doctor's orders: alzheimer’s disease can be slowed with proper treatment and research
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reaching out for support and resources can be a huge boost for caregivers of people with alzheimer's disease, helping them learn how to effectively communicate with their loved one, discuss financial issues and future planning for the future.
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there’s a common myth about aging that dr. roger wong sees as prohibitive for a large segment of the greying canadian population. people think that memory loss and slower thinking is typical when you get into your later years. that’s just the way it goes, so there’s widespread acceptance and continued decline.
in fact, these are common early signs of dementia, a longstanding health condition that affects the brain and many parts of the different brain functions. the most common type of dementia is alzheimer’s disease, also called alzheimer’s dementia.
“alzheimer’s disease is not a normal part of aging. and knowing about it early is helpful because it empowers the person living with the disease, their clinician, and their care partners, who are often their families and loved ones, to strategize and figure out how to best support them so that they have good quality of life. so early knowledge is very important,” he says.
awareness is key for alzheimer’s disease
wong is vice dean of education in medicine at the university of british columbia in vancouver, b.c. and a practicing clinician specializing in geriatric medicine and a leader in alzheimer’s care. he was appointed a member of the order of canada in 2020 for his contributions to geriatric medicine, including the advancement of policies, education and culturally sensitive health care.
he’d like to see more awareness and understanding of alzheimer’s because prevalence is predicted to rise exponentially, with serious impacts on healthcare and growing numbers of family members who will take on the role of caregiver, putting their own lives and jobs on the sidelines. he cites the alzheimer society of canada’s comprehensive landmark study as mandatory reading to get a fuller picture of the future of alzheimer’s in canada and what can be done to mitigate “an impending dementia care crisis.” the first of the study’s three reports was released in september 2022.
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“the study showed there are more than 600,000 canadians who are living with dementia from coast to coast in canada and, if nothing were to change, that number will go up to triple in the next 30 years to over 1.7 million people,” wong says. women will continue to outnumber men diagnosed with the disease, but the reason is not fully understood.
what is known is that the older you are, the greater your risk of alzheimer’s, and women tend to live longer than men. genetics may be a risk factor as well. research has shown that people with a parent or sibling with alzheimer’s are more likely to develop the disease.
“not only are we talking about the numbers going up, which means that it will be very commonplace for any one of us to know someone either as a loved one or family member or neighbour or friend who is affected by the condition. it also has an impact on societal health because you can imagine the impact not only within the health sector, but also affecting many other things.”
alzheimer’s disease and the role of the caregiver
wong points to caregiving as a significant part of the alzheimer’s experience that needs to be recognized, as terminology for these individuals is moving from “caregiver” to “care partner” because of the critical role they play in the health-care team.
care partners are often family members or loved ones, but they can also be friends, neighbours, and church parishioners, because many people who develop alzheimer’s are older adults who may be living alone and turn to whomever they can for support. and care partners for people with dementia provide an average of 26 hours of caregiving per week compared to 17 hours per week for older adults with other health issues, according to the landmark study.
“that’s a lot of hours for family care partners,” wong adds, “and that work is unpaid.”
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early detection of alzheimer’s is an important part of the solution because it can delay the progression of the disease. this promotes better quality of life and helps minimize care needs. while people in later stages of alzheimer’s disease generally require around-the-clock care, someone diagnosed early still maintains some independence and can be left alone for periods of time.
signs and symptoms of alzheimer’s disease
in simple terms, alzheimer’s is the most common type of dementia and the most common cause of dementia, involving the degeneration of brain cells that affects brain function. what’s key is recognizing the warning signs like forgetfulness. if someone is forgetful, but hasn’t incurred any loss of their day-to-day function, they may be diagnosed with mild cognitive impairment, or mci, wong notes. often mci is a state that increases the likelihood or the risk of developing alzheimer’s later on.
“initially, alzheimer’s could be misplacing personal items or losing track of personal schedules. then it’s starting to be forgetful about names of individuals who people haven’t seen for a while. and then moving further, instead of just forgetfulness, there could be other warning signs such as the inability to perform a motor action or movement kind of action. a good example is someone who forgets how to operate a remote control of a television set or someone who has purchased a new oven and has difficulty using the digital buttons, so learning new things is difficult.”
another common sign that can be especially trying for caregivers is repetitive conversation where the person keeps asking the same question or saying the same thing over and over again.
wong advises that these early warning signs are not always alzheimer’s because many things can influence a person’s emotional state and affect memory, like anxiety or grief. “the question that we always ask: is there any functional loss? if it is affecting day-to-day living, then it could be dementia,” he says.
