I was re-organizing my files today when I came across a Wall Street Journal article describing a woman’s predicament following a diagnosis of Alzheimer’s disease. The story, “Curse of a Diagnosis,” detailed her perilous journey through brain imaging, spinal fluid analysis, and imaging tests. Her husband commented, “There’s no way this diagnosis benefits people who have it”, and allowing his wife to be tested “was the biggest mistake of my life … a bomb has gone off ….” He acknowledged that his wife “sometimes gets confused and repeats herself. But why not me; I eat right, exercise, and no one else in my family has this.” The couple owns an import saddle business in California. To add to the couple’s misfortune, she had to relinquish her driver’s license by California regulation.
This story, though not uncommon, touches my soul. The most compelling dimension of the article is what it doesn’t cover.
Let's put aside this woman’s unhappy situation for a few moments and look at the subject matter from another dimension. A healthy lifestyle that includes exercise, strong family and social connections, and dietary changes can delay and may prevent most chronic disease, including Alzheimer’s. A through medical evaluation is mandatory before we label someone with the “A-word.” Health conditions that act like Alzheimer’s are lengthy -- chronic heart disease, endocrine problems, Vitamin B12 deficiency, heart disease, uncontrolled diabetes, multiple sclerosis, depression, stroke, mini-stroke (transient ischemic attack), Lyme Disease, pesticide exposure, traumatic brain Injury, and medication side effects.
Now consider a healthy lifestyle approach. Anti-oxidants, such as pomegranates, avocado, fish, turmeric, cinnamon, and alcohol/caffeine in moderation can improve memory and long term brain function. Regular exercise, such as walking, dancing, Tai Chi, and golf relieve stress, improve concentration and balance, sharpen the mind, and enhance blood flow to the brain. In other words, what’s good for the brain is good for the heart.
Neurocognitive rehabilitation can help with mental focus, memory recall, name recognition, and abstract reasoning. Two excellent references on healthy brain strategies include The Alzheimer’s Prevention Program, Keep your Brain Health for the Rest of Your Life (Small and Vorgan, Workman Publishing), and Neuropsychological Rehabilitation, Theory, Models, Therapy,and Outcome (Wilson, Gracey, Evans, and Bateman).
There are numerous peripheral issues regarding treatment and evaluation of memory impairment, including insurance coverage and Social Security Disability. Finally the medical term, “dementia,” evokes images of insanity, derangement, idiocy, and lunacy. In my opinion, we should avoid the “dementia” when referring to memory impairment and use, “mild cognitive impairment,” and “organic brain dysfunction of the Alzheimer’s’ type.”
It’s time to show optimism regarding Alzheimer’s evaluation and treatment. More diagnostic and treatment strategies are on the horizon. Alzheimer’s is not a death sentence.
Clement Hanson D.O. MPH