Understanding Symptoms, Causes, and Risks for Alzheimer s Disease

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1 Understanding Symptoms, Causes, and Risks for Alzheimer s Disease Gene E. Alexander, Ph.D., Professor of Psychology, Neuroscience, and Physiological Sciences; Director, Brain Imaging, Behavior & Aging Lab University of Arizona

2 What is Alzheimer s Disease? Goal: Review the signs, symptoms, and current thoughts on the causes and risks for Alzheimer s disease

3 Some Statistics Estimated that 5.2 million Americans have Alzheimer s disease today Alzheimer s disease is the 6 th leading cause of death in US In the US alone, Alzheimer s is estimated to cost $203 billion and is projected to cost 1.2 trillion by 2050 With a rapidly growing population of older adults, the number of people with Alzheimer s disease in the United States will nearly triple by 2050 Alzheimer s Association, 2013

4 What is the Impact of Alzheimer s Disease? Profound effects for the Individual Increasing burden and stress for caregivers Loss for family and friends Impact on local communities and nationally

5 A Little History 1906: Dr. Alois Alzheimer first describes the brain changes in a patient who had profound memory loss 1968: Measurement scales are developed to relate memory and daily activities to brain in Alzheimer s disease : National Institute on Aging is established; Alzheimer s disease recognized as the leading cause of dementia : Proteins of brain pathology (plaques & tangles) of Alzheimer s disease are identified : First genes for Alzheimer s disease are identified 1993: First drug to treat symptoms approved by the FDA today: Brain scans and other biomarkers evaluate Alzheimer s disease over the lifespan

6 How does the course of Alzheimer s Disease differ from healthy aging? Brain changes of Alzheimer s disease may begin long before symptoms appear Mild cognitive impairment (MCI) for memory may be an early sign that differs from typical aging Problems with memory and other abilities later begin to interfere with daily activities As the disease progresses, there is loss of independence National Institute on Aging, 2008

7 What are the Signs and Symptoms of Alzheimer s Disease?

Signs and Symptoms Memory problems are often among the earliest warning signs Some have

Alzheimer s disease - called mild cognitive impairment (MCI) When memory loss

activities, then a diagnosis of dementia is given Common symptoms of Alzheimer s

8 Signs and Symptoms Memory problems are often among the earliest warning signs Some have memory difficulties that are more than normal aging, but not severe enough to be Alzheimer s disease - called mild cognitive impairment (MCI) When memory loss progresses to include other abilities, that are severe enough to affect daily activities, then a diagnosis of dementia is given Common symptoms of Alzheimer s dementia include profound problems with forgetfulness, word finding, judgment, spatial abilities, and problem solving

and friends, dressing, eating, and other basic living skills emerge Behavioral changes can include problems with wandering,

9 Signs and Symptoms Thinking problems lead to difficulties in daily activities, e.g., keeping appointments, finances, making change, remembering names and events, and navigating in familiar places As the disease worsens, problems in recognizing family and friends, dressing, eating, and other basic living skills emerge Behavioral changes can include problems with wandering, impulsivity, agitation, and mood In the severe end stages, the person is unable to communicate and they are dependent on others for all self care

10 How does Alzheimer s disease affect the Brain? Cutting edge research

Brain Cells in Alzheimer s Disease Become Dysfunctional Abnormal proteins form

efficiently, losing their ability to communicate with each other and cells

spread from key brain areas for memory to other brain regions As the disease

11 Brain Cells in Alzheimer s Disease Become Dysfunctional Abnormal proteins form deposits of plaques and tangles of Alzheimer s disease Brain cells work less efficiently, losing their ability to communicate with each other and cells eventually begin to die Accumulation of plaques and tangles with loss of connections spread from key brain areas for memory to other brain regions As the disease progresses, the affected brain regions begin to shrink; in the severe stages, the brain volume is greatly reduced

Brain Changes of Alzheimer s Disease Progress

the disease progresses to affect memory and

12 Brain Changes of Alzheimer s Disease Progress as Symptoms Worsen Preclinical AD Mild to Moderate AD Severe AD The blue areas show how the plaques and tangles spread in the brain as the disease progresses to affect memory and then other abilities National Institute on Aging, 2008

13 Brain Scan Differences in Alzheimer s Disease and Healthy Aging MRI scans showing less brain volume in 145 patients with Alzheimer s Dementia compared to 159 healthy elderly Reiman et al., Lancet Neurology, 2012

Brain Scan Differences in Alzheimer s Disease and Healthy Aging Alzheimer s Disease Healthy Aging Brain Amyloid Imaging Brain Glucose Imaging Brain PET scans

