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Alzheimer's Disease: The Latest Advances in Treatment and DiagnosisAired July 22, 2000 - 2:30 p.m. ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
RHONDA ROWLAND, HOST: Today on a special edition of YOUR HEALTH, Alzheimer's disease. We'll bring you the latest advances, including new clues for predicting who may be at risk, and what you can do to better your odds.
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UNIDENTIFIED FEMALE: And they need a lot of love, and they need a lot of care, and they need around-the-clock supervision.
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ROWLAND: ... a look at what experts call a growing caregiver crisis, and check out some of the creative ways of caring for those with Alzheimer's.
Welcome to this special edition of YOUR HEALTH. I'm medical correspondent Rhonda Rowland. We're coming to you from Eden Brook (ph) Assisted Living, one of many such facilities across the country caring for those with Alzheimer's disease.
The Alzheimer's Association estimates one in 10 people over age 65, and nearly half of those over age 85, suffer from this form of dementia. Over the past two weeks, researchers meeting at the first World Alzheimer Congress discussed findings ranging from diagnosis to caregiving.
First, we'll tell you about a new way to diagnose a pre- Alzheimer's condition.
(voice-over): Sixty-two-year-old Gary Nemitz opens his book and tobacco store every morning. He balances the financial books, helps customers.
GARY NEMITZ: Right on.
UNIDENTIFIED MALE: (inaudible).
NEMITZ: Thank you very much. ROWLAND: But if the request is more complicated...
NEMITZ: This is where I get -- have the problem. Dan, what do I...
ROWLAND: Nemitz does not have Alzheimer's disease, at least not yet. His doctors diagnosed him with mild cognitive impairment, a transitional stage between normal age-related memory loss and early Alzheimer's disease.
DR. RONALD PETERSEN, MAYO CLINIC: That their activities of daily living are performed fairly well, so they're out in the community living independently, driving, and doing their checkbook, doing their finances, and doing pretty well.
ROWLAND: But they have persistent memory problems. Dr. Petersen, who is President Reagan's physician, says most patients with the diagnosis will go on to develop Alzheimer's within a few years, but not all. Some memory deficits could be due to another medical condition.
PETERSEN: In general, when a person is diagnosed with having mild cognitive impairment, their risk of developing Alzheimer's disease is about 10 to 15 percent per year.
ROWLAND: Compared to older people with normal memory who develop Alzheimer's at a rate of 1 percent per year.
(on camera): When people become forgetful, they can't help but wonder if it's normal age-related memory loss or an early sign of Alzheimer's. Doctors here at the Mayo Clinic say if a person repeatedly forgets in that they try to remember, it could be a sign of disease.
(voice-over): Researchers use a variety of tools to diagnose mild cognitive impairment, like memory tests.
UNIDENTIFIED FEMALE: If a family drove 325 miles in five hours, what was their average speed in miles per hour?
UNIDENTIFIED MALE: Sixty-five.
ROWLAND: No problem. But listen to this question.
UNIDENTIFIED FEMALE: A few minutes ago, I had read a long list of words to you, and now I'd like to see if you can remember any of those words.
UNIDENTIFIED MALE: Doesn't really come back.
ROWLAND: Blood tests check for known genetic markers and a protein that may be a valid predictor. MRI brain scans measure a memory structure known as the hippocampus. And now, for the first time, researchers have identified a measurable brain chemical associated with dementia. DR. CLIFFORD JACK, MAYO CLINIC: So you see this stepwise increase in this brain chemical as the severity of the disease increases.
ROWLAND: Even if a patient gets a diagnosis of mild cognitive impairment, what can they do about it?
PETERSEN: If we can characterize people clinically early in the course of the disease, such as having mild cognitive impairment, we may be able to intervene.
ROWLAND: For instance, studies are under way to see if vitamin E, the FDA-approved drug Aricept, estrogen, and nonsteroidal antiinflammatory drugs can delay memory loss. Patients and their families can also make plans.
NEMITZ: Hopefully one of these days, Dan will probably have this business, and I'll own the building. So that -- but we don't know when it will be, but...
