Issue link: https://viewer.e-digitaledition.com/i/89851
in general are a normal part of aging. Is this true? Q A: In 70 percent of cases, Alzheimer's is the cause of dementia. It is NOT a normal part of aging. It is a chronic illness that starts probably many decades before any of the clinical symptoms are seen. In fact, people in their 30s and 40s can have asymptomatic AD that does not manifest clinically until later in life. Risk factors include a strong family history of the disease or the presence of the genetic marker APOE-4, high blood pressure, high blood cholesterol, head trauma and a lifestyle that is lacking cognitive and social engagement. Really, up until now, what clinicians mainly did was diagnose it when they first started seeing those clinical symptoms of memory loss, problems fining words and problems doing daily activities. What we're trying to do is diagnose people as early as possible so that when disease modifying treatments are available, we'll be able to use them hopefully with more success and with more pertinence to the patient and their family. Earlier diagnosis also enables us to address risk factors more aggressively and potentially delay progression of the illness. QA: So how do you diagnose AD 'early'? The most important thing in diagnosing AD is ruling out other medical conditions which may cause dementia, such as vitamin deficiencies; hypothyroidism; autoimmune illnesses; primary psychiatric illness such as depression, kidney or liver disease; and cerebrovascular disease such as stroke. It's been commonly thought that Alzheimer's disease and dementia We do a comprehensive neurological evaluation, blood work, and brain MRI. And then depending on the individual patient, we may go into more depth with FDG- or amyloid PET imaging, or spinal taps to look at disease associated proteins in the spinal fluid. As active participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI), we are identifying features of early Alzheimer's disease through imaging tests and biomarkers found in blood and spinal fluid. We're also studying diagnosing AD with retinal scans and with a simple blood test that looks for high levels of ceramide which has been linked to the development of the disease. Patients and families need to know if AD is present. Planning the future, adjusting expectations, and reassessing are all part of living with AD. This is best done when the patient can participate fully in the process. QA: What treatments are available? We have cholinesterase inhibitors (donepezil, rivastigmine and galantamine) and the NMDA antagonist memantine which we use to treat people with dementia. These help patients maintain cognitive ability for a longer period of time. There's currently no known disease- modifying treatment. What we have now is only supportive treatment, and that is akin to taking analgesics for pain, instead of fixing the broken bone causing the pain. For patients with mild cognitive impairment (MCI), many of which may have underlying AD but have not reached the point of dementia, I recommend they obey a three-prong approach: first, to do anything that they would think of to keep their heart healthy — a heart healthy diet and frequent exercise; second, to engage in any cognitive activity such as reading, doing crossword puzzles, sudoku and playing video games; and, third, to engage in social activities and routinely interact with others. These lifestyle factors slow down the progression of the illness and may even be protective in some circumstances. Education and support are important, too, for families as well as for patients. Initially, the patient is more affected by Alzheimer's, but later as the disease pro- gresses the family is much more affected. So we offer counseling, educational events, social services and support groups — some in partnerships with organizations such as the Alzheimer's Association. to diagnosis Alzheimer's disease. In what research are you involved to treat it? Q A: Our center is one of the leading sites in the country to conduct advanced clinical research, and we are mak- ing important strides toward finding cures for Alzheimer's. Numerous trials of promis- ing experimental therapies for dementia are available for patient participation. (For a complete list, visit clevelandclinic.org/ brainhealthtrials. Click on the 'Connect with Research banner' for most up-to-date information.) Volunteer participation in clinical trials is key to finding a cure for and prevention of Alzheimer's disease. The Cleveland Clinic Lou Ruvo Center for Brain Health provides services in Cleveland OH, Lakewood OH, Las Vegas NV, and Weston FL. For more information, visit www.clevelandclinic.org/brainhealth. To refer a patient, call 866.588.2264. s "As active participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI), we are identifying features of early Alzheimer's disease through imaging tests and biomarkers found in blood and spinal fluid. We're also studying diagnosing AD with retinal scans and with a simple blood test that looks for high levels of ceramide which has been linked to the development of the disease." — Brian Appleby, MD NOVEMBER-DECEMBER 2012 s MDNEWS.COM s MD NEWS Cleveland/Akron/Canton | 23 You had mentioned Cleveland Clinic's involvement in research