Alzheimer's patients not going without a fight

LONG ISLAND, N.Y. - Alzheimer’s disease is inexorably robbing Phyllis Blais of her memory and mind. But the 79-year-old grandmother has decided to fight back.

Each week, she tests wits with a group of people like her who’ve received a diagnosis of early-stage Alzheimer’s. They come to the Long Island Alzheimer’s Foundation to work puzzles, play word games and compare memories of current events. The hope is that this mental activity will help short-circuit the disease and keep brain wiring intact as long as possible.

Blais and her classmates, whose ages range from the mid-50s to the 90s, listen to clues and questions and then vie to be the first with the right answer. And those answers come in rapid fire. Surrounded by others with fading memories, no one feels self-conscious.

So far, there's no proof that mental exercises can stave off Alzheimer’s, but growing evidence suggests that it might be possible to slow down the disease’s impact.

Blais thinks the classes are making a difference, and that makes her all the more determined. “I’m not completely gone,” she says. “I’m gonna fight it and make sure I don’t get that bad.”

Around the country, other early-stage patients are grasping at this possibility. They flock to Alzheimer’s centers that offer support groups and opportunities to tune up aging brains. This may be another path paved by boomers. The oldest of that generation are beginning to show signs of the disease and they want to take more control of their destinies.

Exercise your mind Getty Images Wordy brain workouts: Think of the "S" word Words with double meanings

“There is a changing landscape when it comes to Alzheimer’s,” says Dr. Peter Reed, senior director of programs at the national office of the Alzheimer’s Association. “The baby boomers are more vocal and more interested in playing a greater role in their experience. Those in the early stages have a lot more remaining ability and capacity to be involved in their own decision making.”

Patients with early-stage Alzheimer’s account for about half of the estimated 5.1 million Americans afflicted with the disease. Increasingly, Reed says, Alzheimer’s is being diagnosed early — when symptoms are subtle and patients still have the promise of several years of relatively normal life.

“People in the early stages,” he says, “are not so much dying from the disease as they are very much living with it.”

Bracing for a decline
Seated in a semicircle, Blais and 10 others listen intently as Alana Rosenstein asks them to supply the word that will finish the two phrases: “Buster ____ and ____ v. the Board of Education.”

An elderly man says, “Brown.” And the answer becomes a springboard for a history discussion. “What was Brown v. the Board of Education about?” asks Rosenstein, director of Early Stage Programs at the Long Island Alzheimer’s Foundation.

Moving on to the next word game, Rosenstein gives a clue to prompt for a word that can be made from the letters in “conglomerate”: “When people get married, there’s a bride and a … ”
“Groom!” several voices call out.  Blais playfully elbows the man next to her. “Hopefully,” she says with a sly smile.

A few seats away, Gertrude Rothenberg carefully scrawls each answer down so she’ll be able to test her daughter with today’s brain teasers.

At a very early stage of Alzheimer’s, Rothenberg, 84, shows a face of the disease at odds with the public perception. The only change in her life since her diagnosis a year ago is a bit more attention from her adult children. Rothenberg still lives on her own. She drives. She does her own shopping, pays her own bills and volunteers at a hospital near her Mineola, N.Y., home.

Dr. Ronald Petersen isn’t surprised at how normal Rothenberg’s life is post-diagnosis.  People in the early stages of Alzheimer’s can function at a very high level, says Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center. “They may still be driving and handling their own daily activities,” he says.  “But there needs to be frequent contact by someone who knows them well — family members and the like.”

The extra scrutiny is needed so that any decline will be spotted quickly, he adds.

Rothenberg’s diagnosis did bring a prescription for the medications Aricept and Namenda. Aricept works by boosting the availability of a neurotransmitter, acetylcholine, which sharpens signaling in the brain. Namenda helps by blocking a different neurotransmitter — glutamate — which can be toxic to brain cells.

