Preventing Alzheimer's Disease and Memory Loss: Chat Transcript February 1, 2000

ElderCare Online Presents "Preventing Alzheimer’s Disease and Memory Loss:" An educational chat with Dr. Mary Sano, Columbia University. Tuesday, February 1, 2000. 1:00-2:00PM EST.

RichMODERATOR> Hello Dr. Sano. Welcome to ElderCare Online.

RichMODERATOR> I will give you a minute to get organized.

[DrSano] Nice to be here.

RichMODERATOR> Since we have a nice-sized group, we can be casual. If it gets crowded, I will ask people to Private message me to "get in line."

RichMODERATOR> Welcome and thank you for joining us. Dr. Sano is hosting a discussion on Alzheimer’s Disease research, treatment and care. Please feel free to ask questions, provide additional insight or just listen in.

RichMODERATOR> Dr. Sano -- Could you tell us a little about your background?

RichMODERATOR> And your current work

[DrSano] I am a neuropsychologist by training

[DrSano] Most of my work is in conducting drug studies in Alzheimer's Disease

RichMODERATOR> You wrote an article recently for the ElderCare Beacon newsletter on "Participating in Clinical Trials" for AD patients

[DrSano] My most recent work is in a Prevention trial with Estrogen for woman who have a family history of A D

[DrSano] Yes research is important to getting the right answer

[Bubblehead1] How long has that trail been going Dr. Sano and how long will it take to get answers on it?

[DrSano] We are recruiting women now and hope to complete the study in 5 years.

RichMODERATOR> Do most trials take that long to conduct and analyze?

[Bubblehead1] What age group are you looking for?

[DrSano] Yes, it takes a while particularly if we want to know about prevention.

[AgelessD] Regarding research, we hear about so many studies, ApoE's, cholinterase inhibitors, apoliproteins, attacking plaques, tangles, and so on. How optimistic are you that a cure will be found, and are plaques and tangles a result of the disease or more like a cause? (chicken or the egg syndrome)

RichMODERATOR> If I can add to AgelessD's question -- Do you have any comments on the recent reports on the use of Huperzine-A in the treatment of Alzheimer's and are any clinical trials planned?

[DrSano] A cure may be a long way off but much work is leading us in a positive direction. In the past 5 years we have had 2 treatments become available -- that is a beginning.

[lee416] Caloric intake for Stage 7 is one of my concerns. Is there a minimum/maximum guideline for a 100 pound loved one?

[DrSano] I have read several summary reports of Huperzine-A, which may act via a similar mechanisms as Aricept. Unfortunately, rigorous studies have not been done to demonstrate its effectiveness. Also the safety of this drug in patients with Alzheimer's Disease has not been demonstrated. It certainly is a hopeful agent, like so many other things. I do hope that the studies get done.

[AgelessD] What are your thoughts on plaques & tangles - cause or effect?

[DrSano] This is a good question. Plaques and tangles are the hallmark of the disease. We do not know if making them disappear would make the disease go away, but it is a reasonable approach for scientists to take.

[s] What causes them?

[DrSano] I do not know about caloric intake, but I recommend she discuss it with her doctor.

RichMODERATOR> A related question from offline: Can Alzheimer’s be prevented with a good diet, and good food, and can you recommend any foods to have, and any foods to avoid?

RichMODERATOR> TIP to avoid being booted: Every 3 minutes or so, just type ". . ." and Enter

[DrSano] I am often asked about diet. The truth is no study has demonstrated a beneficial effect on cognition from any specific diet or nutritional element.

[s] What about vitamin E and gingko, etc.?

RichMODERATOR> How about diet and alcohol consumption -- is there a link between alcohol consumption and AD or other dementias?

[DrSano] I should add that no diet has been found to be particularly detrimental to cognition. However a healthy diet is always a good idea

[pbgma] What about heredity if both parents have AD?

[DrSano] Dietary vitamin E has not demonstrated any protective effect.

