Alzheimer's and Senility Information

Edward Lichten, M.D.,PC
180 East Brown Street
Birmingham, MI 48009 
248.593.9999

 

Photographs and Excerpts from: Newsweek Jan. 31, 2000 pp. 46-51


Alzheimer's Disease: Old Treatments yield New Therapies

This is the disease of the millennium and the future of the 'Baby Boomers." Senile dementia is described as "life where your body outlives the functional usefulness of your brain." A disease where you lose your vibrant memories and essence of 'self' to become a vegetable within a ever weakening and non-functioning body. Death is not only inevitable; for you and your loved ones it comes as a relief.

Sounds scary. Well it is! When first described by Alois Alzheimer in 1906, senile dementia was extremely rare. Most people died before reaching 60. But with the dramatic increase in life expectancy, now approaching 85 years, the incidence of Alzheimer's disease affects half of Americans over 85 years of age. Twenty percent of men and women 75 to 84 years old are affected. That is 4 million today. And the numbers are expected to increase to 6 million by 2010 and 14 million by 2050. We baby boomers not only must deal with caring for aging and debilitating parents but also the realization that this will probably be our fate- unless medical miracles intervene.

Recent research in this field has been dramatic, states Dr. Bruce Yanker of the Harvard Medical School. These discoveries include more information about how Alzheimer's destroys the brain and that there may be treatments on the pharmaceutical horizon.

Yet, there are no reliable diagnostic tests for Alzheimer's disease. Subtle signs include forgetting where your left things, appointments, or even the seven digit phone numbers you try to dial. You forget names of places you go all the time; you crash your car and even have trouble getting yourself dressed in the morning. You find it difficult to complete even simple tasks and you are painfully aware that something is wrong. Then the fog thickens the personality changes and the world becomes a different place. Family members are strangers yet you need help even eating. At this point, the diagnosis of Alzheimer's becomes a mute point.

 Physicians' ability to diagnose this disease is limited to the Mini Mental State Exam and a MRI to rule out strokes. The atrophy of the brain mass is typical of aging. When it affects the white matter (cortex-surface brain) it is called Binswenger's Disease, when it affects the gray matter it is called Alzheimer's disease. The underlying process is the same. The brain is not functioning properly and it is shrinking. Recent studies using a technique called PET scanning (see photo at right) shows that the brain on the right is not metabolizing glucose (colors in brain on the left). Where there is no glucose metabolism, there is no oxygen metabolism. From this information, it is logical to assume that that brain tissue is dead or dying.

When the brain is subjected to autopsy, there are a number of changes noted. First, there are plagues with protein filaments know as tangles. The excessive deposit of beta amyloid (A-beta) is the result of beta and gamma enzymes work together to produce a shorter, stickier protein. It is not that an Alzheimer's patient develops more A-beta, it is because there is a reduction in the body's ability to dissolve A-beta. If the body fails to remove A-beta normally, it will first fold and stick together to form first fibrils and then the plaques. When the plaques trigger an inflammatory reaction then the brain cells die within the area of inflammatory response. One could say they "die in friendly fire." When neurons die they take your memories, names, faces and normal function with them.

Why are some individuals stricken in their 50's while others not in their 90's? Hereditary may be part of the answer. Researchers have found three genes that, when mutated, cause our cells to over-produce A-beta. These mutations run in families and the inheritance guarantees that the disease will be present by age 60. But this is rare, accounting for less than 5% of all cases. Many more cases are found in families where one or more parents are affected. Folks with one affected parent are three times more likely to develop the disease; both parents increase the risk to five-fold. Dr. Tanzi states "Their genetic makeup makes them more susceptible to environmental triggers." Those who have been knocked unconscious as adults developed Alzheimer's at three times the rate of those who had not. But this again is rare.

Most sufferers of Alzheimer's disease have the following characteristics:
1) Rural backgrounds
2) Lack of schooling
3) Lack of mental stimulation
4) LACK OF ESTROGEN
5) Lack of antioxidants: Vitamin 'E'

"Recent studies have identified several substances that may help us minimize that damage as we age. In test-tube experiments, vitamin E helps quell the toxic free radical associated with A-beta. Epidemiological studies suggest that regular use of ibuprofen and other anti-inflammatory drugs may quell the toxic free radicals association with A-beta. And estrogen, which inhibits the formation of A-beta, offers another possible shield. In a 1996 survey of 1300 elderly women, Mayeux found that those who'd taken the hormone after menopause reduced their Alzheimer's risk by half-regardless of family history.

The expensive prescription medications, Cognex and Aricept, can ease the symptoms by boosting the action of a brain chemical, acetylcholine. But these drugs don't work for most and may be helpful for only a few months. Although pharmaceutical companies are pursing drugs to reduce or vaccinate against A-beta. Others are attempting gene therapy. A blood test for A-beta is being developed. But in the meantime, the disease continues its relentless spread within our population.

MEDICAL BREAKTHROUGHS

The key treatment today is anti-oxidants and hormones. Will a diet high in anti-oxidants prevent oxidation damage and A-beta deposits? No one knows. But we do know that 1000mg of Vitamin C and 800 mg of Vitamin E with every meal reduces oxidative stress on the body by 70%. Taking an aspirin or ibuprofen 200mg daily may offer both cardiovascular and some Alzheimer's protection. These measures are easy, safe and may offer real protection. It should become an integral part of my daily vitamin- anti-oxidant therapy. It sure can't hurt.

