Dr. Fortanasce’s bestselling book The Anti-Alzheimer’s Prescription is one of the first books on Alzheimer’s prevention. The American Neurological Association in 2009 stated, there is no medical treatment to prevent Alzheimer’s on the horizon. All physicians agree prevention is the only remedy. Note all the medications currently used for Alzheimer’s Disease do not stop its progression.
If you are having worries about your memory or fear a loved one or friend maybe showing the symptoms please get a consultation immediately.
Patients with Mild Cognitive Impairment (MCI) can be helped.
If you have a family relative with Alzheimer’s; if you snore, are obese (Male – 40 inch waist/Female – 35 inch or greater); have insulin resistance (Fast glucose over 100) or Diabetes; hypertension or are under constant stress or suffer from insomnia; call for a consultation.
Take the Alzheimer’s test – 25 questions prepared by Dr. Fortanasce.
Table of Contents
- What is Alzheimer’s Disease?
- What is Mild Cognitive Impairment (MCI)?
- Alzheimer’s Stage 1: Difficulty with Memory and Learning
- Alzheimer’s Stage 2: Irrational Thinking, Poor Insight and Judgment, and Behavioral and Psychological Changes (Paranoia, Agitation, Delusions, and Hallucinations)
- Sundowning Is Common and Frightening
- Driving Becomes Hazardous
- Alzheimer’s Signs of Regression
- Alzheimer’s Stage 3: Progressive Loss of Daily Living Skills
- Stages of Alzheimer’s Disease and Symptoms
- Does Aging Predict Dementia?
- Can Dementia Strike at Middle Age?
What is Alzheimer’s Disease?
Dementia is an illness characterized by loss of memory. While most elderly adults (60 to 80 percent) with chronic dementia have Alzheimer’s disease, there are other common types of dementia such as vascular dementia, dementia with Lewy bodies, Parkinson’s disease with dementia, alcoholic dementia, and even reversible dementias from misdiagnosed depression or as a side effect of medication.
Alzheimer’s disease, a subtype of dementia, is the most common type of dementia. With Alzheimer’s disease there are physiological changes in the entire brain with amyloid plaques, a buildup of proteins that cause loss of neurons. There is vascular damage that destroys the very cells that store our memories. The Alzheimer’s brain also has fibrillary tangles, insoluble clumps of twisted fibers that build up inside the neurons and between the dendrites (the communication wires), which cause memory, learning, and creativity to cease.
Alzheimer’s was first recognized in 1906 when a German neurologist, Dr. Alois Alzheimer, examined the brain of a woman who died after years of progressive dementia and described an autopsy with nerves caked with sticky plaque and filled with tangled fibers, which are still the characteristic findings in patients today.
Like most degenerative illnesses, Alzheimer’s disease is defined by its stages that affect cognition, behavior and activities of daily living, including –
- Changes that affect cognition: Executive function (planning, sequencing, orchestrating, anticipating, and accepting delayed rewards), Memory, Attention, Intellect, and Language;
- Changes that affect behavior and psychological changes such as indifference, anger, illusions, hallucinations, and paranoia; and
- Changes that affect activities of daily living such as errant driving, leaving the gas on the stove “on” and unattended, bowel and bladder incontinence, and imbalance and falls due to a loss in our automatic memory to walk (apraxia).
What is Mild Cognitive Impairment (MCI)?
The field of aging and dementia is in particular focus today. When is it just aging? When is it dementia? When is it more than just absent-mindedness, yet not Alzheimer’s? Is there a premonitory state, a category of people who are at particular danger of developing Alzheimer’s disease? The answer is yes. Though not all of those fulfilling these symptoms will develop Alzheimer’s disease, a majority will. Concentrating our efforts on this group may be important for prevention.
Dementia comes from two Latin words: de, out of, and mentis, mind. Therefore out of one’s mind. The practical difference between natural aging and dementia is that an aging mind still has the ability to live independently. The demented mind even with their best effort, cannot. One recognizes reality and the other one increasingly loses it. Recent research has identified a transitional state between normal cognitive decline and Alzheimer’s disease. We call this Mild Cognitive Impairment. Both clinical criteria and now imaging and laboratory criteria seem to overlap in distinguishing a segment of our population that is at high risk for developing Alzheimer’s disease. Studies have estimated that those fulfilling the criteria for MCI develop Alzheimer’s at a rate of 17 to 20 percent per year. However, not all develop Alzheimer’s. Recognizing this group is important for both medical treatment and practical reasons. The practical reasons are that these individuals can make the proper choices for their future health care and life before they lose their ability to do so. Medical treatment, risk mitigation and prevention are all crucial. Family, social and financial support can help them optimize their lives and delay early entry in a nursing facility.
