Butler Hospital doctor at forefront ‘in the war on Alzheimer’s’

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“A tsunami of Alzheimer’s” is occurring across the world today, Dr. Stephen Salloway told the audience packed into the Sopkin Auditorium during The Miriam Hospital Women’s Association meeting on Oct. 19.

The likelihood of being diagnosed with the disease doubles every five years after age 65, and then reaches 30 to 50 percent after age 85.  Women are affected by Alzheimer’s disease at a slightly higher rate than men, and are two times as likely to be caregivers to someone with the disease.

As people continue to live longer, it is predicted that there will be 125 million cases worldwide by 2050, Dr. Salloway said in his address, called “Breakthroughs in the War on Alzheimer’s and What We Can Do in the Face of this Diagnosis.”

Salloway is chief of neurology and director of the Memory and Aging Program at Butler Hospital, and a professor of neurology and psychiatry at the Warren Alpert Medical School of Brown University. He is an internationally recognized leader in clinical trials for the prevention and treatment of Alzheimer’s, as well as being the author of more than 300 scientific articles and abstracts on the disorder and lecturing widely about early diagnosis and treatments.

During his lecture, Salloway commented on how Jewish values affect his work, including tikkun olam, and relying on tzedakah from private donors. He also said he was inspired by his paternal grandmother, who experienced pogroms in Ukraine, and lived with his family after she got dementia, influencing his career choice. His maternal grandmother, he said, was also an inspiration, and encouraged him to become a doctor.

The costs associated with Alzheimer’s now exceed those of cancer or heart disease, Salloway said. People fear Alzheimer’s more than cancer, because they don’t want to lose their independence. Yet much more money is allocated for research into cancer and heart disease. 

One of the few things Congress can agree on, he said, is that Alzheimer’s is a scourge, and lawmakers have launched a national plan to develop treatment breakthroughs by 2025. 

Salloway’s research team is helping to build a worldwide research infrastructure. Part of this is the Alzheimer’s Disease Neuroimaging Initiative, funded by the National Institutes of Health and private support, with a goal of developing new tests to identify people at risk. Butler Hospital is one of the leading centers in the world in this effort to slow down memory loss and move towards prevention. But, in addition to technical and financial help, they need people to participate in studies. Salloway said he is inspired by such volunteers because they are affecting future outcomes for Alzheimer’s patients.  

It was in 1906 that German psychiatrist Alois Alzheimer described the tangles (made of tau protein) and the plaques (made of amyloid protein) that are the hallmarks of Alzheimer’s disease.  

Advances such as molecular brain imaging and PET scans now allow doctors to detect the buildup of plaques before dementia becomes evident.  (People often think Alzheimer’s and dementia are the same thing, but they are not: Alzheimer’s is one of the diseases that leads to dementia. Dementia refers to cognitive impairment that interferes with daily functioning.) This buildup of plaques can begin 15 to 20 years before symptoms of dementia occur.

There have also been major advances in genetics, allowing for identifying a major risk gene (APOE4) and gene mutations that can cause early-onset Alzheimer’s. 

 Interestingly, Salloway said, changes in the retina may also show amyloid, and this could become a cost-effective way of diagnosing the disease. In earlier years, a diagnosis wasn’t possible until dementia was evident. Today, it is possible to diagnose a pre-clinical phase, mild cognitive impairment due to Alzheimer’s, and finally Alzheimer’s disease/dementia.

People often wonder if “senior moments” are an Alzheimer’s indicator, but things like misplacing items, finding it harder to memorize or find words, and slower reaction times are a normal part of aging. In contrast, real warning signs include frequently being repetitive, not coming up with words (even later), not recalling conversations and not realizing there is a memory problem.

What can you do to lower your risk? Dr. Salloway advocates a healthy lifestyle, specifically:

              •            Staying mentally and physically active

              •            Staying engaged socially

              •            Controlling cardiovascular risk (blood pressure and cholesterol)

              •            Not smoking

              •            Sleeping well

              •            Controlling depression

              •            Eating a well-balanced, Mediterranean-type diet

For those at higher risk, medications are being tested to reduce the amyloid plaques and tau tangles. Prevention trials have begun for people, age 60-85, with normal memory but at a higher risk of Alzheimer’s disease based on APOE4 testing or an amyloid PET scan. The goal is to delay memory loss.

Finding out about your Alzheimer’s risk is a personal decision. Fortunately, 70 percent of people who screen for these studies learn that they are at low risk for Alzheimer’s. 

If you’re interested in taking part in the Butler study, call 401-455-6403 or sign up for the Butler Hospital Prevention Registry at www.butler.org/memory.

As Former Surgeon General C. Everett Koop used to say, “Not participating in medical research could be hazardous to your health.”

The committee that organized The Miriam Hospital Women’s Association’s event includes members Sherry Cohen, Marilyn Myrow, Barbara Horovitz Brown, Marianne Litwin, Cynthia Schwartz, Lori Elias, Sharon Gaines and Robin Kauffman.

To learn more about TMHWA, contact Association Administrator Vickie Scott at vickie.scott@lifespan.org or 401-793-2520. 

BARBARA HOROVITZ BROWN is co-vice president of program development for The Miriam Hospital Women’s Association.