The Local Fight Against “The Greatest Global Health Care Challenge of the 21st Century”

Pictured Above: Amyloid PET Scan imaging, which detects the plaques that cause Alzheimer’s Disease in the brain, is a crucial diagnostic tool that remains uncovered by insurance companies.

Alzheimer’s Disease is well on its way to becoming the “greatest global health care challenge of the 21st Century,” says Dr. Christopher Christodoulou, a neuropsychologist at the Stony Brook Center of Excellence for Alzheimer’s Disease, echoing an alarm being sounded around the world by Alzheimer’s researchers.

The disease causes a long-term decline in cognitive abilities and motor function and is ultimately fatal. It is is currently affecting 47 million people worldwide, nearly 6 million in the U.S. and 54,000 people on Long Island. And as people live longer, these numbers are expected to rise.

Dr. Christodoulou gave a presentation on the latest research in preventing Alzheimer’s Disease, organized by Stony Brook Eastern Long Island Hospital, at Peconic Landing Dec. 18.

While the greatest risk factor for Alzheimer’s Disease is advanced age, Dr. Christodoulou points out that, contrary to some public opinion, Alzheimer’s is not a normal part of aging. And while there is no treatment that can stop Alzheimer’s, early detection and lifestyle changes can help people with the disease lead much fuller and more enriching lives.

While no new Alzheimer’s medications have been approved in the last ten years, and those that have been approved merely temporarily slow the progression of the disease, there is a growing consensus among researchers that exercise holds a big key to not only preventing Alzheimer’s, but also improving the lives of people who already have the disease.

“Until the 1990s, we thought that, as adults, we don’t grow any new brain cells, but it turns out the brain does create new cells in the hippocampus,” he said. “Exercise encourages this new cell growth.”

“Exercise is not only a preventative measure for dementias, but it can also be used to treat cognitive symptoms as well,” he added. “People who do aerobic exercise are able to do more cognitive tasks and learn new information better than those who don’t exercise. The size of the effect is larger than any of the medicines we have. Exercise is the best medicine.”

Dr. Christodoulou added that “treating vascular risk factors is very important,” both in prevention and treatment of Alzheimer’s, but also in other forms of dementia like vascular dementia, the second most common form of dementia that is often co-occurring in patients with Alzheimer’s.

Doctors tend to see three overlapping areas of concern as they look to prevent and treat Alzheimer’s Disease: Increasing the brain’s cognitive reserve, reducing brain damage and reducing brain inflammation. 

Activities that help increase the brain’s cognitive reserve include preserving hearing — hearing loss is often co-occurring with the onset of Alzheimer’s — continued education and cognitive training.

Depression is also a major factor — and it is often one of the earliest signs that someone may be developing Alzheimer’s Disease.

“They’re not mutually exclusive, and each is a risk factor for the other,” he said. “Treating depression can help improve cognition.”

A Mediterranean diet — with lots of vegetables and fruits, olive oil, fish, limited red meat and herbs instead of salt, has been widely touted to help prevent Alzheimer’s Disease. While research on diet is difficult to do — it requires that people eat what researchers tell them to eat over a long period of time or even a lifetime, this type of diet is known to reduce brain inflammation and damage. People who live in cultures where these diets are the norm tend to score better in overall cognition as they age, he said.

Dr. Christodoulou says that exercise, diet, cognitive training and management of vascular and metabolic risk factors are the key to preventing Alzheimer’s Disease, as documented by the researchers who published the landmark 2017 Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability.

As people age, they often wonder if the cognitive changes they are experiencing are normal parts of aging, or if they are signs of Alzheimer’s Disease, said Dr. Christodoulou. These distinctions can be difficult for an observer without experience to discern.

With age, a person whose brain is functioning normally will often feel a decreased ability to retain new information or keep their attention focused on a topic at hand, and will also have difficulty with tasks that require cognitive flexibility and fluid reasoning, he said. These changes are to be expected in people who have done many of their daily tasks so many times that they can do them on autopilot.

But changes in memory due to dementias are more specific, he said. They often first manifest themselves when people develop confusion with time or place or scheduling their daily activities, often asking their loved ones the same questions over and over. 

“What’s the plan?” is a common refrain heard from patients in the early stage of the disease, as they attempt to sort out the order in which to plan their day.  In these early stages, family members may notice the person has a decreased ability to plan their daily life or solve everyday problems.

The disease can also often manifest itself in the early days in trouble with communication, including hearing loss, as mentioned above, and in having difficulty following or participating in conversations. 

As the disease progresses, it can cause what’s known as Sundown Syndrome, a period of restlessness, confusion, fatigue and emotional disturbance around sunset.

Loved ones whose family member is developing Alzheimer’s Disease often report changes in mood or personality that accompany the onset of cognitive symptoms, including withdrawal from social activities, sadness, outbursts of anger and paranoia. They may also notice their loved one developing a disregard for social norms in conversation, or a lack of attention to grooming and hygiene.

The Stony Brook Center of Excellence for Alzheimer’s Disease, at Stony Brook University’s main campus, does evaluations of patients who suspect they may have Alzheimer’s Disease, and provides resources for future treatment. It is also involved in conducting clinical trials. Family members are encouraged to attend these evaluations to help participate in the process, and to find support for their role as caregivers. To schedule an evaluation, call 631.954.2323 or visit ceadlongisland.org.