When neurologist Serge Gauthier first appeared in The Senior Times in its early days, Alzheimer’s was thought to mostly affect old people, a consequence of strokes, and was described then as senile dementia.
Dr. Gauthier and other specialists pursuing research into Alzheimer’s then began to describe it as a disease, mostly due to amyloid deposition in the brain.
Current thinking is that Alzheimer’s results from a combination of factors, such as small, mostly silent strokes added to age-related changes within the nerve cells (tau fibrils) and outside the nerve cells (amyloid fibrils), and chronic neuroinflammation, Gauthier tells The Senior Times.
Dr. Gauthier, an expert in the field, is a professor of neurology and neurosurgery, psychiatry, and medicine at McGill. He is director of the Alzheimer Disease and Related Disorders Research Unit of the university’s Research Center for Studies in Aging at the Douglas Mental Health University Institute.
Current treatments for the disease aim at restoring neurotransmitter balance in the brain, mainly by increasing levels of acetylcholine – an organic chemical released by nerve cells that sends signals to other cells.
Treatments are evolving and, Dr. Gauthier reports, new drugs are being tested to amplify this effect. Other drugs under testing are designed to reduce the amounts of the protein called tau and amyloid fibrils in the brain, or to decrease inflammation. Further, the public should understand that dementia is a stage of Alzheimer’s Disease, which is the most common cause of dementia, but not the only one. The pathology of Alzheimer’s disease can be silent in the brain, resulting in no symptoms for up to 20 years.
He notes that not everyone with the Alzheimer pathology has symptoms of the condition, because of such compensatory factors as “brain reserve” – the result of education, good genes, and other factors under study.
Dr. Gauthier teaches, does clinical work, and conducts research, but he also makes a point of participating in public education, as he did last month in an informative talk at the Alzheimer Society of Montreal. He laces his delivery with humour, giving his discussion of the evolving science an aura of humanity and hope.
Among the points he made in his talk:
• Concerned baby boomers account for about half the people taking part in memory clinics. There are some 30 such clinics in Quebec.
• While memory loss is part of ageing, “when you stop looking at the calendar, there is a
problem. When your daughter keeps track of your appointments, there is a problem. We’re talking about a gray zone it’s not black and white.”
• There are seven stages in the progression of Alzheimer’s disease, the third involves cognitive issues, which indicate decline, but can remain stable. When dementia sets in and help is required, you get to stage five, meaning you cannot live alone. Stage six includes incontinence and at stage seven you cannot walk.
• Signs of memory loss include not knowing the word for a common object, not finding your keys, or hat, or glasses, forgetting why you went to the basement, or names of people you know, but these do not necessarily indicate Alzheimer’s onset – you could be lacking sleep.
• One of the tests to indicate whether you have Alzheimer’s symptoms is called the Montreal Cognitive Assessment, available online at
mocatest.org. There is an important distinction to be made between attention deficit and failure to comprehend.
• Once early symptoms appear, 15 per cent will show some deterioration; after five years, half will show signs of dementia. The risk of progression is higher if you carry the gene ApoE4, discovered by Dr. Judes Poirier, a McGill Univerisity professor of Medicine and Psychiatry and senior scientist of the Canadian Institute for Studies in Aging Research.
• Hopefully, in a few years a cocktail of medication tailored to every patient’s needs will slow down the evolution of the disease.
• Not everyone who has Alzheimer’s will develop dementia – you could die first, or benefit from protective factors in your body. Less than half of those who have mild cognitive impairments will have Alzheimer’s.
• One-third of patients who have Alzheimer’s in the early stages need an antidepressant, and a new one called Trintellix can help with memory issues. As Alzheimer’s progresses, other classes of medication will be prescribed.
• On the preventive side, stay in school as long as possible, or go back to school, take courses. Start power walking, at least three times a week – it’s beneficial for your brain. More exercise and less smoking are associated with a lower risk of dementia.
• There is evidence that the “Mediterranean Diet” is good to prevent heart attacks and strokes, and therefore should also help prevent dementia, but this is not fully demonstrated.
• Married men not only live longer they also experience fewer Alzheimer’s cases than those who live alone. If you are a single man, “get a girlfriend,” Dr. Gauthier said with a smile.
• Intellectual stimulation and social interaction contribute to delaying the progression of symptoms.