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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

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

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

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

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