Dr. Daniel Murman, a neurologist at the University of Nebraska Medical Center (UNMC) in Omaha, focuses on older adults who have cognitive impairment or dementia. As an academic neurologist and professor with the UNMC Department of Neurological Sciences, Dr. Murman invests about half his time with patients and the other half teaching and doing research at the university. We spoke with Dr. Murman to learn more about how we can lower the risk for Alzheimer’s and take care of someone living with the disease.
What lowers the risk of getting Alzheimer’s?
There is a lot of interest in preventing Alzheimer’s, and the big three risk factors seem to be age, genetics and lifestyle. You can’t change your age or your genes, but you can definitely change your lifestyle. The main lifestyle factors that seem to be associated with decreased risk are increasing physical activity (exercise), being mentally active and socially connected, and eating a healthy diet. Then if you have high blood pressure, high cholesterol or diabetes, it’s a matter of identifying and controlling those diseases, which will also lower your risk for Alzheimer’s. The diet that has been studied the most is the Mediterranean Diet, or the MIND Diet, but in general, it’s the heart-healthy diet of lower cholesterol, lower salt, and lots of fruits and vegetables. Eating healthy fats and fish would also be part of this diet that seems to be ideal for successful brain or cognitive aging.
What are the benefits of an early diagnosis of Alzheimer’s?
For a person who is starting to show symptoms, there are a lot of reasons to get an early diagnosis. One is to determine if there is a dementia problem or if the symptoms are from normal aging. If there is a cognitive problem, you will want laboratory tests to identify if there are any treatable conditions, for example, low vitamin levels such as B-12 or low thyroid function, which are treatable. Common for early diagnosis, we’ll do brain imaging on someone who is having symptoms to try to understand if there are signs of cerebrovascular diseases or stroke changes. Then we would more aggressively treat those factors that might increase their risk of stroke, for example.
I see a lot of people in the 50 to 70 age range who have undiagnosed and untreated obstructive sleep apnea, which is a treatable condition that in some studies show may even contribute to the risk for Alzheimer’s. Also during the initial evaluation, we would review if the person is on any medications that may be worsening their memory. One class is called anticholinergic, or drugs that block acetylcholine, which can be as simple as drugs like Tylenol PM®, which is an older antihistamine. Diphenhydramine (Benadryl®) is the “PM” part of that. It is important to review all medications a person is taking for any medications that may be making their memory worse.
There are also medications that can improve cognitive symptoms. They are not a cure. They don’t slow down dementia, but they can improve memory and stabilize a person’s function. Evaluating this early is important, as well as trying to identify if there are safety issues such as driving or making mistakes with medications or being vulnerable to financial scams and such. If you ignore symptoms and don’t evaluate a person, they are more at risk to have negative safety consequences. If they’ve been evaluated, everybody is aware and trying to prevent problems. For a lot of older adults, cognitive issues will just be attributed to aging, but oftentimes it is more. With normal aging, someone would still be functionally independent. But when they can’t live on their own, that is a sign that something else is going on besides aging.
What are some care tips for caregivers of Alzheimer’s patients?
One is getting a thorough evaluation for their loved one. Usually people seek medical help when they see a change in function or when a person is having trouble with something they’ve always done. Maybe now they’re getting lost in a familiar area while driving. Maybe they’re making mistakes with the checkbook. Or maybe there are signs that the person is not cooking for themselves or eating well. A change in function would be the trigger to get an evaluation. For a person with symptoms, you want to maximize their function and thinking, so a medical evaluation and treatment can make sure they’re getting everything that might help them.
As a person moves into more moderate to severe stages of Alzheimer’s, a lot of the focus is on quality of life and things the person with dementia finds enjoyable. There is a balance between making sure they are safe but still maximizing enjoyment. Often it’s hard, but we need to shift to the present time period and not ask, “What did you do yesterday?” That’s going to be the challenging part. It is important to just focus on what’s going on right now and do activities in the moment. Also, a lot of areas of brain function are well preserved such as musical abilities. Music appreciation can be advantageous. Physical activity and enjoyment of activities like listening to music are important because they don’t involve remembering what happened yesterday.
About the Author
An award-winning journalist who has documented stories in nearly 20 countries, Beth Lueders is an author, writer and speaker who frequently reports on diverse topics, including aging and health issues for both U.S. and international corporations.