August 25, 2016
Miami Herald
Connie Ogle

The battle against Alzheimer’s and dementia is a long way from over. The news sounds bleak: Progress of the disease can occasionally be slowed, but there is no cure. Drugs and treatments are limited. There are no new medical breakthroughs to offer hope to the more than five million Americans with the disease — or their families.

But South Florida health care specialists aren’t throwing in the towel. They can’t, especially not in light of the looming demographics. The Centers for Disease Control estimates that by 2050, the number of Americans with Alzheimer’s will reach 14 million.

“When you consider baby boomers getting older and the fact that people stay in the work force longer, if we don’t find a way to slow Alzheimer’s, it will be devastating from an economic standpoint,” says Dr. David Loewenstein, a psychologist at UHealth—University of Miami Health System. “It’s a horrible illness, devastating for family members and patients, and the greatest risk factor is age. We really have to get a handle on it. That’s why our group in Florida is looking at early detection, at finding the earliest biological changes, so we can isolate those changes and target treatments.”

In 2015, Loewenstein became part of a group that embarked on a five-year study investigating normal aging vs. early signs of memory loss in hopes of differentiating between normal and abnormal cognitive aging. Results, participants hope, could be key in early detection of Alzheimer’s disease, a crucial part of the process.

Fueled by a $2.3 million federal grant and $500,000 from the state of Florida, the collaborative study includes UHealth, Mount Sinai Medical Center, the University of Florida, Florida Atlantic and Florida International universities. A year in, there’s no conclusive data yet. But there’s hope.

“The idea is to evaluate people who are cognitively normal as well as the mildly cognitively impaired,” says Dr. Ranjan Duara, medical director of Mount Sinai’s Wien Center for Alzheimer’s Disease and Memory Disorders, who has worked with Loewenstein for 30 years. “We’re trying to look at people who start out normal, compare risk factors and life styles and see how those affect cognitive development.”

Duara and his team have also worked on what’s known as the nationwide A4 study, which tests older individuals for amyloid plaques in the brain, a sign of Alzheimer’s. Using PET scans as a tool, he says, has helped the process: “The PET scan has been around for about 10 years, but it hasn’t been approved for diagnostic use till fairly recently. … It’s providing us a lot more diagnostic consistency, telling us not only about the underlying disease but what the prognosis is and the rate of expected progression.”

Memory loss is to be expected as we get older, of course: In our 40s, our brains start to degenerate slowly, so forgetting things we used to remember isn’t necessarily cause for concern.

“We all have incidents where we can’t come up with a word or forget where we put our phones or go into a room and forget why we’re there,” says Dr. Po-Heng Tsai, a neurologist at Cleveland Clinic of Florida. “That’s not concerning. But if a patient tells me, ‘I have forgotten to pay my water bill two months in a row’ or ‘I’ve gotten lost a couple of times while driving’ or ‘I forgot to take my medicine,’ that’s different.”

Cleveland Clinic and Mount Sinai are among the institutions offering free memory screenings in South Florida. While they’re not 100 percent accurate in diagnosing dementia, they can point to issues that warrant further investigation.

Of course, not every patient presents in the same way, Duara cautions.

“Some people have language problems, problems with words, as their earliest symptoms,” he asys. “Some have visual changes, so their vision gets impaired, and it’s not an eye problem. The visual part of their brain is affected first. It’s unusual, but it happens. Some people have judgment as an initial problem. They can perform well on a memory test, but they can make shockingly bad choices, bad judgment with finances. They can be subject to all kinds of abuse or scams. . . . some early Alzheimer’s patients present with depression or anxiety or irritability. Many individuals treated by psychiatrists for depression and anxiety, for a long time no one realizes they’re developing Alzheimer’s.”

Researchers are studying the role of genetics in Alzheimer’s, as well as whether diet and environment play a role in developing the disease. According to the CDC, scientists have found evidence that risk factors for heart disease and stroke — high blood pressure, high cholesterol, low levels of the vitamin folate — might increase the risk of Alzheimer’s.

The CDC also reports there’s growing evidence that physical, mental, and social activities can protect against the disease. Along those lines, UHealth’s The Brain Fitness Pavilion, directed by Loewenstein’s colleague Dr. Philip D. Harvey, offers not only assessments of everyday skills but also a customized brain fitness training program. The pavilion uses BrainHQ, an online training program designed by Posit Science, that aims to help patients improve memory, concentration, attention and mental speed.

“I think cognitive training is very important,” Loewenstein says. “I’ve always been a believer. Part of healthy aging is keeping your brain active, doing things that are novel.”