Alzheimer’s Stage 1: Difficulty with Memory and Learning
The first stage of Alzheimer’s is typified primarily by cognitive changes as short-term memory loss, memory retrieval, and the inability to learn. Short-term memory is typified by an ability to recall recent events such as remembering an important address that you were told several minutes before or what you ate for breakfast. Memory retrieval is the ability to recall short-term memories or long-term memories such as the name of a friend or the of the company that you worked for in the past.
In stage 1 Alzheimer’s, people, forget important appointments, and routinely forget where they place things. Life soon becomes a constant search and rescue mission for those who live with the Alzheimer’s patient. Behaviorally they become disinterested in normal activities and they call friends and family members less frequently. When they do make phone calls, they talk briefly.
As the disease progresses they forget they just called and will call soon after with the same question, such as “When is the doctor’s appointment? Behaviorally, toward the end of the first stage, Alzheimer’s patients may have some paranoid ideation, which is a distorted perception that someone or something is trying to harm them or take advantage of them. They often become accusatory, asserting that family members and friends are stealing from them or spying on them.
The premonitory stage Minimal Cognitive Impairment gives “hints” that the brain’s cognitive reserve is drying up. When the brain’s reserve “runs dry,” the person will experience the classic symptoms of memory loss, difficulty learning, loss of smell, and loss of interest in usual activities that impair their ability to function independently. So many times, a doctor may misdiagnose an Alzheimer’s patient with depression, and treat them with antidepressants, missing a critical time to treat and prepare the patient and family for the decline.
Experiments in animals have shown that a precursor of MCI may be a loss in olfactory cells and connections-structures located on either side of the forebrain involved in processing odors.
The pathological changes in Alzheimer’s first hit the hippocampal area near the temporal lobe more severely than other areas of the brain. The hippocampus is our brain’s center for storing and retrieving memory and learning, but it’s not the only area to do so.
Alzheimer’s Stage 2: Irrational Thinking, Poor Insight and Judgment, and Behavioral and Psychological Changes (Paranoia, Agitation, Delusions, and Hallucinations)
Sundowning Is Common and Frightening
As I’ve seen repeatedly in hundreds of patients-and also in my own father–in Stage 2 Alzheimer’s, not only is the short-term memory significantly impaired, but the patient experiences periods of confusion we call “sundowning.” Sundowning is named because it occurs at dusk. As everything darkens, the person’s familiar surroundings disappear, causing confusion and severe anxiety. We’ve all experienced similar fears being in strange places in the dark. I tell families if they want to understand their loved one’s fears, imagine how they would feel trapped in a basement or attic with all the lights out, or walking down a unfamiliar street without lights. Yet for the Alzheimer’s patient, it only takes a dimming of the light to bring on tremendous fear and disorientation. Finally, in Stage 2, as brain cells lose connections, there are no longer specific “rooms” for past, present, and future thoughts. The thoughts meld together and become as one, as the walls in the brain that normally separate the past, present, and anticipated future disintegrate.
These individuals are no longer able to recognize family and friends from foe. As the patient transitions into Stage 2, they often become a danger to themselves and to others-one of the more frequent reasons patients with dementia are placed in nursing homes.
At this time, a patient’s paranoia may turn to hallucinations, visual or auditory, whereby they become highly agitated as they imagine something that’s not present. Patients at this stage lose their usual social inhibitions, and usually act in an atypical manner for their personalities. For instance, I’ve seen many refined, sophisticated women in this stage use expletives and make sexual innuendos during normal conversation. Patients may suddenly talk explicitly about sexual acts, shocking family members, or friends. Of course, these changes are in no way associated with their “real personality”-they are the result of a diseased brain. Along with that, I have had many spouses tell me that they are elated that the patient’s personality has changed dramatically. For most of their married lives, the person was impossible to live with: aggressive, accusatory, and outright bossy. Now, the Stage 2 patient is docile, calm, and agreeable. Alternately, some Stage 2 patients who were meek, humble, and agreeable most of their adult lives suddenly become aggressive, demanding, and hypersexual! The behavior changes have little to do with their prior personalities. This “new” Alzheimer’s personality is totally determined by the parts of the brain that work-and don’t work.