[DrSano] Several studies have demonstrated a protective effect of moderate amounts of alcohol

RichMODERATOR> And "popular" dietary supplements such as ginkgo? Are there any studies underway with them?

[dale174] The New York Times has an article on forgetfulness, and refers to it all as AD, is this fair when people are suffering from a whole range of dementias? (You will need a free password to access the article)

[DrSano] One study demonstrated a benefit in delaying the clinical progression of AD with vitamin E. We cannot assume this is also a protective and will prevent AD, but this question is under study

[dale174] Seems as if we have turned senility into AD.

RichMODERATOR> Any advice or suggestions on how much Vitamin E a LO should be taking?

[DrSano] Ginkgo has been shown to have a small benefit on some measures in AD. There is also a large study underway to determine if it can prevent AD and this is sponsored by the National Institute of Health.

[AgelessD] I have also heard it mentioned that there are more than one kind of AD (beyond familial and random). Given the diversity that I have seen in people with AD, this seems possible. Your thoughts?! And if so, how would this affect your studies?

[s] This is good news.

[DrSano] The vitamin E study used 2000 International Units. Studies with lower doses have not been done.

[s] Don't some folks grow old gracefully?

[DrSano] You ask a great question about the diversity of AD. When we do studies we try to capture many aspects of the disease so that we can see if there are subtypes that respond better or worse to treatment. Right now there is no definitive groups but we are looking.

[dale174] Elderly have great fear of hearing Alzheimer’s mentioned and I find people are using it very freely.

[longmm] My husband has been on Aricept and 2000 IU Vitamin E for two years, since diagnosis at age 60. For more than a year he remained virtually unchanged, but in last few months has had increasing trouble with verbal expression and short term memory. From here on, how beneficial are medications and vitamin E? Does decline escalate or remain gradual? Also, his father almost certainly had AD (undiagnosed) from about age 70, died at 84. Does earlier onset affect life expectancy?

[DrSano] Senility is not a real diagnosis. The most common form of dementia is Alzheimer's Disease. A good clinician will take a medical history, conduct needed medical tests to rule out other diagnoses and can diagnose Alzheimer's Disease with about 80-90% accuracy.

RichMODERATOR> In the early and even mid stages of Alzheimer's, is there a way to tell the difference between it and just elder onset dementia and TIA's, short of testing?

[DrSano] One thing that may help is to realize that there are mild forms of AD and that there are healthy people with AD who can do many things. We are still the people we are even if we have a diagnosis.

RichMODERATOR> Are there tried and true symptoms that the layperson can look for, other than just forgetfulness?

[longmm] Hi Mark - what does the NeuroLogic technology do for AD patients?

[DrSano] Symptoms that may indicate dementia include trouble with:1) Learning and retaining new material: repetitive, forgets recent events/appointments 2) Handling complex tasks: balancing a checkbook, following a complex train of thought; 3) Reasoning: unable to describe a plan of action; disregard for rules or social conduct; 4) Spatial abilities/orientation: trouble driving; 5) Language: word finding difficulty; 6) Behavior: appears more passive/less responsive

RichMODERATOR> Are there clinical or behavioral hallmarks for different types of dementia?

[DrSano] One type we are learning about is Lewy body dementia (LBD). This is suspected when a person has some Parkinsonism and when they are having hallucinations

[dale174] AD has taken under it's umbrella, all senility, dementia issues and treatments.

[DrSano] Parkinsinism is a rigidity and may also include balance problems causing frequent falls

[artcar] Isn't it true that just about any type of brain disease can be mimicked by Alzheimer’s?

[AgelessD] It was a news press release this morning by a company called NeuroLogic. As a press release, it didn't say much. We have a newsletter that will give you all the details on our web site go to Advice & Advances. See their website at or their e-mail address .

[DrSano] No, actually our clinical diagnoses can be about 80% accurate with higher rates of accuracy in specialty centers.

[artcar] Would this mild Parkinsonism be due to what part of the brain Alzheimer’s attacks first?

