Many people probably know that there are specific signs in the brain that indicate the presence of Alzheimer’s disease. Doctors look for telltale evidence in the form of deposits called plaques and nerve clusters called tangles – “the fingerprints of Alzheimer’s disease” – that, when discovered, should mean cognitive decline is imminent, if not already present. But what if someone has all the pathological markers of Alzheimer’s disease but few if any of the symptoms? Does that person have the disease or not?
A New View of Alzheimer’s Disease
According to this recent article from CNN, many neurologists are starting to ask that question, and it’s causing some to re-think what “having Alzheimer’s disease” actually means. The CNN article is written as an opinion piece by New York physician and neurologist Gayatri Devi. She describes a 64-year-old patient, a high-powered attorney, who had started experiencing some memory loss. Even though he appeared fine on initial examination, Dr. Devi gave him a thorough neurocognitive evaluation which revealed some auditory memory problems. “Because he was still functioning extremely well, I diagnosed him as having cognitive impairment,” Dr. Devi writes, “and put him on medications to help his memory.”
Over the next three years, this man’s memory test scores continued to show some decline, and he wanted to know what was happening his brain. Finally, a more detailed analysis revealed the presence of tell-tale plaques and tangles. This patient now had biological evidence of Alzheimer’s disease. Nevertheless, he was still functioning well at his law firm. “Few people suspected problems,” the doctor writes. “Even I, his neurologist, with 25 years of experience in cognitive neurology, could not tell from repeated conversations with him over three years that he had any real memory issues. So, what was my verdict? Did he or didn’t he have Alzheimer’s disease? My answer has gotten more complicated over the years.”
Alzheimer’s Disease: the “Disconnect” Between Pathology and Symptoms
Apparently, evidence of this anomaly – what CNN calls “this disconnect between pathology and clinical symptoms” – is creating confusion for patients and physicians alike. A July 2019 study published in JAMA Neurology examined more than 5,000 American adults between age 60 and 89 and found “significantly more people with biologically defined Alzheimer’s…than there were people with clinical Alzheimer’s disease, exhibiting symptoms.” In fact, the older the patient, the greater the disconnect. “Among 85-year-olds,” writes Dr. Devi, “for every three people with the pathology, only one person had symptoms. In other words, most men and women with biologically defined Alzheimer’s had no symptoms.” As many as 40 percent of adults 80-plus have plaques in the brain yet are without symptoms, says the article.
With so many showing the pathology of Alzheimer’s disease without the outward symptoms, the definition of the disease is shifting. “It is becoming clear that the association between such pathology and symptoms varies from person to person,” says Dr. Devi in the CNN article. “Many factors affect the progression to Alzheimer’s, in addition to genetics, including cognitive and physiological factors, and the areas of the brain that are affected. These factors are so influential that even in identical twins, symptom onset of Alzheimer’s disease can vary by as many as 18 years.” For some reason, patients like Dr. Deva’s 67-year-old attorney, appear to have healthy brains that can resist the typical progression of Alzheimer’s disease.
Don’t Buy Into the “Grim Narrative” About Alzheimer’s Disease
For many of these patients who are functioning well despite biological markers of Alzheimer’s, the biggest problem can be psychological. The disease carries with it a commonly-held belief that the prognosis is inevitably grim. Dr. Deva worried that her patient, once he learned that he was – medically speaking – an Alzheimer’s sufferer, would stop trying to live his active life and instead buy into the “nightmarish predictions” concerning his future. “I needed him to understand that an individualized approach is key to diagnosing, treating, and living fully with Alzheimer’s disease,” said the doctor. Because every brain is unique, “some people [stay] stable for years, even without treatment. Yet…with Alzheimer’s disease the overwhelming belief is that everyone ends up in a wheelchair, unable to recognize family and themselves. While this is true in some, it is not the case for all.”
In her CNN article, Dr. Deva advocates for what she calls a “better definition of different types of Alzheimer’s” so that researchers can do a better job of developing different drugs to treat different types of patients. She also says the “scientific narrative” which recognizes the nuances of Alzheimer’s disease needs to align with the “societal narrative” that the illness is always a grim death sentence. “Bridging this divide is crucial for destigmatizing the disease and for providing the type of tailored treatment that will bring success in treating those with clinical symptoms of the illness,” she writes. Meanwhile, patients like Dr. Deva’s now-67-year-old attorney, who in many ways are functioning normally, will have to deal with continual worry and doubt (what she calls “The Doubting Disease”) as he wrestles with the implications of “his own private Alzheimer’s disease.”
The Right Physician and the Right Plan for Your Future
We applaud Dr. Deva’s approach, encouraging us as a society to re-think what “having Alzheimer’s disease” truly means. But what should seniors do with this information? As you prepare for your retirement future, you’ve probably put some careful thought into getting the right health insurance, but we also suggest you get the right doctor – a board-certified geriatrician. These professionals understand the minds and bodies of older patients and are more likely to give you the right advice and treatments no matter what your circumstances. We can refer you to a geriatric physician near you if you’ll contact us at AgingOptions.
However, as important as it is, there’s much more to retirement than health care. Maybe you’ve put together a basic financial plan or thought about whether you might want to age in place in your own home. But chances are that you’ve never been shown how essential it is that all the pieces of your retirement puzzle actually fit together. That’s the genius of a LifePlan from AgingOptions. Imagine that your family relationships, your legal protection, your financial plans, your medical coverage and your housing strategy were all like gears meshing seamlessly. That’s how a LifePlan works, giving you a sense of security and peace of mind that you never thought possible.
We would love to show you more, and to answer your many retirement-related questions, without cost or obligation. You’re cordially invited to join Rajiv Nagaich at a free LifePlanning Seminar, at a location that works for you. For a complete calendar of upcoming seminars, visit our Live Events page and sign up online (or give us a call this week). We’ll see y0u soon – and meanwhile, age on!
(originally reported at www.cnn.com)