December 6, 2021 by John Fernandez
Experts Discuss Alzheimer’s Disease and Brain Health
June is Alzheimer’s and Brain Awareness Month and, according to the Alzheimer’s Association, 50 million people worldwide are living with Alzheimer’s disease and other types of dementias. In the United States alone, more than six million people have the disease, which each year kills more people than breast cancer and prostate cancer combined.
Thomas C. Hammond, M.D., a neurologist at Marcus Neuroscience Institute who specializes in Parkinson’s disease and other disorders of the brain, says that dementia is really an umbrella term for a group of symptoms. These include, among others, memory loss that disrupts daily life, difficulties in planning or solving problems, and difficulty completing familiar tasks.
Not all memory loss is a sign of dementia, Dr. Hammond notes, and the disorder can develop with symptoms that are subtle and easy to write off. “With all forms of dementia, you’re losing nerve cells, and the symptoms can be similar to Alzheimer’s,” he says. “Alzheimer’s, however, is a degenerative brain disease and the most common form of dementia. It accounts for up to 80 percent of all dementia cases.”
Over the last 15 to 20 years, the body of knowledge around Alzheimer’s has grown significantly, Dr. Hammond says. “We believe the disease is associated with the production of certain abnormal proteins – tau proteins within the nerve cells and clumps of amyloid surrounding the nerve cells.” These proteins, he says, build up over time and can become plaques (amyloid) and tangles (tau) that compromise the function and cause death of nerve cells, and thus, lead to diminished brain function. “There is often a genetic component to the disease,” he adds.
The earliest symptoms of neurocognitive disorder, or mild dementia, are often mistaken for normal aging, depression, or anxiety, according to Dr. Hammond, which is why he says early and accurate diagnosis is important. Other symptoms to watch for, he says, are personality shifts, a change in mood and changes in language. “These symptoms of early cognitive decline can be subtle and easily missed,” he says. “Family members often attribute such changes to the individual being depressed, anxious or under stress.”
Marcus Neuroscience Institute has three neurologists, including Dr. Hammond, who are specially trained in neuro-imaging to better evaluate neuroanatomy in neurocognitive disorders.
It is one of only a couple of facilities in South Florida to have advanced NeuroQuant imaging capabilities, he says – a sophisticated software that analyzes brain MRIs and helps identify and assess neurodegeneration in its earliest stages.
“People with Alzheimer’s have a loss of cortical tissue – particularly in the hippocampus lobe, which governs memory, and also in the parietal and frontal lobes,” he notes. “The NeuroQuant protocol we employ here allows us to precisely gauge the thickness of the cortical tissue and determine if tissue loss has occurred.”
In addition to aiding in the diagnosis of Alzheimer’s and dementia, the NeuroQuant protocol is also being used to improve the early detection and treatment of traumatic brain injury, multiple sclerosis and epilepsy, Dr. Hammond says.
Many times, an Alzheimer’s diagnosis begins with your primary care physician, who is trained to spot signs of cognitive decline and dementia. Jose Vazquez, M.D., a primary care physician with Baptist Health Primary Care, specializes in the prevention, diagnosis and treatment of a wide range of health issues. He often sees patients who are experiencing symptoms consistent with Alzheimer’s disease and dementia.
“We’re often the first ones to see it,” Dr. Vazquez says about the role primary care physicians play in the diagnosis of Alzheimer’s. “Many patients come to see me for something else – an illness, a routine checkup, lab work or medications, maybe – but as an internist, I treat the whole person and I’m trained to spot the early warning signs of dementia.” That means looking beyond the patient’s physical symptoms, he says, and evaluating their cognitive health as well.
How can one tell the difference between Alzheimer’s and other forms of dementia? Dr. Vazquez says that although the symptoms for both are very similar, other forms of dementia usually have a known cause, such as multiple traumas to the head or multiple strokes, while Alzheimer’s is more global and usually occurs in elderly patients. “A clinical diagnosis can rule out any other conditions,” he adds.
Knowing when to refer the patient to a neurologist is also important, says Dr. Vazquez, who sends patients for evaluations with Baptist Health neurologists when he suspects they may have Alzheimer’s or dementia.
Although there is not yet a cure for Alzheimer’s, newer therapies have come a long way in helping patients manage their symptoms, Dr. Hammond says. “For the past 15 to 20 years we’ve been using cholinergic drugs such as Aricept, Exelon and Razadyne, along with healthy lifestyle recommendations, to treat Alzheimer’s and dementia.” Namenda is another drug being used with good results, he says. “Although it’s not a cure for Alzheimer’s, it does seems to slow progression of the disease.”
Dr. Hammond says a healthy lifestyle can help minimize the symptoms of Alzheimer’s. That includes no smoking, no more than one to two drinks of alcohol per day, maintaining a body mass index below 25, eating a healthy diet and exercising for at least 30 minutes a day, five days per week, he says. “Regular aerobic exercise is felt to have both neuroprotective and potentially neuro-restorative benefit in patients with memory and cognitive disorders.”
As an internist, Dr. Vazquez understands the importance of prevention. In addition to the physical benefits, he says a healthy lifestyle can also help prevent – or at least delay – the onset of cognitive decline associated with Alzheimer’s and other forms of dementia. “Diet, exercise, keeping your brain active every day – these are all important for your brain’s health,” he says.
Some people believe that anti-inflammatory and hormone medications can help prevent Alzheimer’s, Dr. Vazquez adds. “They don’t,” he says. Others believe they can ward off cognitive decline with a diet of vitamins and supplements. Dr. Vazquez says that while it’s perfectly safe to take gingko biloba or vitamins B6, B12 and D, “there’s no solid evidence yet that they work.”
As for Dr. Hammond, he recommends keeping cognitively engaged in mid-life by reading, writing, doing puzzles and participating in social activities with others. “A study has demonstrated that remaining cognitively engaged in mid-life diminishes amyloid deposition in the brain and may prevent cognitive decline as one ages,” he says.