Know the 10 Signs: Early Detection Matters, the Alzheimer’s Association’s national early detection campaign, can help you to recognize the warning signs of Alzheimer’s in a loved one.

The signs are a key tool in increasing recognition of changes that indicate Alzheimer’s or another dementia. Early detection, diagnosis and intervention are critical because they provide the best opportunities for treatment, support and planning for the future.
The 10 signs include:

• Memory changes that disrupt daily life
• Challenges in planning or solving problems
• Difficulty completing familiar tasks
• Confusion with time or place
• Trouble understanding visual images and spatial relationships
• New problems with words in 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

If you or someone you care about is experiencing any of the 10 warning signs, please see a doctor to find the cause. For more information about the signs, early detection and diagnosis, contact the Alzheimer’s Association at 877.IS.IT.ALZ (877.474.8259) or visit www.alz.org/10signs.

A rapidly aging population and dramatic increases in the number of Alzheimer cases in the coming years underscores the urgency in dealing with a crisis that is no longer emerging, but here.

Generation Alzheimer’s also describes the effect Alzheimer’s has on families and friends. Beyond the 10 million baby boomers who will either die with or from Alzheimer’s, millions of caregivers will be devastated, not only by the progressive loss of their loved one, but also by the care they will  provide – care that could negatively affect their health, financial security and their future.

 Most people survive an average of four to six years after a diagnosis of Alzheimer’s, but many live for as long as 20 years with the disease. This often long duration places increasingly intensive care demands on Alzheimer and dementia caregivers – as many as 11 million nationwide.

Alzheimer’s disease will also have a profound effect on our nation, killing more than diabetes and more than breast cancer and prostate cancer combined.  According to preliminary data from National Center for Health Statistics, the number of Americans that die each year from Alzheimer’s disease has risen 66 percent since 2000. In 2010, Alzheimer’s and other dementias cost American society – families, insurers and the government – $172 billion; during the next 40 years it will cost more than $20 trillion, enough to pay of the national debt today and still send a $20,000 check to every man, woman and child in America.

Generation Alzheimer’s calls for a federal government committed to a thorough, aggressive and innovative approach to ending Alzheimer’s.

For more information about Generation Alzheimer’s, Alzheimer’s disease or resources to help, visit the Alzheimer’s Association at alz.org.

New partnership facilitates patient support, connects loved ones

For patients going through a significant health challenge, the first couple weeks can be extremely overwhelming. In times like these, patients and their families rely on support from extended family and friends. Confronted with treatment plans that often involve complex medical terminology, patients are also burdened with updating concerned family members and friends, a process that can be exhausting.

There is an easier way. CareGivers America recently partnered with CaringBridge, a nonprofit that offers free, private websites that connect family and friends to share information, love and support during a significant health challenge. Now patients and their families can use a CaringBridge website to centralize communication during all types of serious health events, easing the burden of updating family and friends and allowing caregivers to stay focused on caring for the patient.

The websites can be an important tool for patients and families to reduce isolation and stress in a difficult time, giving them a much-needed outlet for sharing their feelings and receiving support. Rather than individually contacting each member of their support system, a CaringBridge site allows patients and their families to update everyone concerned with just one journal entry.

A CaringBridge site also helps patients build therapeutic connections with their support networks, allowing family and friends to send messages of love and encouragement through the patient’s guestbook. Many authors of CaringBridge sites say that overwhelming compassion they receive through the guestbook helps them experience emotional healing and improved quality of life.

CaringBridge was founded in 1997 when founder Sona Mehring’s close friend developed a life-threatening pregnancy. To keep family and friends informed about the critical situation, Mehring created a website to communicate information to a wide circle of people without disturbing the mother’s need for rest or placing additional demands on hospital staff. From such humble beginnings, CaringBridge has grown to host more than 254,000 personal sites that connect over half-a-million people daily. The CaringBridge community includes authors, visitors and donors in all 50 states and more than 225 countries and territories around the world.

For more information or to create your own CaringBridge site, visit www.CaringBridge.org or www.caregiversamerica.com

About 200,000 Americans are estimated to have early-onset Alzheimer’s disease, which means the disease is found before age 65. Alzheimer’s is the most common form of dementia, and it a causes significant memory and thinking problems. There is no cure.

Tennessee Women’s Basketball Coach Pat Summitt, who announced her diagnosis — and her intention to keep coaching — this week, is 59.

