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Fact vs Fiction in Alzheimer Disease

Commentary
Article

November is Alzheimer Awareness Month and a good time to look at common myths held by clinicians and patients alike - and the facts to refute them.

In honor of National Alzheimer Awareness Month, held November 2023, Michael K Racke, MD, medical director of neurology at Quest Diagnostics, delved into some commonly-believed myths about Alzheimer disease and provided his insight on the scientific explanations for these assumptions.

Fact vs fiction in Alzheimer disease image credit Quest Diagnostics

Michael K Racke, MD

There has never been a more exciting time in Alzheimer care than today. Promising innovations in therapies and diagnostics for this most common form of dementia are emerging at a faster pace than at any other time in medicine. At the same time, science is revealing that, for some, preventive behavioral measures can meaningfully delay progression. These developments together provide greater reason for optimism for those at risk of Alzheimer than at any other time in recent memory.

And these medical achievements couldn’t come at a better time. More than 6 million patients nationwide live with Alzheimer disease (AD). By 2050, this number could reach nearly 13 million – with costs of care topping $1 trillion.1

Yet, this rapid pace of change also threatens to confuse providers and patients who may not be up to date on the latest science on Alzheimer. Dispelling long-perpetuated misunderstandings of this complicated condition may open more avenues leading to better outcomes.

Myth #1: Only older patients need to worry about AD.

Fact: AD often begins in the brain in middle age – sometimes decades before symptoms emerge. While age increases risk, it is not a direct cause of Alzheimer and patients of all ages can begin to take steps to potentially slow cognitive decline. A recent study conducted by the CDC showed pediatric patients can reduce their risk of developing AD later in life in a number of ways, from managing their blood pressure and blood sugar, to being physically active.2

Myth #2: AD is primarily an inherited genetic disease.

Fact: Genetics are only one possible factor in the development of AD, and having a family history of Alzheimer does not necessarily doom one to developing the disease. At the same time, a lack of family history does not eliminate the possibility a person will develop Alzheimer. There are 2 categories of genes that influence whether a person develops a disease: risk genes and deterministic genes. While Alzheimer genes have been found in both categories, less than 1% of AD cases are believed to be because of deterministic genes.3

Even those who have these genes may never develop AD; risk genes increase the likelihood of developing a disease, but do not guarantee it will happen. Researchers have found several such genes that increase risk. Apolipoprotein (APOE) ε4, one common form of the APOE gene, has shown to have the strongest impact on risk, as researchers estimate that between 40-65% of people diagnosed with Alzheimer have the APOE-e4 gene.3 Those who inherit copies of APOE-e4 from their parents have an increased risk of developing AD, but it is not a certainty. These individuals can still take steps to mitigate their risk by reducing environmental factors or taking preventative steps to better their condition.

Myth #3: Most patients don’t want to know if they are at risk of developing AD.

Fact: A recent Harris Poll commissioned by Quest Diagnostics found that only 4 in 10 Americans surveyed said they would speak to their clinician right away if experiencing memory or cognitive loss, suggesting an aversion to being diagnosed with a dementia like Alzheimer. Yet, when asked directly, the majority (7 out of 10) expressed a desire to know if they have AD as early as possible to allow for treatment – illustrating a willingness to confront the prospect of a scary medical diagnosis if treatment can enhance the odds of a favorable outcome.4

Myth #4: Only high-powered imaging tests can help evaluate for AD.

Fact: New diagnostics, including those using simple blood tests, are rapidly opening doors to accessible risk evaluation for many. These blood tests generally help assess β-amyloid or tau, 2 brain proteins associated with Alzheimer pathology in the brain. Amyloid-β creates “plaques” which may lead to “tangles” of tau in the brain. For this reason, many diagnostic companies, including Quest Diagnostics, are focused largely on tests for amyloid protein, given its potential to detect early stages of disease.5

Growing acceptance of blood tests is needed, as emerging pharmaceutical treatments for Alzheimer will require better tools to assess patients. This is because conventional tests, such as PET scans and those that use cerebral spinal fluid, are expensive and specialist dependent. Plus, there is a growing shortage of neurologists.6 Laboratory tests, when combined with other screening methods, can be a powerful tool in crafting an effective patient care plan – in fact, in a survey of physicians, 84% said testing for early risk of AD will lead to earlier and improved disease management. Among U.S. adults, 86% agree, stating they believe blood tests for the early detection of Alzheimer risk will increasingly become a regular part of preventative care.7

Myth #5: Only pharmacological therapies can meaningfully address AD.

Fact: For some, Alzheimer may be a preventive condition. New research shows it is possible to reduce risk of AD or at least slow progression. Some studies suggest people who exercise more, including walking an increased number of steps at an advanced pace, have better memory retention and are less likely to develop conditions like Alzheimer or dementia.8 Studies have also shown creative activities like playing games, learning an instrument or reading books may help preserve brain function.9 As a patient gets older, it can be more challenging to maintain social activity, though some research shows this can also help preserve mental function and slow mental decline.10 Yet, the same lifestyle choices and behaviors that can reduce risk of developing heart disease, diabetes and other chronic conditions may also offer some protection against Alzheimer. Addressing depression and hearing loss are other key steps to reduce risk.11

Myth #6: Cognitive decline is irreversible and because of dementia.

