Health & Exercise Forum

Mario Cornacchione, D.O.

TCMC Author: Dr. Mario Cornacchione DO

Dr. Cornacchione, a specialist in Geriatric Medicine, is an Associate Professor and Assistant Chair of Family Medicine in the Department of Clinical Sciences at the Commonwealth Medical College. He is also the Research Director at the Northeastern Pennsylvania Memory and Alzheimer’s Center where he currently is the principal investigator in clinical trials studying new disease modifying agents for the treatment of Alzheimer’s disease and prodromal Alzheimer’s disease (MCI).

Dr. Cornacchione is a national speaker on a wide range of topics on geriatric medicine, dementia, aging and long term care. He is a coauthor and reviewer of a number of National Clinical Practice Guidelines in long term care and on the editorial board of the Journal of Parkinson and Alzheimer’s Disease.

WORLD ALZHEIMER’S AWARENESS MONTH

September is World Alzheimer's Awareness Month. It would be very unusual to find a person whose life has not been affected by someone with Alzheimer’s disease (AD). Unfortunately, there is a tsunami coming of those baby boomers that will develop the disease. AD is only one form of dementia and an estimated 5.4 million Americans of all ages currently have the disease.

• One in nine people age 65 and older (11 percent) has Alzheimer’s disease.

• About one-third of people age 85 and older (32 percent) have Alzheimer’s disease.

The future numbers are even more staggering:

• By 2025, the number of people age 65 and older with Alzheimer’s disease is estimated to reach 7.1 million, a 40% increase from 2016.
• By 2050, the number of people age 65 and older with Alzheimer’s disease may nearly triple, from 5.2 million to a projected 13.8 million, barring the development of medical breakthroughs to prevent or stop the progression of the disease.

Although older age is a risk factor, Alzheimer’s is not a normal part of aging, and older age alone is not sufficient to cause the disease. A family history of Alzheimer’s is not necessary for an individual to develop the disease. However, individuals who have a parent (especially a mother), brother or sister with Alzheimer’s are more likely to develop the disease than those who do not have a first-degree relative with AD.

Alzheimer’s disease symptoms vary among individuals. The most common initial symptom is a gradually worsening ability to remember new information. This occurs because the first neurons to be damaged and destroyed are usually in brain regions involved in forming new memories. As neurons in other parts of the brain are damaged and destroyed, individuals experience other difficulties. The following are common symptoms of Alzheimer’s:

• Memory loss that disrupts daily life.
• Challenges in planning or solving problems.
• Difficulty completing familiar tasks at home, at work or at leisure.
• Confusion with time or place. Trouble understanding visual images and spatial relationships.
• New problems with words when speaking or writing.
• Misplacing things and losing the ability to retrace steps.
• Decreased or poor judgment.
• Withdrawal from work or social activities.
• Changes in mood and personality, including apathy and depression.
• Increased anxiety, agitation and sleep disturbances.

As a geriatrician who has taken care of thousands of pateients with Alzheimer’s I can tell you this disease not only eventually steals the essence of who a person is and what their life has been, but also inflicts a large toll on the families of those affected.

No single, simple test exists to diagnose Alzheimer’s disease. Although physicians can almost always determine if a person has dementia, it may be difficult at times to identify the exact type of dementia. We use a variety of approaches and tools to help make a diagnosis. They include the following:

• Obtaining a medical and family history from the individual, including psychiatric history and history of cognitive and behavioral changes.
• Asking a family member or other person close to the individual to provide input about changes in thinking skills, ability to perform common daily functions, and behavior.
• Conducting cognitive tests and a physical examination.
• Having the individual undergo blood tests and brain imaging to rule out other potential causes of dementia symptoms, such as a tumor or certain vitamin deficiencies.

Not all memory issues are due to a dementia such as AD. Mild Cognitive Impairment (MCI ) is a condition in which an individual has mild but measurable changes in thinking abilities that are noticeable to the person affected and to family members and friends, but do not affect the individual’s ability to carry out everyday activities. Approximately 15 percent to 20 percent of people age 65 or older have MCI. People with MCI, especially MCI involving memory problems, are more likely to develop Alzheimer’s and other dementias than people without MCI. A recent systematic review of 32 studies found that an average of 32 percent of individuals with MCI developed Alzheimer’s disease in 5 years.

There is sufficiently strong evidence that regular physical activity and management of cardiovascular risk factors (especially diabetes, obesity, smoking and hypertension) reduce the risk of cognitive decline and may reduce the risk of dementia. In addition, a healthy diet and lifelong learning/cognitive training may reduce the risk of cognitive decline.

Thing that may lower your risk of developing Alzheimer’s disease:

• Practice Good Nutrition All of Your Life: High calorie foods and drinks should be discouraged to prevent obesity and diabetes.
• Eat Lots of Fresh Fruit and Vegetables: This will increase your intake of antioxidants, chemicals that help reduce inflammation in your body. Broccoli, cabbage cauliflower, artichokes, okra, kale and bell peppers top the list of vegetables high in antioxidants. Other options include asparagus, red cabbage and tomatoes. Blueberries, blackberries, raspberries, strawberries and cranberries are among the top fruit sources of antioxidants.
• Avoid Saturated and Trans Fat, Use Vegetable Oils Instead: A low-fat, plant-based diet with lean meat, chicken and small amounts of dairy is preferred. Avoid frequent use of oils high in omega-6 such as corn, safflower, sunflower, and peanut oils.
• Eat Foods High in Omega-3sEat fish at least once a week. For those who do not like fish, try supplementing with Omega 3s. Limit use of fish that are high in mercury and PCB’s such as: swordfish, king mackerel, albacore and fresh tuna, to twice a week. Less contaminated fish are: haddock, Pollock and wild Alaskan salmon.
• Increase Physical Activity: At least 150 minutes per week of moderate aerobic exercise, even walking at a brisk pace, may reduce the risk of AD.
• Increase Social Activity: Social activity on a regular basis may reduce the risk of AD and is also useful for people who already have the disease. Volunteer, join a club, play a sport or game with a group, take classes, travel and keep in touch with friends and family.
• Exercise Your Brain: Do crossword puzzles, word games, board games, and Sudoku.

Alzheimer’s disease is and will continue to be the major health crisis for the US to deal with in this century. With nearly 14 million people who will have the disease by 2050 it is essential that people with AD and those with mild cognitive impairment participate in clinical trials to help find a medication which will prevent, reverse, delay the onset of or significantly slow the course of the disease. We are fortunate to have clinical trials of potential new medications available locally at the NEPA Memory and Alzheimer’s Center in Plains, PA.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.