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Ask the expert

How many years does it take Alzheimer's Disease to develop before it can be diagnosed?

It will take many years for Alzheimer's disease to progressively install itself in the brain, probably a decade or two.
-Judes Poirier, Ph.D., Mini-Psych School 2006

Can we check to see if our chromosomes have high-risk genes for common Alzheimer's?

This type of testing is done in research laboratories and not by diagnostic laboratories for all kinds of reasons. For one thing, Canada lacks confidentiality laws regarding genetic information. In other words, an insurance company can easily access your genetic tests and take whatever measures it feels is appropriate not to have to pay later for your hospitalisation. So, you have to see that as a risk. In the United States, on the other hand, each state has a genetic confidentiality law and there is a federal law as well. Canada will probably put protections in place sometime in the future.
-Judes Poirier, Ph.D., Mini-Psych School 2006

If a parent is diagnosed with Alzheimer's Disease, how likely is it for the next generation to develop it?

In the disease called Familial Alzheimer's disease, every generation has a strong percentage (~50%) of children affected. The common form of Alzheimer's disease may run in families, especially if individuals carry the genetic defect my research team discovered a few years ago. However, it may skip a few generations, affect a generation and then skip a generation. To summarize, there's proof of the more common form of Alzheimer's disease is running in families, but it's not as frequent as in the pure familial forms.
-Judes Poirier, Ph.D., Mini-Psych School 2006

There are a lot of old people in Japan. Do many of them suffer from Alzheimer's?

There are slightly more people celebrating their 100th birthday in Japan than in North America, but the Japanese also have less cancer. When Japanese people, with exactly the same genes, have the genetic defect our team discovered, they develop “vascular dementia” instead of Alzheimer's disease. Vascular dementia damages the blood vessels, but leads to the same kind of symptoms as in Alzheimer's disease.
-Judes Poirier, Ph.D., Mini-Psych School 2006

If a person doesn't drink wine, would it benefit him to eat grapes instead?

No. I'll give you a short, but clear, explanation. In wine, the protective factor is not in the juice. It is actually the mold that grows on the grape. If you purchase grapes and leave them in the refrigerator, you will observe that a white powder (mold) forms on the top of the grape. The more mould you have when you let the wine age, the better the taste. The percentage of mold in the recipe is very important. Bordeaux wines have less mold than Burgundy wines, which is why Burgundy wines claim to be more effective against Alzheimer's disease.
-Judes Poirier, Ph.D., Mini-Psych School 2006

What percent of Down's Syndrome patients develop Alzheimer Disease?

If they reach the age of 65 or 70, it is 100%.
-Judes Poirier, Ph.D., Mini-Psych School 2006

What about Omega 3 in the treatment of Alzheimer's Disease ?

Right now, it's intriguing. We have one study from the States and one from Europe suggesting that a slightly higher than normal consumption of Omega 3 (two kinds: one derived from fish and one derived from plants), when combined together, appears to slow the progression of the disease. However, these were not blind studies. The physician knew who had the pill containing the oil and who did not. The only way for us to prove this speculation is to have the doctor oblivious to whether he is giving a patient a sugar pill or an oil pill. These studies have not yet been performed. Until they are, we will not be totally convinced. However, it is positive.
-Judes Poirier, Ph.D., Mini-Psych School 2006

Are there risks associated with taking statins for periods of 10 to 20 years?

Apparently not. They are used to prevent the appearance and re-appearance of stroke. There are people who have been on Zocor for 10 and 12 years. If there isn't any problem when the drug is first taken, there usually isn't a problem later on.
-Judes Poirier, Ph.D., Mini-Psych School 2006


How do people die from Alzheimer's Disease?

Alzheimer's disease in itself does not kill. One should think of Alzheimer's disease as reversing the “growing up” process we go through as children. Recent memories disappear first, and, after that, older memories. Eventually, the affected person can't remember how to button a shirt or eat. Finally, the person is permanently bedridden and is sometimes fed artificially or by intravenous injection. The person becomes so weak that problems like regular colds turn into bronchitis or pneumonia. The vast majority die of bronco-pneumonia, because they are so fragile they can't rid themselves of infection.
-Judes Poirier, Ph.D., Mini-Psych School 2006

What are early signs of Alzheimer's disease?

Initially, the most visible signs are memory related. Examples include having difficulty remembering simple concepts or having difficulty speaking at times. You shouldn't be alarmed if you forget where you placed your car keys. But it should cause concern if you forget what the car keys are used for!
-Judes Poirier, Ph.D., Mini-Psych School 2006


Why was aluminium thought to be a factor in Alzheimer's Disease?