ROWLAND: Gary Nemitz's workdays have become shorter. He spends more time on the golf course.
JEAN NEMITZ: I'm scary, you know, it is a scary future, you know, because I know what it's going to be, somewhat, because my mother passed away a year and a half ago with Alzheimer's. So -- but everyone's different, and they may come up with a cure or some type of help before it gets too bad.
ROWLAND: But for now, the Nemitzes enjoy one day at a time.
When we come back, we'll tell you how your genes and your lifestyle may affect your chances of developing Alzheimer's.
Although Alzheimer's disease is most often characterized by memory loss and decline in cognitive abilities, people with Alzheimer's can also exhibit behavioral symptoms such as agitation, aggression, and paranoia.
ROWLAND: It's been almost 100 years since Dr. Alois (ph) Alzheimer called attention to the two key brain changes that characterize the disease, plaques and tangles. Ever since, there's been controversy over which comes first, and how the two work together to cause trouble with thinking and memory.
Now researchers believe they're close to a consensus. Most believe the amyloid brain plaques build up first, and that nerve tangles in the brain follow, leading to brain cell death. In the process, brain tissue becomes inflamed. Researchers believe these brain changes are influenced by genetics.
CNN medical correspondent Elizabeth Cohen has more.
ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT (voice-over): Lewis Rivkin is confused about so many things, simple things like his age.
UNIDENTIFIED FEMALE: How old are you?
LEWIS RIVKIN: Forty...
UNIDENTIFIED FEMALE: Ninety-three.
He is lost in his own world. You know, he knows that he's here, but he doesn't know quite where "here" is.
COHEN: His daughter knows that she could be next.
ROSE ANNE RIVKIN-SCHULMAN, LEWIS RIVKIN'S DAUGHTER: I do worry about what's to become of us, because my grandfather was very much like Daddy, and so, you know, I can see that it might happen in our generation.
COHEN: Researchers around the world are taking a close look at families like the Rivkins, searching through the approximately 70,000 genes in the human body, trying to figure out exactly which ones might cause Alzheimer's.
DR. LENNART MUCKE, UNIVERSITY OF CALIFORNIA-SAN FRANCISCO: Sometimes it's just very hard to find a needle in the haystack, and that's really what these folks have to do.
COHEN: Harvard researchers have announced that after looking at 500 families where several members have the disease, they found an area on chromosome 10 where they suspect an Alzheimer's gene lurks.
RUDOLPH TANZI, HARVARD MEDICAL SCHOOL: Once we announced the new genetic linkage on chromosome 10, that inevitably a race will begin around the world to try to identify this gene. So if we don't in the end identify it, someone will.
COHEN: And this won't be the only Alzheimer's gene.
(on camera): Scientists think there are about five major genes that help determine who will get Alzheimer's, and they say the more genes they can locate, the more drugs they can develop.
(voice-over): The drugs would try to correct a mistake that genes sometimes make. People with Alzheimer's produce too much of the substance called amyloid. Too much amyloid in the brain kills nerve cells and eventually causes Alzheimer's disease.
The pharmaceutical company Bristol-Myers Squibb is now testing a drug based on the one gene already linked to Alzheimer's. Several other genes have been discovered that might be linked to the disease, but scientists aren't sure.
RIVKIN-SCHULMAN: Good morning.
RIVKIN: Good morning.
COHEN: Rose Anne Rivkin-Schulman hopes research like this might help her one day, or her children, even though she knows it'll be too late for her father.
RIVKIN-SCHULMAN: He doesn't know who we are at times. He doesn't know who he is at times, I think, either.
COHEN: Elizabeth Cohen, CNN, YOUR HEALTH.
ROWLAND: Researchers agree that genetic factors alone will not determine whether or not someone develops Alzheimer's. Preliminary studies suggest everyday lifestyle factors may have an impact on triggering the disease.