SI.com: Summitt reveals dementia, plans to coach this year

There is no typical job scenario for early-onset Alzheimer’s. Whether a person with the progressive disorder can continue working successfully depends on his or her case and circumstances, and to what extent the disease has impaired brain function.

“Every case is different and different patients progress at different rates,” said Dr. Patrick Lyden, chairman of the neurology department at Cedars-Sinai Medical Center in Los Angeles, California. “The most important thing is to work closely with a neurologist, talk to your family and your co-workers, and everybody is different. Some people can work longer than others.”

What should Summitt know? Your Alzheimer’s wisdom

The disease can strike people even in their 30s, and others who are in their mid-life, at the peak of their careers — even while raising young children. For those like Summitt who vow to keep working, it takes a dedicated support system.

In a video announcement of her news, Summitt noted that she would be “relying on my outstanding coaching staff like never before.”

Lyden recalled one patient who served as the CEO of a Fortune 1,000 company when he developed dementia. His co-workers were able to double-check his work and still benefit from his expertise for several years.

Another of his patients continued working at his family’s dry cleaning company every day until his condition worsened.

“It’s a topic that we all need to think through. This is going to be happening more and more. If a workplace doesn’t have a plan, they might want to think about developing one,” Lyden said.

Alzheimer’s: Early detection, risk factors are crucial

Summitt told the Washington Post that she hopes to coach at least three more years.

According to the newspaper, the first signs of memory problems started when Summitt started losing her keys more frequently, forgetting basketball team meetings and freezing when it came to offensive plays.

“I’m very impressed that she decided to go public because I think a lot of people would have a tendency to feel like they would retire for personal reasons and not be open,” said Dr. Marc Gordon, neurologist and Alzheimer’s researcher at The Feinstein Institute for Medical Research in Manhasset, New York.

The disease is a spectrum — some people stay in the mild phases longer than others, but ultimately patients lose their ability to remember and learn new information.

The disorder begins in the hippocampus, the structure of the brain crucial for formation of new memories. The pathology of Alzheimer’s, characterized by plaques in the brain, then spreads, but its course is unpredictable.

If a brain region you need for your job hasn’t been hit, you can continue performing certain tasks, but you may need assistance as time goes on, says Dr. Scott Small, professor of neurology at Columbia University.

In mild dementia, people can answer their own phones and communicate, which may allow them to work in some capacity, depending on the person. The mild stage usually lasts for about two years, but varies individually.

“Early-stage people can be pretty independent. As time goes on, they may need increasing assistance,” Gordon said.

It was a tricky path for Lou Bordisso, 57.

His job as a licensed therapist was to help people in their worst moments. He counseled feuding married couples, families in distress and criminal defendants who were found not guilty by reason of insanity in his forensic mental health work for Contra Costa County in California. He was also a bishop.

By no means was he ready to slow down.

But seven years ago, he started losing his way around office buildings. He’d forget where the conference room was located. He missed meeting friends because he couldn’t find the exit from the Macy’s department store in San Francisco.

Finally in May 2010 after spinal taps, neuropsychological testing, MRIs and other tests, the doctor told him he had early onset Alzheimer’s.

He tried to compensate for the deficiencies in his memory by working harder and taking more notes.

Although he had testified in court and written reports to judges in his role evaluating defendants’ mental health, he realized that the disease affected the quality of his work.

“I had been writing a lot of reports to the judge making considerable errors,” Bordisso said. “It became evident with my co-workers, peers and supervisors. It was time to take some time off.”

The decision was mutual. But retiring from his full-time counseling job and his duties as bishop was “devastating,” he said.

“It’s a sense of despair and grief,” he said. “I’m going through what’s similar to when someone loses a loved one in life. I’m hopefully moving to the point of acceptance.”

He continues his counseling work, although he has drastically reduced the number of clients he sees.

Because his long-term memory is better than his short-term memory, Bordisso moved back to his childhood home in Sacramento, California. The move makes it easier for him navigate his neighborhood and home.

“I’m used to contributing as a responsible, accountable person,” he said. “There’s nothing worse for me than not being able to give back.

“Being on the receiving end of services is granting me a new perspective in life. I’m becoming more appreciative of what others are going through. My sense of empathy has increased as well.”