Studies have shown that while these medications don’t stop or slow the disease, they can tune up the brain, improving memory and helping Alzheimer’s patients think more clearly. The drugs help a deteriorating brain much in the same way that high-octane gas boosts the performance of an old car engine. The gas doesn’t fix the problems with the engine, but it can make it run more efficiently.

The diagnosis also provided the impetus for Rothenberg to look into the cognitive-stimulation class. It’s part of her plan to keep her independence as long as possible.

Simple acts, not-so-simple science
Until recently, doctors assumed there wasn’t much to be done once a person was diagnosed with Alzheimer’s. Patients were sent home with kind words, drugs that had a mild impact on symptoms and perhaps some advice on how to deal with the inescapable changes in their brains and the inevitable changes in their lives.

But over the past few years, studies have hinted that lifestyle changes might have an impact. Most of the evidence comes from population and animal studies, which, scientists are quick to point out, are not definitive. But the results have been promising.

Memory-loss worries? Know the signs Worried because you can’t remember a colleague’s name or forgot where you left the car in the mall’s parking lot? Don’t, experts say. These are just normal signs of aging. If, on the other hand, you forget your grandkids’ names or can’t remember why you went to the mall in the first place, then you might want to go to your doctor for a checkup. Even healthy seniors experience some memory loss with age, experts say. Mild Cognitive Impairment But if the memory problems become more severe — you’re forgetting to show up at luncheon engagements or to play golf with friends — that may be the sign that you’ve developed Mild Cognitive Impairment (MCI), says Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center. “The difference may be too subtle to be spotted by a casual observer,” he adds. “But people who know you may notice you’re forgetting things you normally remember quite easily.” Still, people with MCI generally show no problems other than with memory — they drive by themselves, balance their own checkbooks, pay bills, plan trips. What the diagnosis does mean is that you’ve got an increased risk of developing Alzheimer’s. Alzheimer's signs In people with Alzheimer’s, memory problems can be much more obvious — even to those who don’t know you well,  Petersen says. “You may tell your wife that you’re planning to go out,” he explains. “And then tell her the same thing five minutes later.” And the deficits spill over into other spheres of life, Petersen says. “Now it may be more challenging to balance the checkbook,” he explains. “You might pay a bill twice — or not at all. The memory changes aren’t just a nuisance. They’re affecting your daily life.” Others might also notice personality changes, that you’re more irritable than you used to be, for example. If you’re worried about your memory, see your doctor, Petersen says. — Linda Carroll

Take, for example, the studies in mice engineered to carry the human gene for Alzheimer’s. One, published earlier this year in the Journal of Neuroscience, showed that the simple act of learning could have a profound impact on the buildup of the distorted proteins that cause memory loss in both humans and mice afflicted with the disease. Researchers found that mice that had periodically been forced to learn to navigate a maze ended up with fewer plaques and tangles of protein than intellectually idle ones.

“I think you need to look at the mouse studies with a cautious optimism,” Petersen says. “I think it’s probably a modest effect.”

Studies in humans have also suggested that increased mental activity might protect the brain. One study, for example, followed more than 800 Catholic nuns, priests and brothers for four years. Ultimately, researchers determined that the most mentally active people were the least likely to develop the disease.

This doesn’t necessarily mean that the mental activity prevents Alzheimer’s. It’s always possible that the people with the healthiest brains were able to stay more mentally active. Still, experts say, the research does suggest that mental activity might help slow the symptoms.

“In general, I think the ‘use it or lose it’ admonishment is true,” says Dr. Jeffrey Cummings, director of the Alzheimer’s Disease Center at the University of California, Los Angeles.

But mental stimulation isn’t the only factor that’s been found to have an impact on Alzheimer’s. Studies have found that people with active social networks are less likely to develop the disease. In a 2006 study, researchers examined the brains of people who had recently died for the characteristic plaques and tangles of distorted protein. The researchers also had data on cognitive symptoms and how sociable people had been during their lives. What the researchers found was surprising: Even among those with extensive plaques and tangles, Alzheimer’s symptoms were less severe if people had many friends.

So, this makes the mental stimulation class a twofer because it also gives seniors more of a social life.

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