Fact: Cognitive decline is often not because of dementia and can be reversed. There are other potentially reversible causes of cognitive decline that can mimic dementia. These include things as minor as medication side effects or hormonal imbalances, and can be as severe as other chronic conditions like HIV. In 1 study, as many as one in 5 (19.17%) individuals (most over the age of 60 years) with cognitive issues were found to have a “reversible” condition, such as adverse effects from medication or hormone imbalances.12 Without screenings, conditions that mimic dementia may go undiagnosed in a patient and cause adverse health effects. If properly diagnosed, these conditions, may be treated to potentially slow or reverse any associated cognitive decline.13

Certain tools aim to address this. As an example, uMETHOD Health, a health technology company specializing in precision medicine for chronic diseases, recently worked with Quest Diagnostics to nationally debut a risk assessment and care plan service for patients with cognitive decline. The service, called RestoreU, employs artificial intelligence to crunch data on a person’s lab test results and health history, including comorbidities, lifestyle habits and medications, to help identify if risk of cognitive decline is because of a reversible cause.14

Conclusion

With so much attention on emerging therapies for AD, it is easy to overlook the growing body of science suggesting a preventive care approach can help delay the onset of Alzheimer and other dementias in some patients. When it comes to conditions like Alzheimer and dementia, one thing remains clear: patients and providers both seek the ability to provide an early diagnosis and craft the best care plan possible. Though so many remain affected by cognitive conditions, there are steps that can be taken, as with any other health condition, to mitigate risk and ease symptoms. By speaking with a provider about these changes, patients may find these conditions more manageable than first anticipated.


REFERENCES
1. Alzheimer's Association. Alzheimer's Facts and Figures Report. Accessed November 15, 2023. https://www.alz.org/alzheimers-dementia/facts-figures
2. Centers for Disease Control and Prevention. Reducing Risk of Alzheimer's Disease. Accessed November 15, 2023. https://www.cdc.gov/aging/publications/features/reducing-risk-of-alzheimers-disease/index.htm
3. Alzheimer's Association. Is Alzheimer's Hereditary / Genetic?. Accessed November 15, 2023. https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors/genetics
4. Physicians Foresee an Alzheimer's Disease Treatment Revolution Supported by Advanced Testing Tools, New Quest Diagnostics Report Finds. News Release. Quest Diagnostics. May 2, 2022. Accessed November 15, 2023. https://www.prnewswire.com/news-releases/physicians-foresee-an-alzheimers-disease-treatment-revolution-supported-by-advanced-testing-tools-new-quest-diagnostics-report-finds
5. Quest Introduces First-To-Market Consumer-Initiated Blood Test for Alzheimer's Disease Risk Assessment on questhealth.com. News Release. Quest Diagnostics. July 31, 2023. Accessed November 15, 2023. https://newsroom.questdiagnostics.com/2023-07-31-Quest-Introduces-First-To-Market-Consumer-Initiated-Blood-Test-for-Alzheimers-Disease-Risk-Assessment-on-questhealth-com
6. Bender K. The “Grave Threat” Posed by the Shortage of Neurologists. NeurologyLive. February 17, 2022. Accessed November 15, 2023. https://www.neurologylive.com/view/the-grave-threat-posed-by-the-shortage-of-neurologists
7. Physicians Foresee an Alzheimer's Disease Treatment Revolution Supported by Advanced Testing Tools, New Quest Diagnostics Report Finds. News Release. Quest Diagnostics. Published May 2, 2022. Accessed November 15, 2023. https://www.prnewswire.com/news-releases/physicians-foresee-an-alzheimers-disease-treatment-revolution-supported-by-advanced-testing-tools-new-quest-diagnostics-report-finds
8. LaMotte S. Walk this number of steps each day to cut your risk of dementia. CNN. September 6, 2022. Accessed November 15, 2023. https://www.cnn.com/2022/09/06/health/step-dementia-risk-wellness/index.html
9. Sapega S. Playing an Instrument: Better for Your Brain than Just Listening. News Blog. Penn Medicine. January 30, 2017. Accessed November 15, 2023. https://www.pennmedicine.org/news/news-blog/2017/january/playing-an-instrument-better-for-your-brain-than-just-listening
10. How to reduce your risk of Alzheimer's and other dementias. Alzheimer’s Society. November 25, 2021. Accessed November 15, 2023. https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/how-reduce-your-risk-alzheimers-and-other-dementias
11. Centers for Disease Control and Prevention. Dementia Risk Reduction. Accessed November 15, 2023. https://www.cdc.gov/aging/publications/features/dementia-risk-reduction-june-2022/index.html
12. Bello VME, Schultz RR. Prevalence of treatable and reversible dementias: A study in a dementia outpatient clinic. Dement Neuropsychol. 2011;5(1):44-47. doi:10.1590/S1980-57642011DN05010008
13. Booth S. Diseases That Look Like Alzheimer's (But Aren't). WebMD. September 11, 2022. Accessed November 15, 2023. https://www.webmd.com/alzheimers/diseases-like-alzheimers
14. Quest Diagnostics Extends Alzheimer's Disease Portfolio with New AI-Powered Test Service from uMETHOD Health. News Release. Published May 4, 2023. Accessed November 15, 2023. https://newsroom.questdiagnostics.com/2023-05-04-Quest-Diagnostics-Extends-Alzheimers-Disease-Portfolio-with-New-AI-Powered-Test-Service-from-uMETHOD-Health

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