To lower your risk of falling, use the answers to these questions to make your home safer and to know what to do in an emergency.

Q. How often do falls occur?
A. Falls among seniors have become an epidemic that jeopardizes seniors’ chances to live independently. According to the Center for Disease Control and Prevention (CDC), every year in the US, one out of three people age 65 and older will fall. This statistic translates to 13.3 million people who will fall in 2010 or one person falling every 2.3 seconds on average. As alarming as they are, these documented statistics fall short of the actual number since many incidents are unreported by seniors and unrecognized by family members or caregivers.

Q. Why do seniors fall?
A. summary of 12 studies cite the following most common reasons for falls among seniors: accident/environment, gait/balance disorder and dizziness/vertigo. In addition to
the list, the effect of drugs on the elderly and the difficulties surrounding medication compliance, are also believed to be the root cause for many falls.

Q. Are there steps I can take to reduce my fall risk?
A. Yes, here are three suggestions on how to minimize the risk of falling.
Physical Risks
Some people think that the best thing to do if you’ve fallen or if you’re afraid of falling is to be less active. Actually inactivity makes it more likely that you will fall. You should consider an exercise program. Always check with your healthcare professional before you begin.
Remove Hazards In And Around The Home
As we get older, items in our home that used to be virtually harmless start to pose a great risk. Carpets, stairs, even pets can be dangerous. Visit each room in your home and look for overall safety issues and ways to reduce risk, like improving lighting, removing clutter, securing rugs, installing railings and grab bars.
Health and Medicine
Although medications are supposed to keep you from getting sick, they can also put you at risk for falling. It is a good idea to consult a pharmacist or your healthcare provider about all the medications you take, and take medications as directed.

Q. How do you get up from a fall?
A. Healthcare experts recommend that you “learn how to get up safely.” Here are the steps to get up from a fall:
Prepare
Getting up quickly or the wrong way could make an injury worse. If you are hurt, call for help using a medical alert service or a telephone, or by making yourself heard in any way possible. Look around for a sturdy piece of furniture or the bottom of a staircase. Don’t try and stand up on your own. Roll over onto your side by turning your head in the direction you are trying to roll. Then, move your shoulders, arm, hips and, finally, your leg over.
Rise
Push your upper body up. Lift your head and pause for a few moments to steady yourself. Slowly get up on your hands and knees and crawl to a sturdy chair. Place your hands on the seat of the chair and slide one foot forward so it is flat on the floor.
Sit
Keep the other leg bent with the knee on the floor. From this kneeling position, slowly rise and turn your body to sit in the chair. Sit for a few minutes before you try to do anything else.
Talk to your primary care provider about having a fall-risk evaluation. The fact that you have fallen once means that you have a high risk of falling again.

Q. Are there resources available for me?
A. Yes, Philips Lifeline sponsors a website for facts, figures and information on reducing your fall risk. For more, go to www.learnnottofall.com

Contact CareGivers America Home Health Services for more tips: 570-586-2222.

“This is the first study to show that exercise reduces susceptibility to the cognitive impairments that follow infection in aging animals, and the changes taking place in the brain thought to underlie these impairments,” Dr. Barrientos said. Bacterial infections kick off a cascade of events that signal the brain that something is wrong. Barrientos and colleagues previously found older rats experienced memory loss following E. coli infection, an outcome not seen in young adult rats. They also found the microglia, or immune defense cells in the brain of, older animals became more reactive to infection, releasing more chemicals involved in inflammation in the hippocampus, in contrast with younger animals.

In the current study, the researchers allowed unlimited access to a running wheel to determine if exercise could help block the events that follow E. coli infection in the aging animals. Although the old rats only ran an average of 0.43 miles per week (50 times less distance than the young rats), they performed better on a memory test than rats who only had access to a locked exercise wheel. Additionally, the runners performed as well on the memory test as rats that were not exposed to E. coli. The small amount of exercise performed by the aging rats also prevented the reactive response of microglia in the hippocampus. With the go-ahead from your physician, even a little moderate exercise can go a long way to protecting you from age-related health issues, including immunity.

http://www.parentgiving.com/elder-care/newsflash/

by Rita Miller-Huey

As we enter the warmer part of the year, it is more important than ever to drink enough fluids. This is particularly true for children and for persons 65 and older – which could be both the caregivers and their loved ones. Not drinking enough fluids can cause unwanted symptoms, complications from existing disease conditions and may account for many hospitalizations of our elders. Water and juices are the best; coffee, tea and colas with caffeine as well as alcoholic drinks cause the body to lose fluids and are recommended only in small amounts.
Elders are at risk for dehydration for many reasons:

Age related. There is less water in the older body, greater difficulty for the older kidney to maintain fluid balance and less thirst sensations in older folks in general.

