Every 66 seconds someone is diagnosed with Alzheimer’s disease, a neurodegenerative disease that causes an individual’s personality to slowly evaporate. People think of Alzheimer’s disease as a condition that produces absent-mindedness and forgetfulness, but it’s more insidious than that. Executive functions, such as decision-making, problem-solving and reasoning are impaired. In the advanced stages of the disease, one’s ability to retrieve even the simplest of words is taxing and, eventually, some people are left literally speechless.

In the battle between science and disease, Alzheimer’s has been the clear winner for decades. There has not been a new drug approved to treat the disease since 2003. And even those two drugs, memantine (brand name: Namenda) and donepezil (brand name: Aricept), are used more to mask the symptoms than to treat its underlying cause.
Geriatrician Hillary Lum, MD, PhD, assistant professor of medicine at the University of Colorado School of Medicine’s Division of Geriatric Medicine, helps seniors plan for their future.
There are numerous clinical trials underway that aim to discover something close to a cure for Alzheimer’s in the not so distant future. These include studies led by Huntington Potter, PhD, a neurologist and director of the Rocky Mountain Alzheimer’s Disease Center (RMADC) at the University of Colorado Anschutz Medical Campus.

But, until these studies yield substantive results, it’s important that people plan for a future that may include Alzheimer’s disease or some other form of dementia, either as a patient or a caregiver. The old saying that the best offense is a good defense holds true.

Warning signs

The three main risk factors for developing Alzheimer’s are age (about 30 to 50 percent of those over 85 get it), a family history of the disease, and genetic makeup. Although any of the three factors raise risk, having one or more does not guarantee that an individual will develop Alzheimer’s — except for those who have an extremely rare hereditary gene that is directly linked to the disease.

The reality, however, is that we are all at risk for Alzheimer’s, said neurologist Jonathon Woodcock, MD, clinical director for the University of Colorado Memory Disorders Clinic and the RMADC.
Neurologist Jonathon Woodcock, MD, assistant professor and clinical director for the UCHealth Memory Disorders Clinic and the Rocky Mountain Alzheimer’s Disease Center (RMADC), says that a long life can portend a higher risk for developing Alzheimer’s disease.
“This is a very common disease in the elderly,” Woodcock said. “It’s important for everyone to plan for the possibility because the older we live the more likely we are going to get dementia at some point. Making plans ahead of time makes sense.”

First line of defense: lifestyle changes

The first and best line of defense is prevention. Making healthy lifestyle choices can possibly help ward off the disease, and may help to prevent or delay onset for those diagnosed with mild cognitive impairment (MCI), a condition that often, but not always, progresses to Alzheimer’s.

Additionally, there are important steps one can take to slow down the progression or minimize symptoms of those diagnosed with early-stage Alzheimer’s, said Woodcock. These include:

• Medication review: If you’re feeling foggy and not your cognitive self, consult a physician to review your medications. Many medications, such as Ambien, Lunesta, Ativan and certain antidepressants, can cause memory issues. “We cure more dementia by stopping medications which cause memory impairment than by any other way,” said Woodcock.

• Exercise: Potter says that researchers are not sure why exercise helps prevent or delay the progression of Alzheimer’s, but he has seen it work in both animals and people. “It helps mice with pure Alzheimer’s disease and seems to help people who have MCI stop progressing. But what the mechanism is, is not exactly clear,” he said.

• Diet: The MIND Diet, a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, has been shown to improve cardiovascular health. Studies found that strict adherence to the MIND diet reduced the risk of Alzheimer’s by 53 percent and that moderate adherence reduced risk by 35 percent. The diet emphasizes eating whole grains, green leafy vegetables, nuts, beans, poultry, fish and berries, and avoiding butter, cheese, red meat, fried foods, and sweets.

• Stress reduction: Excessive and chronic stress can impair memory function in the near and long term. Stress-relieving activities, such as yoga, meditation, exercise, and therapy, can help.

• Proper sleep: Woodcock suggests regularly getting the amount of sleep that one’s body needs, and to getting it at night. “Train yourself to get up at the same time, fairly close to when the sun comes up in the morning, and then everything generally falls into place behind that,” he said. Woodcock suggests trying melatonin for those who have trouble falling asleep.

Second line of defense: advance care planning

Geriatrician Hillary Lum, MD, PhD, an assistant professor of medicine at the University of Colorado School of Medicine’s Division of Geriatric Medicine, also runs the Conversation Group Medical Visit program at the Seniors Clinic at University of Colorado Hospital. At the group visits Lum talks with patients 65 years and older about things to consider when making plans for future medical decisions and about translating their values and wishes into medical care plans.
RMADC director Huntington Potter, PhD, says research indicates that exercise is a good guard against Alzheimer’s.
“A number of people are worried about not being able to think for themselves, perhaps even more so than getting cancer or another illness,” said Lum. “What they can do is plan, and we help them with anticipatory guidance, meaning laying out what their future may look like.”

It’s always best to plan before an illness, but it’s still possible to make coherent and rational legal, financial and health care decisions even after a diagnosis of MCI or dementia, Lum added.

Additional planning considerations, especially for those recently diagnosed with early stage Alzheimer’s or MCI, include:

• Writing an advance directive for health care: This may include a living will, which outlines decisions for future medical care, and designates a health care power of attorney to make health-related decisions in circumstances when an individual can’t make them for himself.

• Designating a durable power of attorney for finances and legal decisions: This may be a different person than the one designated to make health care decisions. According to the National Institute on Aging, naming a trusted Durable Power of Attorney can help people with Alzheimer’s and their families avoid court actions that may take away control of financial affairs.

• Seizing the day: The New York Sunday Times recently ran a special section called “Fraying at the Edges: Her Fight to Live with Alzheimer’s” about a woman’s journey after a diagnosis of early stage Alzheimer’s. Geri Taylor, 69 at the time of diagnosis, focused on her lifelong interest in photography, made numerous plans to spend time with family and friends and plowed ahead full steam with her life. Her husband took advantage of this period, before the majority of his time would be dedicated to caregiving, by signing up for acting lessons. Lum, too, encourages her patients to do now what they enjoy most, especially with family and friends.

• Gathering a team: Even those with a spouse and children may need more help with cleaning, shopping, and paying bills. “In your future, when you need family support, think about who you are going to be able to build as your team for the stuff of daily life, helping you stay independent in your home,” said Lum.

• Thinking about who you want to know: People diagnosed with Alzheimer’s disease may feel more shame and humiliation than, say, someone diagnosed with cancer or diabetes. People fear they’ll be shunned socially or pitied. “I often encourage them to share with relevant folks who are close to them so that they can build a support network,” said Lum.

• Talking about gun safety: “We try to talk about gun safety because if there’s a gun in the house and the person’s dementia gets worse, they can be very susceptible to confusion that could lead to inappropriately using the gun,” explained Lum.

• Discussing driving: Not being able to drive can be a very big deal to some people. “I told this gentleman today that not being able to drive was the hardest thing we were going to tell him at that appointment, and that was after I told him he had Alzheimer’s,” recounted Woodcock. Look into Uber and other driving services so that the person doesn’t feel isolated and housebound. Woodcock suggests arranging driving tests, specifically for seniors, for those who resist handing over the keys.

Planning for a possible future with Alzheimer’s disease does not mean worrying when symptoms aren’t present. There is no way sure way to predict the disease. The best bet, and the best defense against many chronic diseases, is to live a healthy, fulfilled life.