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Alzheimer’s Disease: It Is Time to Join the Fight

By Jeffrey M. Burns, MD, neurologist

Jeffrey Burns, MDAlzheimer’s disease is a diagnosis physicians are loath to communicate. It is common to dismiss symptoms as natural signs of aging and assume treatment will not make a difference. But some treatments can have benefits. Physicians can help their patients by recognizing, diagnosing and treating the disease and encouraging them to join the fight against it by participating in research.

Recognition is key

Listening to family members discuss the patient’s behavior is the first step. The earliest, most accurate detector is someone who lives with the patient. Primary care physicians can best recognize the disease through a full, uninhibited history from a family member, without the patient present.

Patients themselves can easily fall into denial and assume everyone has memory complaints as they age. We must not presuppose that everyone declines with age. Ageism is a mistaken bias.

Low-tech diagnosis

Patient history is still the most important diagnostic tool, followed by MRI or CT and blood testing for B12 and thyroid function to rule out other potential causes.

Treatments that make a difference

Two types of medication are approved for treatment. The first is cholinesterase inhibitors, such as Aricept® or donepezil, which can help stop acetylcholine from breaking down. These are the standard of care in early stages of the disease.

The FDA also has approved the addition of Namenda® or memantine hydrochloride at moderate or severe stages of the disease; it is not effective in earlier stages. This drug blocks the action of glutamate.

No medication can stop disease progression, but they can slow it down. They also can result in behavioral benefits, such as lessened agitation and better cooperation.

We often argue about how much help these drugs provide. They clearly do not help enough, and we must seek better treatments. Most importantly, we must learn more about prevention. And that is where community physicians can play a vital role.

Although the number of patients with Alzheimer’s is rapidly increasing, we are experiencing a chronic shortage of participants for clinical trials and research. Those who are interested must be urged to join the fight.

Prevention research shows promise

Many studies – including those conducted by the University of Kansas Medical Center – have shown that what is good for the heart is generally good for the brain. So patients interested in lowering their risk for Alzheimer’s should follow the classic advice for improving heart health:
  • Get regular, moderate exercise
  • Eat a heart-healthy diet
  • Control hypertension
  • Manage BMI
  • Control cholesterol

Leading research on exercise effects

A major theme of our research is prevention through risk-factor reduction – namely exercise. We just completed two NIH-funded, randomized, controlled clinical trials to examine the effect of aerobic exercise on cognitive function and biomarkers. A six-month dose-response trial (n=101) suggests cognitive benefits at low doses of aerobic exercise (75 minutes per week), and the benefits may increase with exercise dose. The best predictor of cognitive gain, however, is increased cardiorespiratory fitness (VO2 peak). The optimal exercise “dose” may thus be individualized to maximize gains in fitness rather than time spent training.  

Another trial of exercise in individuals with early Alzheimer’s disease (n=43) suggests that aerobic exercise moderates hippocampal atrophy and thus may influence the neurodegenerative process. Our recently initiated RCT assesses the effect of exercise on biomarkers (brain atrophy and in-vivo amyloid load) among those in the preclinical Alzheimer’s disease stage.

Exercise also may reduce risk in asymptomatic patients

We are the first organization in the world to research the effects of exercise as a predictor of future disease in people who have an abnormal amyloid load with normal brain function.

One in three people over age 65 have abnormal amyloid plaque buildup. But not all of them get Alzheimer’s disease. We are also conducting a one-year study on whether exercise can affect the risk for these people. We will continue recruiting for this study through 2018.

In addition, we are participating in the national A-4 study of a new anti-amyloid drug in asymptomatic patients.

Prevention program targets interested patients

In addition to research, the University of Kansas Alzheimer’s Disease Center sponsors Smart Aging classes to take this knowledge about lifestyle factors and other means to improve and maintain brain health and pass it on to members of the community.

Graduate students present the material and help ensure that class attendees follow some of the advice they receive. They assist interested seniors in sorting through a deluge of information and recommendations in the media and elsewhere.

How can we help?

The Alzheimer’s Disease Center is here to develop new drugs and test new prevention strategies. Referral to our Memory Care Clinic is not required for consideration for a trial. Interested patients can simply call the research number, 913-588-0555, or fill out a form online at kualzheimer.org, and a recruitment coordinator will work with them to determine eligibility and obtain the necessary records.

Dr. Burns is a board-certified neurologist at The University of Kansas Hospital. He also serves as the Edward H. Hashinger professor of neurology at the Alzheimer’s Disease Center at the University of Kansas Medical Center. Dr. Burns is the co-director of the University of Kansas Alzheimer’s Disease Center and also directs the Frontiers Clinical and Translational Science Unit and the Alzheimer and Memory Care Clinic.

To consult with one of our neurologists, please call 913-588-5862, or toll free 877-588-5862. Or, contact us online.