Disease-related reasons for dehydration range from the complex to the simple.  Infections such as pneumonia, chronic obstructive pulmonary disease (COPD) and urinary tract infections increase the need for fluids due to fevers and the overproduction of mucus. Some diseases, such as congestive heart failure, renal disease, stroke or other neurological disorders and diabetes, cause changes in the function of various hormones that regulate the fluid balance in the body. Also, there are acute reasons for dehydration such as prolonged vomiting or diarrhea, over-aggressive diuretic therapy and poor compliance to medication regimens.

Environmental reasons. A decrease in mobility for those with arthritis, diminished vision or confined to bed rest who cannot as easily meet their own needs. Those with diminished appetite or reluctance to bother others for something as simple as assistance in getting a sip of water are definitely at risk.

Medication reasons. May cause increased fluid losses through the kidneys. Diuretics, sedatives and laxatives are common, necessary drugs that require close attention to fluid intake. Other drugs and alcohol can cause the kidneys to work harder, and may damage them, making it harder to maintain fluid balance.

Psychosocial reasons. This is the elder who is cognitively impaired, and possibly unable to drink without full assistance, or those who may intentionally restrict fluid intake in the hopes of decreasing the risk of incontinence.

Economic reasons. This may include the lack of financial resources to maintain nutritional and fluid intake, extreme or prolonged weather fluctuations and the possibility of elder abuse.

How could you tell if your loved one might be becoming dehydrated? Ask yourself if they have any of the above mentioned risk factors. If they complain of nausea, are lethargic, have headaches, vomiting or dizziness, these could all be signs of dehydration. Call your doctor if your loved one had any or all of these symptoms.

Keep track of how much your loved one actually drinks in a day. A simple way to do this would be to put two quarts of water in the refrigerator first thing in the morning. Give all fluids for your loved one from his or her special pitcher. By the end of the day, they should have drunk most of the 2-quart pitcher. It could be plain water, water with lemon or other fruit juices made with water. Regular tea and coffee do not count because they promote fluid loss. Decaffeinated teas and coffees are OK (if your loved one will not drink plain water or juices) because they are less likely to promote urination. Foods that melt at room temperature, such as gelatin or ice cream also have a lot of water content. Serve foods with sauces, juices and gravies – every little bit helps.

There are some diseases for which it is not appropriate to offer so many fluids: congestive heart failure, cirrhosis of the liver and kidney disease. However, for most of us, young and older, the rule of thumb is to drink, drink, drink to keep the body hydrated, and stay away from the hospital and all the tubes and therapy needed if dehydration does occur.

Home care is a viable and often preferred alternative to long-term hospitalization or other institutionalized care. Home care may be recommended for patients with long-term health conditions, acute illness, permanent disability or terminal illness. In these cases, there are often a number of services available. The services of nurses, physical therapists, speech therapists, occupational therapists, social workers, dietitians, home health aides, homemakers, chore workers and companions are all usually available though the home care provider.

Your loved one’s physician will help you decide what services she needs, but choosing the right home care provider takes some time and research.

The first step is to discuss the care recipient’s home care needs with his physician, hospital discharge planner or case manager. Also, ask for a list of local, licensed home care agencies. If a list is not available, request one from the state’s department of aging, health or social services.

The following should also be considered when choosing a home care agency:

Does the agency provide the services your loved one needs?

Does the agency provide continuity of care? Will the same professional Caregiver or team be involved for the duration of the care plan?

Are the care recipients and family Caregivers included when the agency develops or changes the care plan?

When is the agency accessible? Is someone available to assist you and your loved one to answer questions after hours or in an emergency?

Does the provider have a good reputation and positive track record? Ask for a list of references from local physicians, health care professionals, discharge planners, and former clients.

How long has the agency been in business, serving your community?

Is the agency licensed (required in many states) and accredited by a healthcare accreditation organization, such as the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)?

