Alzheimer's disease before the age of 65, it's referred to as young onset Alzheimer's disease, or sometimes, early onset Alzheimer's. Fortunately, only a very small number of people develop symptoms in their forties or fifties. However, even though symptoms may typically appear after the age of 65, research has shown that the biological changes in the brain that lead to an Alzheimer's diagnosis actually start developing up to 20 years before symptoms appear.
[00:07:04] Dr. Sharon Cohen: People are often surprised at how long a disease this is and how early it starts before there are symptoms. And it's actually a little intimidating to think that people in their 70s are developing the disease in their 50s.
Amyloid builds up early and after many years of amyloid accumulation, we see tau accumulate. And tau starts accumulating a few years before symptoms, but it predicts that people will develop symptoms.
[00:07:35] Dan Kendall: Scientists now believe that this period of amyloid and tau accumulation offers a treatment window that can change the course of developing Alzheimer's.
[00:07:44] Dr. Sharon Cohen: We do think, in most fields of medicine, that detecting a disease early will be the best way to approach it and will give us the better outcome. So if we can catch it early, the way we do with so many other diseases, with cancers, we don't wait until a lump becomes large. We try and get those few cancer cells early. The same with Alzheimer's,
if we can identify early, when tau is very low or just amyloid is accumulating, then we may have the best opportunity to prevent people from going on to symptoms, if we're talking about a prevention paradigm.
[00:08:21] Dan Kendall: Too often, however, people don't seek medical help, at the early stages of Alzheimer's disease. They wait until their symptoms have progressed to a point where they notice something is wrong.
[00:08:32] Dr. Sharon Cohen: Alzheimer's disease does have stages. Different people describe different stages, but now that we understand that this is such a long disease, we often describe it as having the preclinical stage, the mild cognitive impairment stage, and the dementia stage. And the dementia stage is often divided into mild, moderate, and severe dementia.
[00:08:56] Dan Kendall: The dementia stage is what many people think of when we hear the word Alzheimer's. However, the preclinical stage and mild cognitive impairment stage are earlier stages of the same disease.
[00:09:07] Dr. Sharon Cohen: Mild cognitive impairment is a state in which individuals notice a change in their memory and thinking. It is noticeable to the individual and can be detected on testing by a healthcare practitioner. However, the symptoms are mild enough that the individual is still independent in everyday activities. So they may still be working, driving, banking, shopping, traveling, whatever it is they normally would do, they are still able to do.
Somebody with mild cognitive impairment may be frustrated, may have to employ some additional compensatory strategies to keep themselves going, making lists more or relying on calendars more, but they are still able to do their activities independently.
[00:09:57] Dan Kendall: Since Alzheimer's is a disease that impacts the whole family, it's during this mild cognitive impairment phase, or MCI phase, that close family members may start to express frustrations or concerns. We'll hear more about the early symptoms of Alzheimer's in episodes three and four of the series.
[00:10:16] Dr. Sharon Cohen: Family members may notice a change. They likely will, because this isn't the most subtle earliest change. When you get to the stage of mild cognitive impairment, there is a definite impairment, be it in memory, or language ability, or other thinking abilities, but the person is still able to compensate.
[00:10:36] Dan Kendall: It's important to know that mild cognitive impairment, or MCI, can be caused by several different conditions. So being diagnosed with MCI, doesn't always mean Alzheimer's. We'll cover this more in episode four, when we discuss how Alzheimer's is diagnosed.
So if mild cognitive impairment is when the changes are noticeable and appear on tests, is there a stage before these symptoms appear?
[00:11:04] Dr. Sharon Cohen: Yes, there is. So in terms of symptoms, we talk about subjective cognitive decline as a stage that describes an individual who notices a decline. It could be memory, it could be language ability, again, different aspects of thinking, but they come to me and they say, "Hey doc, something's really changed, I'm not remembering things as well."
I do the testing and the score is normal. So I say, “okay, I'm not picking up the abnormality, but you know yourself. I believe you if you say something's changed. I can't see it on my test.”