Actually, it started in the 1950s. Researchers unknowingly used a stain containing aluminium to color the amyloid plaque found in the brain of Alzheimer's disease. The scientists were actually adding the aluminium to the brain through the stain they used. The aluminium is definitely not causing Alzheimer's disease.

-Judes Poirier, PhD, Mini-Psych School 2006

Is there a possible passive vaccine for Alzheimer's?

Several years ago, scientists tried to provoke an immune response to force the bloodstream to react to the infamous amaloide plaque. They injected the molecule that causes the plaque, hoping the body would react by making antibodies to destroy it. Several researchers were against this concept, but the pharmaceutical company went forward with the experiment. Three people died and twenty-five ended up with massive encephalitis—major inflammation of the brain—and went into a coma. The experiment, which had essentially told the body to attack something it normally produces, was halted by the FTA.

Passive immunization involves injecting an antibody to deal with amyloid without triggering other effects, like swelling of the brain. A study using this strategy finished in 2008, but the findings were inconclusive. Brain imaging revealed with certainty that the number of amyloid plaque deposits in the brains of Alzheimer's patients had been greatly reduced; however, no  improvement in memory or learning was detected. A number of scientists are questioning this medication approach in light of the few benefits that this technique has generated in the past years.
-Judes Poirier, Ph.D., 2010

Does sleep apnea have any correlation with Alzheimer's over time?

No but there is a recent association, however, between apnea and depression. Although surprising, when we look at the biology behind it, it makes a lot of sense.
-Judes Poirier, Ph.D., Mini-Psych School 2006

Why is Alzheimer’s disease grouped with mental illnesses?

Alzheimer’s disease is classified as a mental illness because it causes behavioural symptoms as well as cognitive symptoms. “Mental” means a manifestation of the function of the brain, and Alzheimer’s is certainly a manifestation of brain function. People sometimes wonder why psychiatrists are interested in Alzheimer’s disease, as psychiatrists typically and historically have delved into other kinds of conditions. But it should be noted that Alzheimer (the person after whom the disease was named) was a psychiatrist. So the profession has a long and noble history of dealing with mental phenomena and changes in mental states and helping people with these conditions. Often it is less the memory symptoms and more the other kinds of behaviour or perceptual symptoms that are the most troubling and most difficult to care for. And that is right up our alley, as psychiatrists deal with these kinds of symptoms every day in a variety of different conditions, not just dementia.
-John Breitner, MD, MPH, Mini-Psych School 2012

Is hiding things a typical behaviour in Alzheimer’s?

Based on our current understanding, this behaviour can be common. As people lose their grasp of reality and their ability to understand their surroundings, they lose things. This may be related to memory, but it may be related to other difficulties. People with a limited amount of insight into what is happening to them may believe that other people are trying to steal things from them. These people are likely to hide things. But this is just one explanation and just one example of disordered behaviour, of which there are many examples. So while fairly common, this behaviour is definitely not present in every case.
-John Breitner, MD, MPH, Mini-Psych School 2012

Are there any accepted alternative treatments for Alzheimer’s (e.g.., EPA, Primrose oil)?

These treatments have not shown to be beneficial with formal scientific testing. However, absence of proof does not constitute proof of absence; there may always be that one person who takes these products and really does get better. But in terms of whether there are scientific bases for believing that the drug or supplement is likely to help, then the answer is probably no.

-John Breitner, MD, MPH, Mini-Psych School 2012


Are there gender differences in Alzheimer’s disease?

Evidence indicates that development rates of Alzheimer’s disease are almost identical for men and women up to about age 80, after which women develop the disease at an accelerated rate compared to men. One possible explanation for this is that women go through menopause, which is a violent change in the hormonal milieu of the brain. There is some evidence to suggest that menopause actually increases the risk of developing dementia, but the risk does not manifest until 20 or 30 years later. If this is the correct explanation, it would help us understand the gender difference after about age 80. The best and largest studies show this gender difference very consistently.
-John Breitner, MD, MPH, Mini-Psych School 2012

What is the difference between normal memory loss and predictive memory loss?

There’s a lot of controversy as to how many people will develop Alzheimer’s disease if they actually live long enough. Our data and other data suggest that among people who live well into their nineties, more than half will end up with Alzheimer’s dementia. Almost all people over the age of 50 or 55 notice that their minds or memories are not as sharp as they were. So now that we know there is a 20-, 30- or 40-year biological process that predates the onset of symptoms, the question is whether this almost ubiquitous or inevitable change in cognition in middle age is a harbinger of things to come in 30 or 40 years. There is a lot of controversy surrounding this issue. In the end, we really don’t know.
-John Breitner, MD, MPH, Mini-Psych School 2012

How do you approach someone whom you feel is suffering from some memory loss or is showing symptoms of Alzheimer’s disease?