Does the agency accept Medicare, Medicaid, or other public third party payors? Because each state has its own eligibility requirements, the home health agency may not accept patients covered by Medicaid.

Is the agency Medicare certified? Only Medicare certified agencies can provide services covered by Medicare. It is also beneficial to determine if the agency will continue services if Medicare or other reimbursement sources are exhausted.

The agency you choose should be an extension of the physician’s original plan of care for the patient. It is essential that the agency and Caregivers work well with the care recipient, her family and physician. The common goal for everyone involved in the patient’s home care services should be a successful recovery.

Older people who do not have help for daily tasks such as dressing and bathing are much more likely to be hospitalized for acute illness than older adults who receive the help they need, a Purdue University study indicates, suggesting that reducing health-care costs for older adults may be as simple as providing them with a little household help each day.
A research team, including Purdue nursing professor Laura P. Sands, has found evidence that older adults who qualify for nursing-home care because of their disabilities in daily tasks can continue to live in their homes provided they receive assistance with fundamental needs such as bathing, dressing and preparing food. Elders who lived alone without such needed assistance were more likely to require hospitalization. After a few weeks of help with daily tasks, however, the need for health care dropped off, implying that a little help with the basics goes a long way.

“While such essential care would not include the cost of visits to the doctor, our data suggest that people who receive additional assistance would be less likely to be hospitalized, and that could conceivably allow us to keep our health care-costs down while still providing for our frail elders,” said Sands, who is an associate professor of nursing in Purdue’s College of Pharmacy, Nursing and Health Sciences. “As our population ages, there will be more need to find economical ways to care for this group, and adequate home-based care could be both less expensive and more effective for some than full-time nursing-home care.”

The group’s report appears in the Feb. 6 issue of the Journal of the American Geriatrics Society. Team members also include Purdue’s Yun Wang, George P. McCabe and Kristofer Jennings; the University of California, San Francisco’s Catherine Eng and Kenneth E. Covinsky.

To examine what effect living with unmet needs had on the use of medical services, Sands’ team studied 2,943 frail older people enrolled at 13 sites nation wide in the Program of All-inclusive Care for the Elderly. The program provides medical and social services that also meets the daily living needs of those eligible for nursing homes.

“Nearly 30 percent of adults aged 75 and older have one or more disabilities in performing basic activities of daily living,” Sands said. “Additionally, of the more than 2.3 million older adults with severe disability, 84 percent receive some form of public health insurance. We wanted to find out what might be done to help this group more effectively.”

The team discovered that those who lived with unmet daily living needs before enrollment in the program were more likely to live alone and to have been admitted to a hospital or nursing home in the previous six months.

“People who have difficulty with bathing, dressing and walking across a room require our health-care system to a greater extent,” Sands said. “Those who have trouble performing such activities have higher rates of hospitalizations, longer hospital stays, and more physician visits than those with no disabilities.”

But after six weeks of receiving the program’s services, the number of hospital admissions for those who had been living with unmet needs significantly declined, becoming similar to the admission rates of those who had their needs met before enrollment.

“What this suggests is that if a homemaker or personal assistant helps these frail elders for a few hours a day, they would be less likely to experience medical conditions such as hunger, dehydration, falls and skin problems that occur when disabled older adults do not receive needed help with daily tasks.” Sands said. “As our government is under increasing pressure to develop fiscally feasible solutions for caring for disabled older people, we feel providing disabled elders with adequate home-based care should receive further attention.”

Sands said that while the concept would not eliminate older people’s need for regular medical attention, it could reduce preventable illness, which would improve the quality of life for the generation of baby boomer Americans, many of whom will need some form of care within the next decade.

“We’re talking about helping people stay relatively independent as long as possible,” she said. “That’s what many elderly people and their younger family members desire.”

Sands also said that $132 billion is spent yearly in the U.S. on long-term medical care, about 73 percent of which goes to nursing homes. Half of long-term care is paid by the government. Keeping a person in a nursing home costs the government around $30,000 per year, while paying a personal assistant to visit for a few hours a day would cost perhaps a third as much, she said. “More importantly,” Sands said, “you’d be helping a person stay in their own home.”

This research has been funded in part by the National Institutes of Health.

Members of the research team are affiliated with Purdue’s Center for Aging and the Life Course and the Regenstrief Center for Healthcare Engineering.

The Center on Aging and the Life Course aims to promote aging-related interdisciplinary research and education that enhances quality of life for the elderly.