Driving Becomes Hazardous
I recall one patient, Ryan, age 70, who was once a highly successful business executive. Sadly, Alzheimer’s had robbed him of that position two years earlier, according to his two daughters who accompanied him to the appointment at my clinic. Ryan’s one hold of control over his life was his beloved 1997 Mercedes. At the end of the visit, one daughter pleaded, “Dr. Fortanasce, please tell my dad that he can no longer drive. He’s becoming dangerous. Last week we were called because he couldn’t find his car at the Mall. Yesterday, I found a dent in his front fender and he does not know how it got there.
Ryan’s daughters said they’d shared this frustration with their dad’s primary physician, an old golfing buddy of his who felt Ryan would deteriorate faster if his independence was taken away.
I told his daughters that even in the early stages of Alzheimer’s, certain thought processes in the brain were distorted and emergency skills were impaired. Paying attention to normal safety habits, such as looking both ways at a stop sign, is frequently ignored. Alzheimer’s is not just a disease of memory, but it affects everything from language to intelligence to preparatory skills such as slowing down to stop well before one reaches a red light. A person’s ability to learn and adapt to new environments and emergencies is severely impaired.
I had to do what was in the best interest of Ryan and society. I told Ryan that he could no longer drive, and then I notified the Department of Motor Vehicles. Reluctantly, Ryan agreed, and his daughters seemed relieved. Yet less than one week later, I received a call from the emergency room, and Ryan was there-confused and contused-after driving his old Mercedes into a parked car while attempting to avoid a line of preschool students crossing the street. The daughters learned that it was not enough to tell their father that he could no longer drive. They had to take the keys or have the car removed. To be honest, I’m certain Ryan forgot what I told him by the time he left my office.
Unbelievably, this story has a good ending, as no one was injured. I’ve experienced so many other tragic endings that I will not relay them as they’d be too painful for family members who may read this book. Unfortunately, many times the persons hurt most by Alzheimer’s disease are the patients’ own grand-children whom they nurtured for so many years.
Alzheimer’s Signs of Regression
It’s not unusual for Stage 2 patients who speak English as a second language to begin speaking in their native tongue. I remember last year when a man brought his 80-year-old mother to see me. She had been spending the holidays with him and his family when she awoke speaking fluently in Hungarian. He later explained that she had originally come to the United States from Hungary as a young girl, and her parents and extended family spoke the language for years until they learned English.
Along with the changes in demeanor and memory loss, patients start to have sleep disturbances such as sleeping all day and being wide-awake all night. Their behavior becomes unpredictable with labiality of mood – from depression to anger to apathy.
Activities of daily living also decline in Stage 2. Patients fail to bathe. They wear the same clothes each day. Good hygiene habits are forgotten. Bowel and bladder problems appear, and adult diapers may be necessary. Even housekeeping tasks such as washing dishes or making beds become a major difficulty. Yet, in the midst of this, their language and motor functions remain intact-giving no one but close family members or friends a clue about their diminished state of mind.
One of the more difficult behavioral symptoms is wandering, especially at night. I was called by the police once for a patient of mine who was picked up at the Chicago-O’Hare airport at 1:00 a.m. He had his appointment card with my name and number on it in his pocket-and no other identification. Evidently, he had walked out of his son’s home where he was living, and no one heard him leave. He then paid for a ticket to Chicago from Los Angeles. Later when we spoke, his son mentioned that his dad was born and raised in Chicago, and he was trying to return home.
The most difficult symptom of Alzheimer’s disease is loss of recognition of one’s own spouse, children or close friends. There is no way of describing the impact of this loss on the family, it is simply devastating.
Alzheimer’s Stage 3: Progressive Loss of Daily Living Skills
The progression from Stage 1 Alzheimer’s disease to Stage 2 takes about one to two years. Then it’s about one to two years from Stage 2 to Stage 3, the most horrific stage. In most cases, Stage 3 Alzheimer’s lasts about 5 to 6 years (or longer), as the average patient lives about 8.2 years after the initial diagnosis is made.
The late stages of Alzheimer’s are typified by a rapid progression in the lack of recognition to where it becomes constant. At this time, the person’s ability to walk, get up from a chair, or do simple chores such as getting dressed is highly impaired. In the last stages of Alzheimer’s disease, the person becomes completely dependent, needing 24-hour care.
In Stage 3, memory for recent, past, and future often become obliterated. Recognition of family and friends and eventually the patient’s own identity is lost. Cognitive skills are progressively lost, including language (mute), intellectual, and attention and concentration. Behavioral changes become progressively worse going from severe paranoia and aggressiveness to loss of all personality traits.