[Bubblehead1] I think what you are trying to ask about artcar is behavioral similarities in different neurological diseases with Alzheimer’s

[artcar] Yes

[Bubblehead1] That would be different than actually experiencing a form of Parkinsons.

RichMODERATOR> Related to artcar's question: Do we understand why the mental focus of an Alzheimer's patient comes and goes and why they can stay clear on certain things but totally lose others?

[DrSano] Parkinsonism is usually associated with damage to the part of the brain know as the basal ganglia.

RichMODERATOR> Let's give Dr. Sano a few minutes to compose response(s)

[DrSano] We really do not know why interest wanders. Often old interests are retained or in an advanced stage something very salient (e.g. something loud, bright, happy or frightening) may take the focus of attention, but we cannot really tell what things will capture a person's interest.

[AgelessD] I think part of the key to that question is retrogenesis, a new term by Dr. Reisberg.

[artcar] Can Alzheimer’s damage to the part of the brain know as the basal ganglia?

[DrSano] The basal ganglia is not the typical area for brain degeneration in AD, but there is in some patients an overlap between damage in the cortex and in other brain areas.

[artcar] Is this overlapping coincidental or ALZ induced.

[Dot66] Thanks, I am anxious to see what she has to say.

RichMODERATOR> I have an offline question about Aricept: Can Aricept be used to slow the progression of AD? When is it no longer useful? What MMSE test score is associated with the best results from Aricept?

[DrSano] This is a good question, and we do not really know for sure. We do know that many people with Parksinson's Disease become demented with what looks like AD and many people with AD get some features of Parkinson's Disease.

[artcar] How would you describe the classic symptoms of mild Parkinsonism?

[DrSano] Aricept has been studied in patients with an MMSE from high 20's (@26) to low teens (10-12). Some studies are investigating patients with lower and higher scores but the answer is not out yet.

RichMODERATOR> We are nearing the end of our discussion. We can take two more questions. Please forward them to me by using the Private Chat feature

[DrSano] As far as slowing progression with Aricept, we know for sure it works for up to 6 months and longer studies are being conducted to see if the benefit lasts for a year. The results look promising.

[artcar] Thanks! This has been quickly informative.

[s] I can not tell if my mom has AD with Parkinson's signs or the other way around? Is it important to know?

[artcar] How would mild Parkinsonism differ from standard Parkinsonism?

[DrSano] The way we usually decide is to determine which came first. If they seem to come together we think not of Parkinson's disease but of AD with Parkinsonism or LBD. If the Parkinsonism is causing functional problems sometimes we treat this. If there are behavioral problems different drugs may be indicated.

[Bubblehead1] I was aware that Aricept only slowed the progression of the symptoms, does it at some point actually slow the progression of the disease?

[DrSano] We no of no data that suggests that Aricept changes the course of the plaques and tangles.

RichMODERATOR> Dr.: Thank you so much for participating. I think that everyone had a chance to ask questions, listen and connect with other caregivers. Your answers and comments were right on target.

RichMODERATOR> And thank you to all attendees/participants. I hope that you found some answers to your questions. Please stay in touch for other featured and regular chat sessions.

RichMODERATOR> I encourage you to visit the Sergievsky Center website at

[artcar] Does mild Parkinsonism fail to advance into advanced Parkinsonism?

[Bubblehead1] s, as long as there is life out there and research being done there is always some good news.

[Bubblehead1] Just sometimes the good news only brings a dozen more questions.

[AgelessD] Thank you very much, Rich and Dr. Sano. It was a great chat.

[s] Thanks doctor for taking the time.

[Bubblehead1] Dr. Sano, I enjoyed the time I did have to chat with you.

[artcar] Thank you, Doctor.

[DrSano] May I invite you to our prevention website

[artcar] Can this dialog be saved?

[Bubblehead1] I bookmarked both sites.

RichMODERATOR> I am tracking this and will post the transcript.

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