The Regenstrief Center for Healthcare Engineering at Discovery Park, the university’s research and enterprise hub, aims to re-engineer health-care delivery by applying a multidisciplinary approach emphasizing systems engineering and management principles. Some initial areas of research include improving the safety and efficiency of patient care, providing more efficient deployment of physicians, nurses and other health-care personnel, and better coordinating inpatient and outpatient treatment.

Writer: Chad Boutin, (765) 494-2081, cboutin@purdue.edu

Source: Laura Sands, (765) 494-4037, lsands@purdue.edu

Purdue News Service: (765) 494-2096; purduenews@purdue.edu

By Elizabeth Landau, CNN

With more than 5 million people suffering from Alzheimer’s disease in the United States, a number that’s expected to rise to 16 million by 2050, the pressure is on to find better methods of diagnosis, treatment and prevention.

Around the world, Alzheimer’s disease is the second most feared disease, behind cancer, according to a recent survey of five countries conducted by the Harvard School of Public Health.

Yet there is still a lot of misinformation: Only 61% of Americans who responded to the survey correctly identified Alzheimer’s disease as a fatal illness. Many participants also mistakenly believe there are sure diagnostic methods and effective treatments to slow the disease, but most would seek medical attention if they became aware of their own early signs.

The research that came out of the Alzheimer’s Association 2011 International Conference on Alzheimer’s Disease, which took place in Paris last week, reflects a growing emphasis on early detection.

Research suggests the best targets for exploring treatments are patients who do not have full-blown Alzheimer’s disease, but experience mild symptoms. Scientists have identified biological indicators called biomarkers that seem to be associated with Alzheimer’s, although they are not perfect predictors.

“Things are heading earlier and earlier. And the use of biomarkers has been really essential for helping everybody move toward an understanding of what the earliest changes are and when they can be detected,” said Dr. Allan Levey, chair of neurology at Emory University School of Medicine.

Early detection

So far, no drug has been developed to significantly slow the progression of the disease in all patients. And there’s no way to halt or reverse the decline of memory and other cognitive abilities once Alzheimer’s has been diagnosed. Since attempts to help patients who already have symptoms in these ways have failed, scientists must look to the earliest stages of Alzheimer’s in hopes of stopping it before it begins.

Studies presented at the conference reinforced the notion that signs of Alzheimer’s may develop in the brain 10 to 20 years before any symptoms begin.

A substance in the brain called beta-amyloid has been associated with dementia in people who have those kinds of symptoms. This is the main ingredient of plaques that build up in the brains of Alzheimer’s patients.

People with a rare genetic form of Alzheimer’s, whose specific genetic mutations guarantee that they will develop the disease, tended to show signs of amyloid plaques in PET scans and cerebrospinal fluid 10 to 20 years before the onset of symptoms. These results come from the Dominantly Inherited Alzheimer Network project.

But that represents only a small fraction of Alzheimer’s patients — 1% of cases worldwide, specifically. If you don’t have the genetic form, there’s no way to tell if you will go on to develop the disease, even if you have accumulation of amyloid plaques. There are some people who have them but do not show symptoms of Alzheimer’s.

The kinds of tests that would detect beta-amyloid levels are not widely available. And it’s not clear that pulling the amyloid plaques out of the brain reverses the process of cognitive decline; this is one area of research right now.

Another biomarker of interest is a protein called tau, implicated in the neurofibrillary tangles — which basically take the shape of cells and destroy them — that build up in the brains of Alzheimer’s patients, particularly in the memory center called the hippocampus. But there’s no scan to detect these tangles in a living patient.

A major focus of research on early detection is patients who have mild cognitive impairment, a collection of symptoms involving difficulty with memory, language and other mental functions, but which does not interfere with everyday life. It is not necessarily a precursor to Alzheimer’s disease, but it does raise the risk of progressing into that more severe illness.

Understanding mild cognitive impairment is important in coming up with better treatments for dementia in general, because the brain hasn’t deteriorated as much as in Alzheimer’s, so it may not be too late to intervene, experts say.

The brain is the primary organ the disease attacks, but a small study presented at the conference suggests the eyes may also reveal signs of Alzheimer’s. Researchers looked at photos of retinal blood vessels and found some differences in Alzheimer’s patients, but further research is needed to confirm this idea of using an eye exam to help diagnose Alzheimer’s. The same holds for a study suggesting that falling is indicative of Alzheimer’s early stages: It’s a preliminary idea that needs further investigation.

