Medical experts are learning more each day about the coronavirus, but there’s quite a bit that remains a mystery. Why, for example, are men affected so much more than women? Why do some people become seriously ill while others experience what amounts to a mild cold? And perhaps one of the greatest puzzles is, why do some patients who test positive for the coronavirus display no symptoms at all?
Thinking about this question brought to mind an article we published here on the AgingOptions blog earlier this year, about a disease that terrifies most of us even more than COVID-19: Alzheimer’s disease. 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?
Moreover, once someone is diagnosed with Alzheimer’s disease, can that diagnosis be reversed? Research suggests some encouraging answers.
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. Devi’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. Devi 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. Devi 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. Until then, patients like Dr. Devi’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.”
Is Alzheimer’s Disease Reversible?
One more question to ponder: can Alzheimer’s disease be reversed? There’s clinical evidence that, for some patients, the answer may be yes. Some years ago, doctors at UCLA published this report of a pilot study of ten people with dementia. After a series of individualized therapeutic treatments, the outcome was dramatic. “Nine of the 10 displayed subjective or objective improvement in cognition beginning within 3-6 months,” said the final report. Even more telling, of the six patients whose work lives had been ended or disrupted by illness, “all were able to return to work or continue working with improved performance.”
The study came to this optimistic conclusion. “Results from the 10 patients reported here suggest that memory loss in patients with subjective cognitive impairment, mild cognitive impairment, and at least the early phase of Alzheimer’s disease, may be reversed, and improvement sustained.” We’re tracking stories like this and will keep you updated.
Two Important Retirement-Planning Announcements from AgingOptions
At AgingOptions our chief desire is to help you prepare for the kind of retirement you’ve always dreamed of having. Toward that end, we want to share two important announcements that are designed to facilitate your LifePlanning process even during this period when most of us are required to avoid gathering in groups.
First, Rajiv Nagaich has scheduled several of his popular, free LifePlanning Seminars in the form of webinars that you can watch conveniently at home. Simply visit our Events Page and register for the webinar of your choice.
Our second announcement: in cooperation with our partners at LifePoint Law, we are excited to launch a ground-breaking new service called the LifePoint Law Emergency Legal Kit. Without leaving your home, you can now consult with a LifePoint Law attorney who will work with you to prepare and sign a complete set of vitally important legal documents including both Financial and Healthcare Powers of Attorney, a Living Will/Advance Directive, a Will or Trust, and much more. Click on the link or call us at AgingOptions and we’ll explain this excellent service to you.
Reliable information has never been more important – and that’s our promise to you at AgingOptions and LifePoint Law. Age on!
(originally reported at www.cnn.com)