ANSWERS TO YOUR ALZHEIMER'S QUESTIONS

Dr. Janice Knebl has cared for residents at the James L. West Alzheimer Center since it opened 16 years ago in Fort Worth, Texas. Knebl, a geriatrician, is also a prominent researcher in the field of Alzheimer's and dementia. Here she discusses the disease, its treatment and prevention.

Q: Are we close to a cure for Alzheimer's?

A: I'm not as optimistic about a cure. I view this disease at the same complexity level as diabetes. We do not have a cure for diabetes, but we have great approaches, prevention, treatment and management. If we can do what we've done with diabetes, that could be awesome. It would have a major impact.

Q: How much do we know about the causes of Alzheimer's?

A: We don't know the cause, but we know a lot more than we did. (Proteins called plaques) are like gum interfering with the way cells talk to each other. Also, another kind of protein (tangles) actually gets in the nucleus and causes cell death. The brain actually degenerates and shrinks.

There is just a huge amount of research at many different levels. One is looking at those plaques and tangles and trying to understand how they're made. Can we stop them from being produced or can we eliminate them once they are produced? Another area we look at is what's called neurochemicals. It's how the brain cells talk to each other. Research is being done, trying to alter the amounts of those chemicals in the brain to help people function better. But those drugs do not alter the course of the disease.

Q: Can anything be done to reduce the odds of developing Alzheimer's?

A: People need to be physically active because the brain is attached to the rest of the body. Walking is great. Diet is really important. If you have high blood pressure, you need to get that treated because high blood pressure is not good for the brain. Smoking is another one. Drinking in moderation. Those practical things.

If people are under undue amounts of stress and suffer from depression, it's got to get treated. People with late-life development of depression have a higher risk of developing dementia. We don't understand the connection, but it's clearly there.

The other thing is just keeping your brain active. There are all kinds of games now. Nintendo has come out with them, and Dr. Gary Small at UCLA has his own kind of brain game. Something simple to do is to not drive home the same way every day. Change it up, because you get into a rote mode. You get home and you don't even remember how.

Unfortunately, the activity we're talking about is still no (guarantee of) prevention. Look at Ronald Reagan, with all the things he was doing as president. But to me, it's something you have control over. Forty to 50 percent of what's going to happen to you as you age is based on genetics. We can't change that at the moment. But the other 50 to 60 percent is in your control. That's a huge chunk. That makes me optimistic.

RESOURCES FOR FAMILIES AFFECTED BY ALZHEIMER'S

At the James L. West Alzheimer Center, a private, nonprofit facility in Forth Worth, Texas, a residential room can cost up to $200 a day, or more than $70,000 a year. The West center does not accept government assistance like Medicaid. But options are available for families without those financial resources, says Theresa Hocker, executive director of the North Central Texas chapter of the Alzheimer's Association. The key is to research them before a medical crisis happens.

"It's just awful when people have to decide very, very quickly where their loved ones go," Hocker says. "It's just such an important decision."

For starters, she says, it's crucial to understand the difference between Medicare and Medicaid. Medicare, a federal program, pays some medical bills for the elderly, but not for long-term care. Medicaid, which is administered by the state, does fund long-term care, but families must qualify by need.

Long-term-care insurance also is something families should investigate, Hocker said.

"That's a real personal process of evaluating your finances, knowing whether you have a nest egg to fall back on or you don't," she said.

The Alzheimer's Association has staff members trained to help families research their options, Hocker says.

Alzheimer's Association, www.alz.org, 877-IS IT ALZ (877.474.8259)

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WARNING SIGNS

As many as 5.3 million people in the United States are living with Alzheimer's, according to the Alzheimer's Association (www.alz.org). And while you may know that that this progressive and fatal brain disease is associated with memory loss, there are some specific symptoms to be aware of.

The association provides this list of 10 warning signs. If you or someone close to you is experiencing any of these symptoms, please see a doctor.

1. Memory loss that disrupts daily life. Memory loss, especially forgetting recently learned information, is one of the most common signs of Alzheimer's, along with forgetting dates and events, repeatedly asking for the same information, and relying on memory aides or other people for information.

2. Challenges in planning or solving problems. Some people experience a change in their ability to create and follow a plan or work with numbers, such as following a familiar recipe or keeping track of bills. Concentration also may be difficult and tasks may take longer than they did before.

3. Difficulty completing familiar tasks at home or work. It may be hard for people with Alzheimer's to complete daily tasks like driving to the store, managing a budget or remembering the rules of a game.

4. Confusion with time or place. People with Alzheimer's can lose track of dates, seasons and time. They may forget where they are or how they got there.

5. Trouble understanding visual images and spatial relationships. Vision problems can be a sign of Alzheimer's. People may have problems determining colors, reading or judging distance, or they may have problems with perception.

6. New problems with words in speaking or writing. It may be difficult for people with Alzheimer's to join or follow conversation. They may struggle with vocabulary, call things by the wrong name or have problems finding the right word. They may stop in the middle of conversation and not know how to continue, or repeat themselves.

7. Misplacing things and losing the ability to retrace steps. People with Alzheimer's may lose things and be unable to find them again, put things in unusual places or accuse others of stealing.

8. Decreased or poor judgment. There may be changes in judgment or decision making, such as paying less attention to hygiene or suddenly giving large amounts of money to telemarketers.

9. Withdrawal from work or social activities. People with Alzheimer's may withdrawal from social activities, work or hobbies.

10. Changes in mood and personality. The mood and personalities of people with Alzheimer's can change. They may become confused, suspicious, depressed, fearful, anxious or easily upset at home or work, or in places where they are out of their comfort zone.

Source: Alzheimer's Association (www.alz.org)

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