We call this subjective cognitive decline, because the person subjectively feels something's going on. It doesn't mean it's all in their heads, it means it's real. They have symptoms, but on objective testing, they're still cognitively normal. And we think that this is a stage prior to mild cognitive impairment.
[00:12:00] Dan Kendall: We now know that mild cognitive impairment, or MCI, is when other people may start to notice changes in memory or thinking, and that decline can be measured in tests. Before MCI, an individual may experience subjective cognitive decline. That's when a person feels that something is different, but that difference doesn't appear in the test results.
Scientists now understand that there's a stage of Alzheimer's disease that starts years before any changes to memory or thinking. This stage is called preclinical Alzheimer's disease.
[00:12:34] Dr. Sharon Cohen: Preclinical Alzheimer's disease is the stage of Alzheimer's that describes the development of brain changes without the manifestations of symptoms. So it's the earliest change. "Preclinical" because there are no clinical signs and symptoms, but the brain is changing. Amyloid is accumulating, tau may be becoming abnormal, and brain cells are being lost. So these proteins injure the brain, they injure connections between brain cells, and we start to lose brain cells in vital areas of memory and thinking.
[00:13:12] Dan Kendall: Although it may be tempting to take a "wait and see" approach or simply avoid having the discussion with a healthcare professional, it's important to detect Alzheimer's disease early to give more time to discuss and consider any potential interventions.
[00:13:29] Dr. Sharon Cohen: And now we're seeing that it's so important to come forward early, because there are things we can do. We don't yet have a cure, but we can slow down the disease if we catch it early and keep people functioning better, keep people at home with better quality of life than if we ignore the disease.
[00:13:48] Dan Kendall: We met Kelly O'Brien at the beginning of this episode. Kelly is an Ironman triathlete and she competes at an elite level.
[00:13:57] Kelly O'Brien: I got lucky and got qualified for not one, but two world championships.
[00:14:01] Dan Kendall: She works hard to keep her body in peak physical shape. And she'll tell you that exercise also helps to keep her feeling mentally sharp. Her experience being a caregiver to her father, made her want to learn more about how to preserve and protect her brain health.
[00:14:16] Kelly O'Brien: For example, when I go to my primary care doc, when she asks me, “What are you interested in?” Or, “What are you concerned about?” I specifically say, my cognitive wellbeing.
[00:14:24] Dr. Sharon Cohen: As patients and consumers of the healthcare system, we deserve to know what's wrong with us. And we shouldn't be shy about asking. And if we're worried about Alzheimer's, speak up and say, “I'm worried about this, is there something you can do for me?”
[00:14:38] Dan Kendall: Treatment options are available. So seeking an early diagnosis of Alzheimer's disease can be beneficial.
[00:14:45] Dr. Sharon Cohen: I tell my patients that they did the right thing coming to get this checked out, and I take them seriously, they know themselves, whatever they tell me, I'm listening.
[00:14:57] Dan Kendall: People like Dr. Cohen, Dr. Stern, Kelly O'Brien, and thousands of others are working to slow and eventually stop Alzheimer's disease. New discoveries and technologies help medical professionals diagnose more accurately and earlier. Stay with us as we continue to learn more about Alzheimer's and what can be done about it in our next episode.
On the next episode of the Rethinking Alzheimer's Disease Podcast.
[00:15:23] Kelly O'Brien: I remember going and they said, "Genes are a risk factor, they're not a determining factor." And I burst into tears. I just thought, "Oh, my God, I thought that I was going to get this because my dad had it."
[00:15:34] Dan Kendall: We'll find out what are the risk factors for Alzheimer's disease? Are there things that we can do to keep our brains healthy?
This is the Rethinking Alzheimer's Disease Podcast, hosted by me, Dan Kendall. This show is part of the Health UNMUTED audio library by Mission Based Media and was created with support from Eisai. To listen and learn more, visit healthunmuted.com/resources and follow our show on your favorite podcast player.