What is not commonly known is that hormones are the most potent anti-oxidants known to men. Melatonin is 1000 times more potent that vitamin C. And the studies with estrogen show that women who take the estrogen longest have one-twentieth the risk of those who have never taken estrogen. Therefore, the best protection against Alzheimer's disease is estrogen replacement for every menopausal woman. And women probably should have some form of estrogen supplementation after the age of 40. This can be in the form of oral contraceptives, vaginal estrogen, or topical natural estrogen creams or patches. Soy products including the over-the-counter medication for hot flushes, Promensil, may not offer any protection. Hopefully, future studies will be more informative.

The other hormones that affect the brain are DHEA, progesterone, testosterone, thyroid and human growth hormone. The lacks of these hormones (SEE representative articles) affect the ability of the brain to function.

Human growth hormone is recognized by many as a strong contributing factor to the support of the Glia brain cells. These cells supply nutrition to the neurons. When the Glia cells are small, shrunken and dysfunctional, then the neurons are likewise. My experience with HGH is that it is most helpful in those individuals with the earliest stages of this disease. As there are no long term studies with HGH, I explain to my patients that the decision to try the medication is the patient's. Many feel that it worth its high cost. An informed consent for HGH is offered to each patient who requests HGH explaining risk and not guaranteeing outcome. Many pharmacies will now fill prescriptions for Human Growth Hormone at costs of $5- $8 per IU making it more cost-effective and available to consumers.

However, the most dramatic changes we have seen are with high doses of estrogen and testosterone. Testosterone is the natural precursor to estrogen in both women and men. Men have less Alzheimer's disease because they have more testosterone and therefore more estrogen to go to their brains. Supplying both men and women with testosterone as injections or pellets can help bring higher levels of estrogen to the brain cells. In women, estrogen replacement should be with injections of estrogen or subcutaneous pellets.

The dosing we use in the office is:

WOMEN

MEN

Testosterone:

Testosterone

INJECTIONS: 50-100mg IM every 2-4 weeks

INJECTIONS: 200mg IM every 7-14 days

Pellets: 100 mg pellet every 2 months

Pellets: 400 mg pellets every 1-2 months

Estrogen:

INJECTIONS: 5mg cyprionate, 10mg valerate Every 7-14 days

Pellets: 50-100mg pellets every 6-8 weeks

Human Growth Hormone-

Human Growth Hormone- Optional

INJECTIONS: 4- 8 IU per week

INJECTIONS: 4- 8 IU per week

DHEA

DHEA

ORAL: 25mg morning and afternoon

ORAL: 25-50mg morning and afternoon

Thyroid:

Thyroid:

ORAL: Armour thyroid 1-4 grains as indicated

ORAL: Armour thyroid 1-4 grains as indicated

The answers to Alzheimer's disease are complex and will take years to make any significant improvement. In the meantime, the best defense is a diet high in anti-oxidants consisting of vitamins, minerals, and hormones. That is our anti-aging program.

Mini Mental State Examination:
Keep Track of Total Score and Date

Value

Tests

Questions

5

ORIENTATION

What is the (year) (season) (day) (month)?

5

Where are we: (state)(County)(town)(hospital)(floor)?

3

REGISTRATION

Name three unrelated objects. Allow one second o say each. Ask the patient to repeat all three after you have said them. Give one point for each correct answer. Repeat them until he or she learns all three.

5

ATTENTION AND CALCULATION

Question

Ask the patient to count backward from 1000 by sevens. Give one point for each correct answer. Stop after.

3

RECALL

Ask the patient to recall the three objects previously stated. Given one point for each correct answer.

2

LANGUAGE

Show patient a wristwatch; ask patient what it is. Repeat for a pencil.

1

Ask the patient to repeat "No ifs, ands or buts."

3

Ask the patient to follow a three-stage command: "Take a paper in your right had, fold it in half and put it on the floor."

1

Ask patient to read and obey the following sentence, which you have written on a piece of paper: "Close your eyes."

1

Ask patient to write a sentence.

1

Ask patient to copy a design (below).


 

 

Are you a  Hormone  Deficient
soon-to-be at risk Alzheimer's Patient?

 

 

 

 

 

 

 

SIGNS of ALZHEIMER's DISEASE
Early signs

*Recent-memory loss begins to affect job performance
*Confusion about places
*Loses initiative
*Mood/personality changes, avoids people
*Takes longer with routine chores
*Makes bad decisions
*Trouble with handling money, paying bills

 

Middle Stage
*Increasing memory loss and confusion
*Problems recognizing close friends
*Repetitive statements
*Occasional muscle twitches or jerking
*Motor Problems
*Problems with reading, writing and numbers
*Difficulty in thinking logically
*Can't find the right words
*May be suspicious, irritable, fidgety, teary
*Loss of impulse control, refusal to bathe, has trouble dressing
*May see or hear things that are not there
*Needs supervision

Late stage
*Loses weight
*Can't recognize family members or images of self in mirror
*Unable to care for self
*Can't communicate
*May put everything in mouth, touch everything
*Can't control bowels, bladder
*May have seizures, difficulty swallowing, skin infections