For example, researchers believe some risk factors for heart disease may play a role in Alzheimer's. There's evidence that those who ate a high-fat diet were seven times more likely to develop Alzheimer's than those who ate a lower-fat diet. High blood pressure and high cholesterol may also increase the risk for Alzheimer's.
Other preliminary studies suggest that staying mentally agile throughout life may be protective. And taking certain antiinflammatory drugs, such as ibuprofen, and digestive drugs, such as Tagamet, may be beneficial as well.
However, more studies are needed before doctors can recommend lifestyle changes to help prevent Alzheimer's.
When we come back, a look at the other stories making headlines this week. And later, it's one of the most common dangers of Alzheimer's, what to do when a loved one wanders away.
ROWLAND (voice-over): Welcome back to YOUR HEALTH. Here are this week's headlines.
Research suggests a combination of new and old technologies could best help doctors detect colon cancer early. The new, still- experimental technology is a type of microray (ph), also called a biochip. It scans for genes related to colon cancer. One day, it could help doctors figure out what type of treatment is best and identify patients at high risk long before they develop the disease.
The old technology is called colonoscopy. It's more invasive than the more commonly used sigmoidoscopy, but two studies in "The New England Journal of Medicine" suggest colonoscopy may be more effective in spotting tumors. If found early, colon cancer is 100 percent curable.
Also, a food fight. The Center for Public Interest, a consumer group, has petitioned the Food and Drug Administration to halt sales of 75 so-called functional foods or foods with supplements added. The group says the foods contain unauthorized ingredients that the FDA does not consider to have been proven safe. The FDA says it will review the complaints.
And those are this week's YOUR HEALTH headlines.
ROWLAND: Coming up on our special edition of YOUR HEALTH, it could literally save the life of someone you love, a program aimed at protecting Alzheimer's patients who wander away.
But first, this week's YOUR HEALTH quiz.
Health Quiz: True or false -- changes in personality can be considered a warning sign for Alzheimer's disease.
Health Quiz: True or false -- changes in personality can be considered a warning sign for Alzheimer's disease.
True. A person with Alzheimer's can change dramatically, either suddenly or over a period of time. Someone who is generally easygoing may become angry, suspicious, or fearful.
ROWLAND: For some, there is no greater emotional stress than caring for someone with Alzheimer's. As the disease progresses, your loved one's personality, behavior, and mood may change. With time, they may no longer recognize you, become confused by their surroundings, and wander away.
CNN's Greg LeFevre has more on how these patients and their families can be helped.
CHERYL CARSWELL, DAUGHTER: And then we're going to go outside. You ready?
GREG LEFEVRE, CNN CORRESPONDENT (voice-over): Her Alzheimer's disease now confines her to a wheelchair, but in the early stages, Mabel Miller used to wander off, walk far from her house, unknowing, unaware she was miles from home, unaware of the danger. CARSWELL: She was taking off quite a bit. She was booking three miles down a main street.
LEFEVRE: Mabel Miller's story is a common one among Alzheimer's patients.
ELIZABETH EDGERLY, ALZHEIMER'S ASSOCIATION: Sixty percent of people with Alzheimer's will walk away from home at some point and not be able to find their way back without assistance. If they're not found within 24 hours, there's about a 50-50 chance that they won't be found alive.
LEFEVRE: Most often dead from exposure.
Now enrolled in a program called Safe Return, Mabel wears a bracelet with a code and a telephone number that alerts authorities to who the person is -- he or she may not know -- and where to take them.
LT. SCOTT CORNFIELD, SAN JOSE, CALIFORNIA, POLICE: At least once a day, we get calls like this, sometimes two, three, four times a day.
CARSWELL: I always thought my mother left with a real purpose, you know, whether she remembered where she was going or what she wanted to do, you know, was beside the point.
EDGERLY: They also tend to go downhill, take the path of least resistance.
LEFEVRE: Into ditches or river beds. Training tapes show police and families how to help.
CORNFIELD: It's not one that's readily apparent to somebody. If you see somebody walking down the street, you don't instantly know that person is in distress.
LEFEVRE: A wandering Alzheimer's patient usually looks like any other adult. The danger may not be apparent. But it's very real.
