By Peter P. Greaney, M.D.

I’m writing, from time to time, about ways in which health care systems fail people and the critical importance of prevention.

To be good at managing the preventive aspects of your health, you must have knowledge of your risks and intervene at the right time, not when the disease has already manifested. For the unfortunate person featured in this case study, the horse may have already left the stable. His doctors should have started investigating 15 years ago.

The Case

A friend of mine called with concerns regarding his memory. Given his family history, it’s understandable that he would be worried about the possibility of early-onset Alzheimer’s disease. Both his father and grandfather developed dementia in their 60s. My friend is 61 years old. I advised him that a thorough evaluation is necessary to identify the cause(s) of his memory decline.

Step-by-Step Approach

Diagnosis

To obtain a correct diagnosis, the following steps are recommended:

1. Clinical evaluation:

• A detailed medical history, including specifics of the memory issue, other cognitive symptoms and family history.
• A review of current medications to rule out any that may contribute to cognitive decline. For example, my friend is a long-term user of Nexium for heartburn, which may have impaired absorption of vital nutrients.
• An assessment of my friend’s comorbid conditions – in this case, diabetes and hypertension. Poor control can affect cognitive function.

2. Neuropsychological testing: Formal memory and cognitive testing helps quantify the degree of impairment and identify specific areas of cognitive weakness.
3. Laboratory tests: Blood tests are used to rule out reversible causes of memory loss, such as vitamin deficiencies (e.g., B12), thyroid dysfunction or metabolic imbalances.
4. Imaging studies: Structural imaging with MRI or a CT scan is recommended to look for brain changes that can be associated with Alzheimer’s disease. Functional imaging like PET scans can sometimes be used to look for patterns of brain activity associated with Alzheimer’s.
5. Genetic counseling and testing: Based on family history, genetic counseling may be appropriate to discuss the risks and benefits of testing for genes associated with early-onset Alzheimer’s.

Treatment Options

1. Medications: Certain medications may be recommended. Cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine) are often used in the early stages of Alzheimer’s to help improve symptoms or slow their progression. Memantine may be added in later stages of the disease.
2. Lifestyle and comorbid conditions: Regular physical exercise, a healthy diet, cognitive stimulation and social engagement can all be beneficial. Optimal control of comorbid conditions such as diabetes and hypertension is crucial because they can exacerbate cognitive decline.
3. Supportive care: Counseling and supportive care for Alzheimer’s patients, their caregivers and other family members is recommended to help manage the emotional and practical aspects of the disease.

Other Considerations

In this case, the health care provider would also be likely to consider the following as part of the diagnostic process:

• Planning for the future. Advance directives and care preferences should be discussed early in the evaluation and treatment process. Early intervention is often helpful in managing the symptoms of Alzheimer’s disease and improving quality of life.
• Medication review to check for any potential drug interactions or side effects that could affect memory.
• Continuous, effective management of the patient’s blood sugar and blood pressure, as noted above.

I advised my friend that there was a possibility of Alzheimer’s disease and that he should seek evaluation sooner rather than later. I was too kind to tell him he should have had this evaluation when he was 45 years old. It would be helpful if he had access to an AI-driven, patient-friendly medical authority to act as a “co-pilot” and guide on his health journey.

In recent years, there has been ongoing research into new treatments for Alzheimer’s disease. One of the newer medications that has been approved by the FDA is Aducanumab, which is designed to reduce amyloid plaques in the brain, a hallmark of Alzheimer’s disease. However, it’s important to note that Aducanumab has been the subject of considerable debate within the medical community regarding its efficacy and the strength of the evidence supporting its approval.

Until next time…

Peter P. Greaney, M.D., is an occupational medicine physician, Executive Chairman and Chief Medical Officer at WorkCare. He is an advocate on behalf of people everywhere who deserve the best possible health outcomes, starting with prevention.