The answer to that is as varied as there are people in the world. There really is no set formula; all people are different and their circumstances are all different. I think the skill comes in appreciating the differences among people and their circumstances and trying to meet them at their level to help them understand what’s going on without scaring them. How do you give someone a diagnosis of cancer? Giving someone a diagnosis of Alzheimer’s may be a little easier, but it’s the same idea.
-John Breitner, MD, MPH, Mini-Psych School 2012

Is there a link between mad cow disease and Alzheimer's?

No. However, it's a good example because mad cow disease is caused by a virus. Researchers use mad cow disease as a prototype for a theoretical Alzheimer's virus. The reason? Mad cow disease kills many cells and the affected people eventually develop memory and other problems. However, it is not the same disease as Alzheimer's disease.
-Judes Poirier, Ph.D., Mini-Psych School 2006

What is the evidence of an association between concussion and Alzheimer’s disease?

It has been shown that people who have experienced head injuries, especially repeated head injuries resulting in loss of consciousness, are at increased risks of dementia. To be at an increased risk, however, you have to have multiple concussions or a severe brain injury that causes loss of consciousness or amnesia for more than 24 hours. As far as we know, the usual kinds of concussions that unfortunately many people experience are not associated with an increased risk of dementia. Currently, a lot of research is being conducted, especially on soldiers fighting in wars in the Middle East and who get blast injuries from IED explosions. There’s a tremendous interest in the relationship between the blast injury or concussion and the appearance of dementia. For the moment, we don’t have all the answers. There may be some associations, but this topic needs more study.
-John Breitner, MD, MPH, Mini-Psych School 2012

Is it true that having a glass of wine every day protects memory in the long run?

We are pretty sure that having a glass of wine, particularly red wine, will help your heart and your blood vessels. But this means one glass of wine and not ten. We also know that things that are good for the heart and the blood vessels are generally good for the brain. This is why we think that consuming a moderate amount of red wine could be helpful for the brain.
-John Breitner, MD, MPH, Mini-Psych School 2012

What is the difference between Alzheimer’s disease and dementia?

There are a lot of people who have masses of plaques and tangles in their brains and who don’t have dementia, while other people with dementia can have very little in the way of this type of brain pathology. We don’t understand this, but we have found some environmental circumstances or even some character or mood traits that seem to coincide with tangles without dementia. It’s an area of vast ignorance in our field.

The problem is that we don’t know what causes the dementia. We see the plaques and tangles, and we know they are present more often than not in people with what looks like clinical Alzheimer’s disease or Alzheimer’s dementia. This is why we think there is probably a cause-and-effect relationship. But certainly at the individual level, this is not necessarily true, so there is a lot more that we don’t know than we do.
-John Breitner, MD, MPH, Mini-Psych School 2012

Does reading/thinking or increasing the use of your brain help prevent Alzheimer’s disease?

The associated studies suggest that this is true. However, it is not clear whether this relationship is causal or whether it is a product of the fact that people with sharper brains or people who read more or do crosswords and Sudoku puzzles, etc. maintain their cognitive function longer into old age. There is a lot of research being conducted in this area, and exercising your brain certainly does not hurt.
-John Breitner, MD, MPH, Mini-Psych School 2012

Can a diagnosis of Alzheimer’s disease be confirmed while the person is still alive or only with an autopsy?

One opinion is that an autopsy isn’t absolutely necessary because we now understand that the relationship between this pathology and dementia is not one-to-one. We are very good now at predicting which people with dementia will have confirmed Alzheimer’s disease upon further study and autopsy, but not just upon autopsy.

The truth of the matter is that any diagnosis a doctor makes is rarely accurate more than 90% of the time. Medicine is an art, not a science. An autopsy isn’t necessary to prove that someone has Alzheimer’s disease, as long as you understand that a diagnosis is always an exercise in probability and is never certain.

Basically, dementia is a description based on how well you know the person and the person’s history. For example, if a chemist with a successful research career comes to you because he can’t tie his shoelaces, you know something is wrong.
-John Breitner, MD, MPH, Mini-Psych School 2012

Can memory enhancers work for non-Alzheimer's people?

Most of these drugs have some side effects such as nausea and vomiting. They are manageable, and are sometimes pretty easy to control in Alzheimer's' patients, who have a deficit in the neurotransmitter stimulated by these drugs. However, people without Alzheimer's don't have this deficit, so when they take these drugs, they may have a little bit more memory, but they'll suffer the side effect of vomiting…a lot. Basically, it's not a wise idea to use memory enhancers in this way.
-Judes Poirier, Ph.D., Mini-Psych School 2006

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