14 Brain Scan Differences in Alzheimer s Disease and Healthy Aging Alzheimer s Disease Healthy Aging Brain Amyloid Imaging Brain Glucose Imaging Brain PET scans that measure amyloid pathology and glucose show differences between patients with Alzheimer s disease and healthy elderly Adapted from Ziolko et al., Neuroimage, 2006

brain areas that extend beyond baseline differences between patients with

15 Brain Scans Show Decline in Alzheimer s Disease Alzheimer s Disease at Baseline Alzheimer s Disease with 1 Year Decline Brain PET scans of glucose show decline in brain areas that extend beyond baseline differences between patients with Alzheimer s disease and healthy elderly Adapted from Alexander et al., Am J Psychiatry, 2002

16 Causes and Risk Factors for Alzheimer s Disease What do we know?

17 What Factors Influence the Risk for Alzheimer s Disease? Determined Risks Age Family History Genetics Modifiable Risks Lifestyle Exercise Diet Social/Mental Activities Environment Head Injuries National Institute on Aging, 2012

increase risk, most notably in rare early onset forms Specific genetic factors have been

18 Deterministic Risk Factors for Alzheimer s Disease Age is the most important risk factor with most cases occurring in individuals over 60 years of age A family history of Alzheimer s disease can increase risk, most notably in rare early onset forms Specific genetic factors have been identified as either deterministic or increasing susceptibility for Alzheimer s disease (e.g., apolipoprotein 4)

, Regular exercise Treating or preventing conditions that may increase the risk

19 Modifiable Risk Factors for Alzheimer s Disease Lifestyle choices can influence the risk for Alzheimer s disease e.g., Regular exercise Treating or preventing conditions that may increase the risk e.g., heart disease, diabetes, high blood pressure Environmental modifications to reduce risk e.g., Prevent head injuries

20 What about treatment? Where are we now?

21 Developing approaches to treat Alzheimer s Disease Treat symptoms of memory loss and other mental abilities by replacing brain chemicals to improve function (e.g., Aricept) Manage changes in behavior and personality that can often occur (e.g., sleep, mood, or agitation) Reducing risk with lifestyle and environmental changes for prevention (e.g., exercise, eating well, social & mental activity, reducing head injuries)

Developing new ways to evaluate potential treatments and interventions Understanding more

22 Some Current and Future Directions for Alzheimer s Research Major Research Initiatives Identify biomarkers to detect the disease early and follow the changes over time Developing new ways to evaluate potential treatments and interventions Understanding more on the genetic and other causes of Alzheimer s disease Develop new treatments and prevention therapies

23 What You Can Do Evidence-based approach

24 Suggestions for daily life changes Keep informed: Stay up on the latest information on aging and Alzheimer s disease

25 Suggestions for daily life changes Regularly follow websites by: National Institute on Aging ( Alzheimer s Association (

26 Suggestions for daily life changes Take steps to reduce your risk for Alzheimer s disease Start by making one lifestyle change

27 Suggestions for daily life changes Be an advocate for aging and Alzheimer s disease research

28 Suggestions for daily life changes Consider participating in research to help advance knowledge about successful aging and brain health

Summary Alzheimer s disease has far reaching effects, extending from

Learning to recognize the signs and symptoms can reduce concerns,

choices, like exercising, eating well, and staying socially and

29 Summary Alzheimer s disease has far reaching effects, extending from individuals to families to friends to local and global communities Learning to recognize the signs and symptoms can reduce concerns, while improving quality of life Unlike age and genetics, lifestyle choices, like exercising, eating well, and staying socially and mentally active can help reduce our risk Don t wait, get started, and stay engaged!

30 Thank You Supporters

31 Cited References Alexander GE, Chen K, Pietrini P, et al., Longitudinal PET evaluation of cerebral metabolic decline in dementia: A potential outcome measure in Alzheimer s disease treatment studies. American Journal of Psychiatry, 2002, 159, Reiman EM, Quiroz YT, Fleisher AS, et al., Brain imaging and fluid biomarker analysis in young adults at genetic risk for autosomal dominant Alzheimer s disease in the presenilin 1 E280A kindred: A case-control study. Lancet Neurology, 2012, 11, Ziolko SK, Weissfeld LA, Klunk WE, et al., Evaluation of voxel-based methods for the statistical analysis of PIB PET amyloid imaging studies in Alzheimer s disease. Neuroimage, 2006, 33, National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services. Preventing Alzheimer s disease: What to we know? 2012, Publication No Alzheimer s Association Alzheimer s disease facts and figures. Alzheimer s and Dementia, Vol. 9, Issue 2. National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services. Alzheimer s disease: Unraveling the mystery. 2008, Publication No

Alzheimer s disease is an

Alzheimer s Disease FACT SHEET Alzheimer s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest