MARCH 12, 1997
Small strokes in the brain accelerate the deterioration caused by Alzheimer's disease, according to the latest Journal of the American Medical Association. New drugs and treatments offer hope for the 4 million Americans suffering from the debilitating brain disorder. Charlayne Hunter-Gault gets the details of the new discoveries from two researchers in the field.
CHARLAYNE HUNTER-GAULT: Today's issue of the Journal of the American Medical Association is devoted entirely to Alzheimer's, the brain disease that turns the golden years of 4 million Americans, mostly over 70, into a period of dementia and even death. But one major story in the magazine suggests Alzheimer's may not be the culprit in many of the changes in the very old and that other studies suggest that many of the symptoms can be avoided or significantly reduced.
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For details on some of these new findings we are joined by two leading researchers in the field, Marcelle Morrison-Bogorad oversees much Alzheimer's research as the associate director of the neuro science and neuro psychology program at the National Institute on Aging. She wrote an editorial in today's journal. And David Snowdon is the lead author of today's study dealing with strokes and Alzheimer's. He is an epidemiologist at the Sanders Brown Center on Aging at the University of Kentucky. Thank you both for joining us. And starting with you, Mr. Snowdon, in the simplest terms, explain what your study found out about the connection between Alzheimer's and strokes.
DAVID SNOWDON, University of Kentucky College of Medicine: We found that one or two small strokes increased the risk of developing the symptoms of Alzheimer's, and once the symptoms appeared one or two small strokes made the symptoms much more severe. We did the study in 102 Catholic sisters who were 76 to 100 years of age. They had been examined yearly, and they had all agreed to donate their brain at death for our study. And we found that those sisters who had an Alzheimer's-like brain, that many of them did not act like they had Alzheimer's, and that the small strokes in strategic regions of the brain appeared to play a role initiating the appearance of the symptoms of Alzheimer's. And once the symptoms appeared, these small strokes were associated with much more severe symptoms.
CHARLAYNE HUNTER-GAULT: And the symptoms you're describing are what, the symptoms of Alzheimer's?
DAVID SNOWDON: Alzheimer's is certainly noted by memory problems, problems in other areas of thinking, such as language and social and occupational problems.
CHARLAYNE HUNTER-GAULT: And the dementia?
DAVID SNOWDON: That's basically what dementia--
CHARLAYNE HUNTER-GAULT: What you just described.
DAVID SNOWDON: Alzheimer's is one of the types of dementia. Alzheimer's is the most common type in the United States and other western populations.
CHARLAYNE HUNTER-GAULT: And when you say an Alzheimer's brain, what did you mean by that?
DAVID SNOWDON: Well, we all develop the lesions of Alzheimer's as we get older.
CHARLAYNE HUNTER-GAULT: Anybody, everybody?
DAVID SNOWDON: Everybody, if they live to be old enough, will get these lesions of Alzheimer's, which are just abnormal deposits of protein. And we find that these sisters, who have abundant lesions of Alzheimer's, that they have what we would call an Alzheimer's-like brain, but many of them don't act like they have Alzheimer's. Basically, it took less of these lesions of Alzheimer's to cause dementia or the symptoms of Alzheimer's if small strokes were present.
CHARLAYNE HUNTER-GAULT: And what caused the small strokes?
DAVID SNOWDON: We were concerned at the beginning that the strokes might be related to the Alzheimer's disease, itself, but we found that the lesions of Alzheimer's disease had no relationship to the strokes, and the major gene for Alzheimer's had no relationship to the strokes, but what was related in our study to small and large strokes was the amount of atherosclerosis and blood vessels of the brain or basically hardening of the arteries of the brain was part of--part of the small and the large strokes. And so they looked, if you will, like garden variety strokes that are probably related to in the general population to high blood pressure, cigarette smoking, and diabetes.
CHARLAYNE HUNTER-GAULT: Just briefly, how does a person know that he or she has had one of these little strokes? Are they discernible as strokes?
DAVID SNOWDON: Well, that's a problem, because we know a lot about larger strokes, that they have very classic symptoms such as numbness, not being able to use an arm or a leg, blurred vision. See, smaller strokes my have different symptoms. Our study shows that what it strongly suggests that there are strong mental impairments, strong mental symptoms associated with a small stroke, but what we're concerned about is that as people get older, their risk of small strokes goes up dramatically. In the sisters they went up dramatically with increasing age to where after age 95 the overwhelming majority of the sisters had the small strokes. What we're concerned about is that some of these small strokes, that many of them may go undetected, even though they are causing problems.
CHARLAYNE HUNTER-GAULT: I know some people who have had small fainting spells, as they call them, and it was later determined that these were small strokes.
DAVID SNOWDON: Correct. And that, basically the National Stroke Association suggests that or claims, makes a very strong statement, rather, that stroke is an emergency. If you think you are having a stroke or a loved one is having a stroke, this requires immediate attention by a doctor because if you get one stroke, your chances of getting another one increase dramatically.
CHARLAYNE HUNTER-GAULT: Ms. Bogorad, how did the scientific community view this, the significance of this finding?
MARCELLE MORRISON-BOGORAD, National Institute on Aging: I think basically we've all thought for a long time that it was quite probable that other problems in the brain were going to--could coerce the symptoms of Alzheimer's. This was one of the first studies to really show that this actually happens, so I think the way that I would think of it is that people get the neuro pathology of Alzheimer's, the changes of Alzheimer's occur in the brain. But when they have a stroke as well, as Dr. Snowdon's study is showing, the mental symptoms are likely to be much worse.
CHARLAYNE HUNTER-GAULT: So what can be done about it? I mean, can it be--now that you know this, what can be done about it?
MARCELLE MORRISON-BOGORAD: I think from two points of view it's important that we try to prevent strokes, first from the point of view of what stroke does by itself, and in this new study from what strokes might do to prevent Alzheimer's symptoms.
CHARLAYNE HUNTER-GAULT: Dr. Snowdon, is there a regimen that can be followed that would reduce the risk of stroke?
DAVID SNOWDON: Oh, absolutely. This has been known for many years. No. 1 risk factor is high blood pressure; No. 2 is cigarette smoking; and No. 3 is diabetes. All three of those things clearly cause atherosclerosis, or hardening of the arteries. All three are related to heart disease. They're all three related to both small and large strokes. So working with your doctor to monitor your blood pressure, to monitor your blood sugar on your own, quitting smoking, not starting smoking, and exercising, exercising may help in weight control, which would play a role in diabetes and blood pressure. Basically, our study, at least by itself, offers hope that there may be things people can do who have the gene for Alzheimer's or have Alzheimer's in their family, or in the early clinical stages of Alzheimer's. There's something that they can do to potentially reduce their risk of the symptoms appearing of Alzheimer's.
CHARLAYNE HUNTER-GAULT: All right. Dr. Morrison-Bogorad, there was another study that talked about the frequency of unrecognized dementia. Tell us briefly about that.
MARCELLE MORRISON-BOGORAD: Well, this was a very interesting study in Japan, where the researchers looked at a number of elderly Japanese men and gave them tests to see whether they had dementia or not, and then once they sorted them out into those who had dementia and those who didn't, they went back to family members and asked the family members if they had recognized that usually their husbands or their father had had dementia. What the study found was that of all the Japanese men who were diagnosed clinically with dementia 20 percent had family members who hadn't recognized that they had it. And this percentage increased to 50 percent if the dementia in these elderly men was just beginning. Now the other thing was, the other thing they did was to--if the family member had recognized the dementia, they then asked if the family member had sought professional help for the elderly gentleman. And 50 percent of the time the answer was no.
CHARLAYNE HUNTER-GAULT: Because they thought there was nothing that could be done about it?
MARCELLE MORRISON-BOGORAD: Well, probably because they thought it was a normal consequence of aging, you know, and that nothing could be done about it, as you say.
CHARLAYNE HUNTER-GAULT: Now you think this is going to help reverse that thinking? I mean, is this a significant--
MARCELLE MORRISON-BOGORAD: I think it's really a push for us to realize that this happens. I think there are several reasons for it being very important. One is that if it's silent, then that means it's not recognized as dementia and underestimating the numbers of people with possible Alzheimer's dementia in the population, and that's become very important when in a few years let's say we develop drugs which can push off the symptoms of Alzheimer's disease for a few years. And that is definitely our hope and our premise.
CHARLAYNE HUNTER-GAULT: But aren't there some drugs now like, for example, Dr. Snowdon, in your study, you mentioned the things that doctors can do, but what about--like I know some Alzheimer's patients with these tiny strokes have been given aspirin, baby aspirin a day. Is that a good preventive or risk reduction factor?
DAVID SNOWDON: Well, aspirin clearly plays a role in the risk of a second stroke and a second heart attack. I think both the studies--both studies, the study of Japanese men in Hawaii and our study on Catholic sisters I think are indicating that it is--that there are many problems in the elderly that are just not--that are basically potentially being ignored that you could do something about. It is not normal for an older person, whether they be 80 or 90, to be having memory problems, serious memory problems or confusion, and that's what they saw in the Japanese men in Hawaii, that I think the people, their family members just thought this is normal for a 90 year old to be slightly confused. It is not normal, and you need to get the attention of your doctors when you have problems like that.
CHARLAYNE HUNTER-GAULT: Dr. Bogorad, there was also a study this week not a part of this one that talked about the use of anti-inflammatory drugs. What was the significance of that and the relationship to what we're talking about, like ibuprofen, for example, Advil?
DAVID SNOWDON: This is the fruit of a study which has been going on for a long time, supported by the National Institutes on Aging, and it's a big population study in Baltimore, the Baltimore Longitudinal Aging Study, and because it contains so many people and because the study is looking at people every couple of years, giving them tests for their memory impairment, lots of medical, other medical tests, what this study was able to do is confirm what several other studies have hinted at in the past few years, and that is that a person that's taking anti-inflammatory drugs it seems to reduce their risk of getting Alzheimer's disease. So they looked at the kind of drugs that people were taking. They made very sure that what the people said they were doing was actually what they were doing, and then they looked at the group who were taking anti-inflammatories and compared the rate at which they were getting Alzheimer's disease with the group who were not taking anti-inflammatories. And they found that if the person had been taking anti-inflammatories for over two years, that the risk was reduced by over 50 percent.
CHARLAYNE HUNTER-GAULT: Briefly, Dr. Snowdon, so many families in America have to deal with this problem what should they take away from all of this tonight?
DAVID SNOWDON: I'd say the most important thing is that some of the co-factors involved in Alzheimer's disease such as stroke. They're a life-long disease process. You don't have to wait till your 80 years old to do something to maintain the rest--the health of the rest of your brain. By preventing stroke, buckling your seatbelt up so you don't get brain damage and doing other things to keep the rest of your brain healthy allows the brain to compensate for some of the damage that can commonly come from Alzheimer's disease. So I'd say stroke prevention whether you're 20 or you're 80 is incredibly important. Whether we're right or wrong, it's an incredibly important thing to do anyways. And there's hopeful findings now on Alzheimer's, things people can do to live a longer high functioning life.
CHARLAYNE HUNTER-GAULT: All right. Dr. Snowdon and Dr. Bogorad, thank you both for joining us.