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as the disease progresses, recognition of not just faces, but other things such as directional sense is diminished, and people start losing their way along what used to be familiar routes. sense of balance can be affected as well and people can be prone to falls. in later stages, behavioural and psychological symptoms of dementia can also occur where personality is altered.
“someone who is always very talkative, suddenly there’s not much conversation. or someone who is always very gentle and mild, becomes abrasive and inappropriate, even aggressive.”
taking action to slow the progression of alzheimer’s disease
if you see signs of alzheimer’s, wong advises the best approach is to see a doctor early on for assessment to diagnose alzheimer’s or determine if there’s something else going on. equally important, he recommends getting informed about the disease through the alzheimer’s society of canada that offers information in english, french, and also in languages for underrepresented populations, such as chinese and punjabi, which is key. wong has found that people who speak minimal or no english present later with more advanced disease and behavioural changes. “the question really is do they present differently in terms of early alzheimer’s, or is it more likely they present later in the disease state, meaning they haven’t been able to access health care? so that’s a concern.”
and while there’s not yet a cure, prevention can make a difference to delaying the onset and progression, he says. other identified risk factors for alzheimer’s include physical inactivity, social isolation, the development of strokes and hearing loss. “if you do as much as you can to counter these things, you can delay progression, so physical activity, exercise, for example – what’s good for the body is good for the brain.”
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for diagnosis, clinical assessment involves reviewing medical and family history and a physical examination. then brain functional testing with standardized tools is carried out for cognitive assessment. brain imaging can also be recommended, such as ct scans, mri or pet scans for different types of imaging, although they may not be necessary depending on individual cases.
wong also notes there are blood tests that are available on a research basis that look for markers that will indicate a higher likelihood of alzheimer’s disease.
“the key thing to remember is when we talk about alzheimer’s disease, it represents a spectrum of condition that every person can be a bit different.” testing and treatments can vary depending on the person. the standard treatment for the past three decades in canada and around the world is a group of medicines called cholinesterase inhibitors. they work by replenishing a neurotransmitter or chemical in the brain that is lacking in dementia and help slow the decline in the function. like most medications, there can be side effects such as nausea and vomiting, frequent urination and watery stool. people who have heart problems or stomach ulcers and other conditions may not tolerate it.
memantine is another medication people who are living with more severe dementia use to reduce the impact of glutamate, a brain chemical that is found in excessive amounts in people living with alzheimer’s.
non-pharmacologic strategies are an equally important part of a treatment plan, with safety a top priority. safety may mean modifying the home environment because people are at increased risk of falling, no longer driving, and managing wandering behaviour with technology to help track where they are. in addition, wong stresses the need for a structured routine. “the person will do the same thing over and over again, and the moment you change the routine, that’s when trouble begins.”
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reaching out for support and resources can be a huge boost for caregivers, helping them learn how to effectively communicate with their loved one, discuss financial issues and future planning for the future.
wong is hopeful about emerging treatments and promising research in the field. he highlights the medication donanemab that has been shown by a study of 1,700 patients published this july in jama to delay the inevitable worsening. it’s a different class of medications called monoclonal antibodies, which are laboratory-produced compounds that can clear out the amyloid protein that is abnormal and problematic in alzheimer’s. the manufacturer is seeking approval for donanemab from the u.s. food and drug administration.
“what it means clinically is a delayed progression of alzheimer’s by an average of four months to seven months, although it does come with significant side effects,” he says, adding the medication is not approved or available in canada. “what is important is this is a proof of concept and it opens up new tools that allow us to start looking at how the disease process can be modified.”
cholinesterase inhibitors and memantine treat the symptoms of dementia, but these new medicines are starting to change the process that is associated with alzheimer’s dementia.
“there’s so much research going on in the field of dementia and alzheimer’s over the past number of years, and this is an example of that vibrant research.”
to learn more about alzheimer’s disease, including alzheimer’s testing and physician engagement tips, visit the alzheimer society of canada.
karen hawthorne is a toronto-based writer.
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