NYT: An Early Sign of Alzheimer's Brings Fear, and New Insight

[janet paterson <janet313@xxxxxxxxxxx>]

hi all

ono
more brain imaging in vivo!

i am glad to see another neurological disease
coming out of the closet

but i read science articles by gina kolata with a grain of salt now

i wonder at the blanket statement
"Nothing has been shown to slow brain cell death."

i wonder how the many studies showing
the brain adapting and growing new neuron pathways
(under certain circumstances) fit into the above

the anxiety that sometimes accompanies depression
can also play self-fulfilling havoc with our cognition and memory

so, for whatever it's worth ...

janet

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An Early Sign of Alzheimer's Brings Fear, and New Insight

June 2, 2002 - Until recently, a patient like Carolyn E. Hoard would never
have been told she was progressing toward Alzheimer's disease.

A 61-year-old mental health counselor in Kittanning, Pa., she reported
nothing more than a mild loss of memory, particularly when it came to
recalling what someone had said in conversation a few minutes ago. Her
first neurologist told her she was fine.

But the memory lapses persisted, and Ms. Hoard went to a second
neurologist, who gave her the news she had been dreading: she suffered from
mild cognitive impairment, usually the first sign of Alzheimer's disease.

The term is new, having entered the vocabulary of memory specialists in the
late 1990's.

Now more and more doctors, combining tools as sophisticated as brain
imaging and as simple as a short test of word recall, are making the
diagnosis.

Researchers and drug companies say the new category will enable them to
track the progression of Alzheimer's disease and understand it better.

They are already testing a wide array of treatments in these patients ?
from vitamins to hormones to new drugs as well as drugs already approved
for Alzheimer's.

"If we in fact can intervene at this earlier stage and alter the course of
the disease, that would have a big impact on quality of life," said Dr.
Ronald Petersen, who directs Alzheimer's research at the Mayo Clinic in
Rochester, Minn.

The signs of mild cognitive impairment are an inability to form memories
for events that just happened and a slight shrinking of the hippocampus,
the area of the brain where these memories are laid down.

On a memory test, a patient may be able to repeat a string of unrelated
words ? red, Oldsmobile, cabbage ? but then fail to recall even one of them
10 minutes later.

No one knows how many people have the condition. While an estimated four
million Americans have Alzheimer's disease, studies to determine the
incidence of this milder disease that precedes it are only starting.

But doctors say the new diagnosis is changing the landscape of Alzheimer's,
giving rise to a growing class of patients with what Dr. Steven DeKosky,
director of the Alzheimer Disease Research Center at the University of
Pittsburgh, calls a sword of Damocles over their heads. Their prognosis is
not good.

Mild cognitive impairment may be caused by other disorders, especially
depression.

But when no such cause is found, it has been shown in studies to lead to
full-blown Alzheimer's, with its additional impairments in reasoning and
thinking, in at least 80 percent of cases.

Patients with mild cognitive impairment progress to Alzheimer's at a rate
of 12 percent to 15 percent a year, the studies show; for people of similar
ages without mild cognitive impairment, the rate is about 1 percent a year.
Nothing has been shown to slow brain cell death.

But doctors and patients alike say the new diagnosis holds one other bright
spot: it is giving a new, first-person voice to Alzheimer's, allowing
patients to talk about the disease before it robs them of the ability to
understand that they have it.

"The problem with dementia has always been that it is so foreign and so
frightening that the impulse is to recoil from it," said Dr. Alan Dienstag,
who coordinates psychology research for the New York chapter of the
Alzheimer's Association.

Now, patients whose impairment is still relatively mild are starting to
tell their stories, he said. "We're on the cusp of seeing a really
substantial change," he added.

Dr. Petersen, of the Mayo Clinic, says mild cognitive impairment was
discovered almost by accident. His group was studying patients who came in
for routine care, looking for those who had complained, or whose family
members or doctors had noticed, that they were getting forgetful.

The Mayo Clinic doctors studied these patients and discovered that their
memory impairment was very specific ? their only problem was remembering
experiences of the last few minutes or hours or days.

