Dedicated to Alzheimer’s disease (AD), the month of September serves as a time to raise awareness and pay mind to the many complex layers of AD. The 2023 World Alzheimer’s Month theme of “Never too early, never too late” points to the importance of AD risk education and risk prevention methods to promote ways for healthy cognitive function and aging. September also serves as Healthy Aging Month to further highlight the crucial need for identifying risk factors and cognitive decline during the aging process.
Lifestyle does impact Alzheimer’s disease and Dementia
1 in 3 senior citizens dies with Alzheimer’s or another dementia, killing more than breast cancer and prostate cancer combined. Studies show that about 40% of dementia cases can be prevented or delayed with lifestyle changes that address modifiable risk factors, including high blood pressure, obesity, diabetes, depression, hearing loss and physical inactivity.
AD is a progressive form of dementia that starts with the loss of synapses and ultimately leads to damage and the destruction of nerve cells in the brain. Over time, the disease leads to a gradual loss of cognitive functions, including the ability to remember, reason, use language and recognize familiar places. The growing number of aging adults led experts to predict that there will be 13 million people with AD dementia by 2050.
Cognitive Function: What’s Considered Healthy?
The process of aging is a normal aspect of life. While some signs of cognitive aging like losing things from time to time or forgetting a certain word and remembering it later are considered normal, other signs like losing items often without being able to find them or having trouble holding a conversation could indicate something more serious.
Mental and physical health are important components for those living independently. While there is a common misconception that symptoms of dementia are a natural aspect of the aging process, the effects of mild cognitive impairment (MCI), dementia and AD are not normal signs of aging. MCI is a condition that affects the memory and method of thinking in older adults. Some symptoms of MCI are forgetting important dates or events or having additional trouble finding desired words when compared to someone of the same age. MCI is considered an early sign of AD, however many patients may not progress to AD or dementia.
In a recent study, 80% of people surveyed between the ages of 65 and 80 indicated that they did not get a cognitive assessment from their clinicians, meaning many older adults could be experiencing MCI or other forms of cognitive decline and not even know it. The same survey also showed 96% indicated older Americans said they would change behaviors to protect their brain health.
Risk Factor Education and Prevention
Physical activity provides great benefits to the overall health of older adults. Several studies show that physical activity can slow the development of MCI, the early stage of cognitive decline or memory loss. The EXERT study showed that older adults who exercised regularly throughout an 18-month period had the same results on a cognitive assessment as they did in the beginning of the study, indicating physical activity stalled the progression of MCI. The benefit was seen irrespective of the level of physical exertion, with people performing simple seated exercises with stretching bands having similar benefits to those able to walk on a treadmill.
Further, the Systematic Multi-Domain Alzheimer’s Risk Reduction Trial (SMARRT) study found that reducing risk factors such as physical inactivity, smoking, depression, mid-life hypertension, mid-life obesity and diabetes could also reduce the prevalence of AD in the U.S.
Additionally, according to the NIH, hearing aids are documented to reduce the rate of cognitive decline in older adults at high risk of dementia by almost 50% over a three-year period. Treating hearing loss by way of hearing aids may be a simple way to lower the risk of dementia in vulnerable populations.
In addition to physical activity, there are lifestyle changes that can prevent MCI progression, such as following a daily routine, learning a new skill, spending time with friends and family, getting enough sleep, limiting alcohol consumption and seeking help for health conditions such as high blood pressure or depression.
Early Intervention Is Key: But How?
Reaching an accurate AD diagnosis becomes even more crucial with the launch of new, expensive FDA-approved monoclonal antibodies to treat Alzheimer’s. These drugs are highly effective at removing amyloid plaques but have not been shown to stop or reverse cognitive decline. Along with associated safety issues, significant patient treatment burden and the known limited benefits of these drugs leave physicians in a diagnostic dilemma for making appropriate prescribing decisions.
Early intervention is recognized as the key to changing disease trajectory. Some patients with early dementia may benefit more from risk factor modification than these new drugs. AD and other forms of cognitive decline, as well as the patient overall health can be benefit from appropriate lifestyle and treatment modifications, reserving drugs for patients not benefiting from lifestyle changes alone.
An Early and Accurate Alzheimer’s Diagnosis
In the AD community, misdiagnosis rates can be as high as 50-70% in the generalist setting and 25-30% in specialized clinics. These unsettling misdiagnosis rates create a risk of overusing invasive or costly diagnostic procedures, leading to over-prescribing of AD drugs.
The availability of an accurate, autopsy validated test has the potential to greatly improve the current diagnostic pathway by identifying the appropriate candidates and improving referrals to physicians to ensure the right patients receive the AD diagnosis they need to gain access to treatments. Assessing morphological changes that take place in the skin has been shown to be a useful tool in the diagnosis of AD. The introduction of DISCERN™, an autopsy validated skin test has shown >95% sensitivity and specificity to identify AD in people recently diagnosed with dementia, even in those with mixed dementia.
In a recent survey, clinicians indicated that they were four-times more likely to prescribe these new drugs with a positive DISCERN test.
DISCERN the only Autopsy-Validated Test (at 98%) to identify Alzheimer’s and meets the NIH Gold Standard for confirming diagnostic accuracy, with patients followed for as long as 8 years prior to death. The test is comprised of three assays that assess the factors directly related to the formation of synaptic connections in the brain impacting loss of memory and cognition in people living with AD. The assays are also related to the formation of amyloid plaques and tau in neurofibrillary tangles, hallmarks of AD at autopsy. DISCERN is administered as a 3mm skin punch biopsy and is easily administered in the community practice setting and is paid for by Medicare.
Author: Frank Amato, President and CEO, SYNAPS Dx