Identifying risk and prevention factors

Another area of focus is identifying risk factors for Alzheimer’s disease. These are associations, not known direct causes.

“Age is a risk factor we can’t modify, at least yet. Our genetics, we can’t modify yet, which is another major risk factor,” Levey said. “But certainly seeking clues about ones that are modifiable is an important” research area.

At the Paris conference, researchers said 3 million cases of Alzheimer’s could be prevented worldwide if lifestyle-based, chronic disease risk factors were reduced by 25%. This estimate is based on a mathematical model.

In the United States, physical inactivity had the biggest association with Alzheimer’s out of the risk factors studied, followed by depression and smoking. Midlife hypertension, midlife obesity, low educational attainment and diabetes are other risk factors.

“If we can demonstrate that these risk factors can be modified, and that it will lead to lower rates of Alzheimer’s disease, the impact could be huge,” Levey said.

People in their 40s and 50s have still got perhaps a couple of decades to modify lifestyle to potentially lower risk, he said.

There is also growing evidence that head trauma may increase the risk of dementia. One study presented at the conference in Paris found that traumatic brain injury was associated with dementia among older veterans.

A study of former NFL players suggests that football players also may be at increased risk for mild cognitive impairment or similar cognitive decline, perhaps as a result of repeated head injury during these former athletes’ sports careers. In fact, 75 former professional football players are suing the NFL, alleging that the league concealed information about the harmful effects of concussions on the brain for decades.

There is also the idea of cognitive reserve: that keeping the mind active can at least delay the onset of dementia. It also seems that intelligence might help the brain stay in the mild phase of the disease longer, although more study needs to be done in this area as well.

“We know that highly intelligent people have more tolerance to plaque buildup and to loss of energy in their brains than people with lower levels of intelligence and less education,” said Dr. Steven DeKosky, vice president and dean of the University of Virginia’s School of Medicine, at an Alzheimer’s forum at the National Press Foundation in May. “Their brain basically fights it off and finds some other ways to get the things done.”

Caregiving

One of the underappreciated effects of Alzheimer’s disease is how great a toll it takes on caregivers. Caregivers are much more frequently ill and die earlier than people who do not care for someone with the disease, studies have shown. The stress of taking care of someone chronically ill is sometimes called caregiver syndrome.

Caregiving is hazardous to health because of the stress of helping Alzheimer’s patients, and because caregivers may ignore their own health, DeKosky said.

“Alzheimer’s patients, when they get into moderate and severe stages, don’t have some real sense of time,” DeKosky said. “They have to be watched every minute.”

Patients may hurt themselves or wander off if not under constant supervision. And it’s common for patients to reverse their sleeping and waking cycles, so caregivers’ daily habits are likewise disrupted.

The cost is staggering: Caregivers provide more than $200 billion in unpaid care, 17 billion hours each year, according to the Alzheimer’s Association.

Why don’t we know more?

Two of the biggest obstacles to finding treatments for Alzheimer’s disease are lack of money and difficulty enrolling people in clinical trials, experts say.

The United States spends $450 million each year in Alzheimer’s research money, compared to $6 billion for cancer, $4 billion for heart disease and $3 billion for HIV/AIDS research.

In spite of the money that does exist for research, Alzheimer’s clinical trials are hard to fill with participants, said Dr. R. Scott Turner, director of the Georgetown University Memory Disorders Program.

Sometimes people believe they’re just having “senior moments” and don’t want to acknowledge their illness, Turner said. In other cases, patients don’t want to go through the hassle of the trial if they’re not guaranteed to receive an experimental drug; but, in order for a scientific study to be valid, patients must be randomly assigned to either the drug or a placebo.

Also, some trials don’t test drugs at all, but simply look for those biomarkers that may help predict disease later or explore other early diagnostic methods. Such methods will be in high demand when an effective treatment is developed, DeKosky said.

“When the first drug is successful, let’s say in symptomatic disease — may it be so — the crush to take advantage of what we know, while it’s still in research format now, will be immense,” DeKosky said.

If you or a loved one are interested in exploring clinical trials, the Alzheimer’s Association runs a system called TrialMatch to assist in finding a trial near you.