Alzheimers on the Rise in Hawai‘i
A wave of graying boomers will change the way we live and age in the Islands. No surprise, we’re finding our own ways of facing the challenge.
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Healthy heart, Healthy brain
This year is the 50th anniversary of the Honolulu Heart Program, started at Kuakini Medical Center in 1965. A valuable source of data and a baseline, it led to a spinoff dementia study in 1991 of 8,006 men of Japanese-American ancestry age 71 to 93 years.
The connection to the heart study proved fortuitous. “Our study was one of the first to find hypertension and high blood pressure predictive for dementia and even Alzheimer’s in late life,” says Dr. Kamal Masaki, director of research at Kuakini Medical Center.
“If high blood pressure is left untreated, there is almost five times the risk of developing dementia and Alzheimer’s,” she explains. “Yet if high blood pressure is treated in midlife, the risk is almost completely removed. However, if you wait to start treatment until people are older, it’s too late.”
Another significant find, more particular to Hawai‘i and Asia, was a vulnerability to vascular dementia, which is caused by tiny, often undetectable strokes. “What we found in our Japanese-American men were histories of what are called silent strokes. The patients didn’t even know they’d had one, but would gradually develop memory problems. We’d do a scan and find several minor strokes” that had been missed by doctors and family members.
The same unusual rate of vascular stroke was also seen in men in Japan, Korea and China. “Unfortunately,” says Masaki, “when the study was started, it only involved men,” so that was how it had to be continued—which means the secret to our population of ageless aunties remains a mystery.
But maybe not for long, says Masaki. “What allows people to live long lives, and then what allows them to live healthy long lives, is the big focus of our study now.”
Four ways to prevent or delay Alzheimer’s/dementia
A breakthrough treatment may be decades away, but science has strongly lined up behind lifestyle changes that can delay and even prevent the onset of Alzheimer’s and dementia.
1. Daily physical exercise, specifically 20 to 30 minutes of brisk walking, has been shown to lower the risk of memory decline (one study says by 46 percent).
2. A diet rich in omega-3 fats from fish and nuts, with plenty of antioxidant fruits and vegetables, reduces dementia risk (by 44 percent, says one study). Also, avoid fast, fried, junk and processed food.
3. Taking on complex mental tasks, especially in midlife, decreases dementia risk (by 48 percent, in studies), which means, do those puzzles and brain-teasers, learn a second language, go back to school, vary your routines, travel, write long letters, etc.
4. Reduce stress, which can cause depression and a twofold increase of risk of Alzheimer’s—meditation, yoga and seven to eight hours of sleep a night do wonders; so does a strong social network (friends and family); and, yes, having that daily glass of red wine.
Sources: Archives of Internal Medicine, 2010; A. Kramer, University of Illinois study; The American Journal of Clinical Nutrition, 2005; The American Journal of Geriatric Psychiatry, 2009; G. Small, UCLA Longevity Center; others.
Where are the breakthroughs?
Since its acceptance as a widespread diagnosis in 1968, Alzheimer’s has lacked effective treatment options. Then, as now, patients were treated with antipsychotics and sedatives developed for other diseases, to calm them down. Two medicines later developed to slow the rate of decline in patients with dementia were donepezil (Aricept) and memantine (Namenda), now sold as a combination, Namzaric.
“They’re used currently to replace a chemical deficiency,” says Dr. Kamal Masaki, professor and chair of the Department of Geriatric Medicine at JABSOM as well as director of research at Kuakini Medical Center. “We need something to stop the development of the plaques and tau tangles in the brain that cause the brain to die.”
Anticipation was high in 2012 for a breakthrough drug, solanezumab, from Eli Lilly, that would arrest the death of brain cells in patients. But trial results were viewed as a failure. Facing a horizon without new trials, researchers went back to solanezumab’s inconclusive clinical trial. In July 2015, they published data suggesting that, by starting patients on the drug earlier, the pace of brain decline could be slowed. If so, says Dr. Eric Siemers of Lilly Research Laboratories, “We think there is a chance that solanezumab will be the first disease-modifying medication to be available.” New trials will be completed in October 2016.
What’s normal and what’s Alzheimer’s?
Don’t worry, that thing you forgot is not a sign of Alzheimer’s. Two things? Are you absolutely, positively sure it’s only two?
|Poor judgment, decision-making||VS||Making a bad decision once in a while|
|Inability to manage a budget||VS||Missing a monthly payment|
|Losing track of the date or the season||VS||Forgetting what day it is and remembering later|
|Difficulty having a conversation||VS||Sometimes forgetting which word to use|
|Misplacing things and being unable to retrace steps and find them||VS||Losing things from time to time|
Other Alzheimer’s warning signs: difficulty completing familiar tasks, trouble understanding visual images or spatial relationships, withdrawal from work or social activities, changes in mood and personality, challenges in planning or solving problems.
SOURCE: ALZHEIMER’S ASSOCIATION
Alzheimer’s Association (national)
(800) 272-3900, alz.org
Aloha Chapter Alzheimer’s Association
Elder Law Program
City & County of Honolulu Elderly Affairs Division
Hawai‘i Aging and Disability Resource Center
City and Family Service
Kōkua Care: Hawai‘i Home Care