Greg LeFevre, CNN, San Jose, California.
ROWLAND: When YOUR HEALTH returns, we'll look at the struggles facing millions of Alzheimer's caregivers and the unique way some are reaching out.
Dementia is the loss of intellectual functions, such as thinking, remembering, and reasoning. Dementia's not a disease by itself but rather a group of symptoms that may accompany certain diseases or conditions. If detected early, it may be reversible when related to depression, drugs, or alcohol, but irreversible when caused by disease or injury. (END GRAPHIC)
ROWLAND: An estimated 18 million people worldwide suffer from Alzheimer's disease. And experts warn of a critical shortage of caregivers in years to come as millions of baby boomers age and develop the disease. That also means the burden on caregivers is likely to increase.
CNN medical correspondent Holly Firfer reports on some creative care techniques.
HOLLY FIRFER, CNN MEDICAL CORRESPONDENT (voice-over): When Margaret was diagnosed with Alzheimer's in 1997, her daughter, Eleanor, tried her best to engage her in honest communication. But honesty was counterproductive.
ELEANOR SHUTTER: We were discussing something, and I just thought, I had to make her understand where I was coming from. And she couldn't. And I kept on and I kept on, and the more I did talk to her, the more agitated she got, the more agitated I got. And it ended up, she sat there and would not speak to me.
FIRFER: Social worker Naomi Feil says when Alzheimer's patients get confused, they tend to revert inward and lose their motivation to continue communicating. That's why she uses what's called validation therapy.
NAOMI FEIL, VALIDATION THERAPIST: And where is your mother now?
UNIDENTIFIED FEMALE: My mother's still living. She's in good shape.
FIRFER: The idea, she says, is to validate or go along with the patient, even if they think you're someone else in another time.
FEIL: The old person who is confused knows you respect them. They have intuitive knowledge. They may have lost clock time, they may have lost speech, they don't know who you are. They put you right into their world.
FIRFER: Instead of trying to explain to the patient that they're addressing the wrong person, go along with it.
FEIL: It's a theory that when people get old, they need to express unfinished issues, and the more deteriorated they are, the more incontinent they become of the emotion.
FIRFER: In other words, they want to keep talking. According to Eleanor, with this therapy, her mother has become more social and outgoing.
SHUTTER: I think she's a happier person now. She's less -- becomes less upset in circumstances. And I think it gives me a good feeling too. FIRFER: At Country Meadows Assisted Living Facility, validation therapy fits into their belief that patients need emotional and spiritual care as well as physical activities to prolong the quality of life. With prayer sessions...
UNIDENTIFIED MALE: Amen.
FIRFER: ... games, and interaction with children residents are able to feel as if they were leading a normal life instead of facing a debilitating disease.
Validation therapy does not seem to put Alzheimer's patients closer in touch with reality, but it does seem to give them a new zest for life.
FEIL: There's a lot in life.
UNIDENTIFIED FEMALE: It's there waiting for you if you want to make it.
FIRFER: Holly Firfer, CNN, YOUR HEALTH.
ROWLAND: Like heart disease, researchers would like to find ways to prevent Alzheimer's disease. Early research suggests it could come in the form of a vaccine. The experimental vaccine, called AN-1792, works by stimulating the immune system to clear the characteristic brain plaques that many believe are the cause of the disease. So far, in 24 president, it appears to be safe.
Scientists with Elan Pharmaceuticals are in the midst of the initial testing to assess safety, and they're encouraged by the results so far. If you're interested in learning more about this potential Alzheimer's vaccine, you can call Elan's medical information center at 1-888-638-7605. Elan is not enrolling any new patients at this time, but expects to begin further enrollment at the end of this year for the next phase of study that will assess effectiveness.
That's it for our special edition of YOUR HEALTH. If you'd like more information on programs or resources for caregivers, click on our Web site at cnn.com/health. It's produced in conjunction with WebMD.
For the entire CNN health team, I'm medical correspondent Rhonda Rowland. Thanks for joining us.
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