Activities of daily living progressively decline in Stage 3. The patient has bowel and bladder incontinence and must be dressed and fed by a caregiver. In time, the patient will be unable to walk or even get out of bed. Without exercise, their bodies become rigid; their muscles become fibrotic and fixed with contractures that can be severely painful. Stage 3 Alzheimer’s patients need constant care for both nutrition and mobility to prevent starvation and bedsores.
Stages of Alzheimer’s Disease and Symptoms
Mild Memory loss (Stage 1) Forgetfulness Apathy Poor attention Difficulty with complex tasks Depression Difficulty with words Language problems Mood swings Personality changes Diminished judgment
Moderate Behavioral, personality changes (Stage 2) Disorientation to place and time Insomnia with Sundowning Unable to learn/recall new information Long-term memory impairment Agitation, aggression sexually inappropriate Wandering May require assistance with daily living activities (ADLs)
Severe Agnosia (inability to recognize people, objects) (Stage 3) Apraxia (inability to perform routine activities like dressing) Aphasia (loss of language function) Aphonia (difficulty with speaking aloud) Aggression Agitation Incontinence Gait, motor disturbances Bedridden Placement in long-term care
Does Aging Predict Dementia?
I did not give you a graphic discussion of the stages of Alzheimer’s to frighten you. Alzheimer’s disease is very real. In fact, millions of Americans have Alzheimer’s at this very moment-maybe even people you know. It is estimated that 85% of people over 40 have a family member or close acquaintance with it. While 50% of people over 85 have Alzheimer’s the other 50% do not. A little known fact is that after 85 the incidence of Alzheimer’s disease begins to level off. The reason maybe a combination of factors. Those with genetic predisposition have already expressed it and those who have lived a life style like proposed in the Anti-Alzheimer’s Prescription have resisted it.
The point I want to make is if you know what may lie ahead in your life – such as the dreadful signs and symptoms of Alzheimer’s disease-then it can motivate you to take control of your brain’s health to prevent this from happening to you.
While Alzheimer’s disease is increasingly common, the real problem is — as goes our mind, so goes our ability to be independent. Most patients with Alzheimer’s are taken from their homes and all that is familiar and moved to a nursing home for fulltime medical care. I often ask my Alzheimer’s patients if they are aware that they’ve been taken from the haven of their home. Sadly, the answer for many is “yes.”
Can Dementia Strike at Middle Age?
On a side note, while most adults with Alzheimer’s disease are first diagnosed in their seventies and eighties, I’ve treated patients as young as 35 and as old as 104. I remember one patient, Elizabeth, who exhibited signs of Alzheimer’s disease early at age 54. Her husband and teenage daughter brought her to my clinic after noticing that she had become withdrawn, depressed, and anxious over a period of several months. An active and engaging woman who once enjoyed playing competitive tennis, she had severed ties with her life-long friends and now spent much of her daytime hours sleeping and roaming the house at night.
When I first met Elizabeth, she had difficulty remembering the names of her siblings and close friends and had lost track of the date and year. Then within months of being diagnosed with Alzheimer’s disease, Elizabeth’s condition declined rapidly. She was unable to understand her husband, had difficulty speaking, and lost complete control of her bowels and bladder. Seven months after the diagnosis, her husband and daughter moved her to a nursing home for 24-hour care where she lived for eight more years.
Elizabeth’s case is not unusual. Early onset now occurs in about 10 percent of Alzheimer’s patients (those younger than 65 years and as young as 30 years of age), and this number is growing beyond expectations for unknown reasons. Sadly, within two years of receiving a diagnosis, 50 percent of Alzheimer’s patients are totally dependent and unable to live alone; 70 percent end up in nursing homes within three years. These patients will live at least five more years-alone and often forgotten in that nursing home. No matter what your age or family history-the message is clear Alzheimer’s disease is a frightening reality, particularly for aging baby boomers that are nearing retirement age.
I’m often asked why are we’ve seen such an increase in young onset Alzheimer’s disease over the last 50 years when America is more affluent and medical care is more widely accessible than ever before.
The answer I believe is simple. Our affluent society thrives on the Western diet with a stressful, sleepless and sedentary lifestyle. We have become our own worst enemy. In fact I believe we have left a legacy of self-destructive habits with our children who are more obese, unfit, and discontent than ever before. If we don’t make some changes, our children won’t change. Remember, children do not do as we say – they do as we do.