In a typical test for mild cognitive impairment, a patient is asked to
repeat a string of unrelated words. The tester goes on to ask other
questions: multiply 5 by 13, name the first president and the current
president. At the end, the patient is asked to recall the unrelated words.

A person with normal memory may falter, but given a hint (for example, that
one of the words was a color) might reply, "Oh, yes, a red Oldsmobile with
a cabbage inside."

But a person with mild cognitive impairment is not helped by hints, said
Dr. Jeffrey Cummings, director of the Alzheimer's Disease Center at the
University of California at Los Angeles, "because the memory was never
stored."

People with Alzheimer's disease are much more impaired. They may have
trouble interpreting what they are reading or writing a grammatically
correct sentence. They have trouble concentrating, reasoning and doing
simple math problems. They have trouble in their daily lives, often getting
lost when they drive a car.

Alzheimer's can also rob patients of self-insight ? the ability to
recognize what is wrong with them.

Many medical investigators believe that this is a consequence of
deterioration in the cells in the brain's temporal lobe, where insights are
formed.

But patients with mild cognitive impairment still have insight, and they
and their doctors say it can be a curse. They know too well what the future
may hold.

"Many have family histories and they have watched the disease process play
out in close family members," Dr. Petersen said. "That's very frightening.
We see depression, anger, `Why me?' We see anxiety develop because people
start to lose their grasp of things."

Many take drugs that have been approved for Alzheimer's or take substances
like vitamin E that researchers hope might help. But for now, Dr. Petersen
said, "there have been no clinical trials that demonstrate that anything
works or doesn't work ? they are all under way."

Yet patients like Ms. Hoard can describe their lives in a way that people
with Alzheimer's cannot. Life, as she describes it, can be achingly lonely.
Even keeping up with a conversation can be a struggle because she cannot
remember what was just said.

"You feel like no one really understands," she said. "They say: `Everyone
forgets. There's nothing wrong with you.' You just want to go: `But you
don't understand. It's not that kind of thing.' "

In a telephone interview, Ms. Hoard explained that conversations could be
difficult and asked if she could send the interviewer a letter about her
experiences.

"Just when you want to assert yourself and have some good confident
`self-talk' going," she wrote, "you `forget' some important detail or
realize you've asked your spouse or friend the same question three or four
times and they are tired of giving the answer over and over! You want to
hide away somewhere and just cry sometimes."

She feels she is in no man's land. "You are not the confident, competent
person you once were, but neither are you debilitated. Knowledgeable
professionals begin to bypass you and give pertinent information and eye
contact to your caregiver."

Even those with mild cognitive impairment struggle with the stigma of
Alzheimer's. "It's like alcoholism," Ms. Hoard said ? denied and hidden by
family members and patients.

Many, like a retired financial planner in Pittsburgh, have not told anyone
outside their immediate family. The man explained, "I try to still maintain
an image that I'm a normal person."

Thomas DeBaggio, 60, a herb grower in Arlington, Va., received a diagnosis
of Alzheimer's three years ago, when he was only mildly impaired. He says
that when he learned of his diagnosis, the local chapter of the Alzheimer's
Association asked him to talk with another new patient.

"I called and his wife answered the phone," said Mr. DeBaggio, the author
of a new book, "Losing My Mind: An Intimate Look at Life With Alzheimer's"
(Simon & Schuster). "I said who I was and that I had been asked to call
him. She said: `He doesn't want to see you. He doesn't want to talk to you.
Goodbye.'

"That told me a whole lot about Alzheimer's," Mr. DeBaggio said. "It's a
disease you hide."


By Gina Kolata
Copyright 2002 The New York Times Company |


janet paterson: an akinetic rigid subtype, albeit primarily perky, parky
pd: 55/41/37 cd: 55/44/43 tel: 613 256 8340 email: janet313@xxxxxxxxxxx
smail: 375 Country Street, Almonte, Ontario, Canada, K0A 1A0
a new voice website: 

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