How Early Detection Could Change Treatment
By Jamie Bussin, featuring Dr. Amer Burhan MD
Many people associate dementia with severe memory loss, but potential problems can be identified much earlier. According to Dr. Amer Burhan, a geriatric and brain intervention psychiatrist and professor of psychiatry at the University of Toronto, recognizing dementia risk factors, identifying early cognitive changes and, in some cases, using blood biomarkers may create opportunities for earlier intervention.
In my conversation with Dr. Burhan in Episode #457 of The Tonic Talk Show/Podcast, we discussed how to distinguish normal age-related forgetfulness from potential warning signs, which risk factors people may be able to modify, and how new treatments for Alzheimer’s disease are changing the conversation around early detection.
One of the most important distinctions to understand is that occasional forgetfulness is not necessarily a sign of dementia. Persistent changes that differ from a person’s usual abilities, however, may warrant further assessment. While newer treatments offer hope, Dr. Burhan emphasizes that the current goal is to slow the progression of Alzheimer’s disease rather than reverse it.
What Are the Early Signs of Dementia?
As mentioned above, occasional forgetfulness is not necessarily a sign of dementia. According to Dr. Burhan, being momentarily distracted, overwhelmed or overstimulated may simply be part of the normal ageing process. However, if memory problems become persistent, such as difficulty keeping track of appointments, remembering recent conversations or recalling names, they could be early signs of cognitive changes.
As we age, our brains change. Some loss of neurons and connections occurs naturally. However, a person’s knowledge and certain aspects of intelligence tend to crystallize with age. Crystallized intelligence includes wisdom, language skills and the ability to articulate strategies for solving problems. These abilities can improve with age.
What may change with age is attention span — how much information we can keep in mind while performing tasks.
Can a Blood Test Detect Alzheimer’s Disease Before Symptoms Appear?
According to Dr. Burhan, biological markers can also be measured through blood tests. He explains that a blood test known as p-tau217 can help identify biological changes associated with Alzheimer’s disease. The marker is currently available through research studies and in some clinical settings.
Dr. Burhan notes that such testing may help identify changes associated with Alzheimer’s disease almost 20 years before symptoms appear.
Which Dementia Risk Factors Can You Change?
Hereditary factors can play a role in dementia risk. Some families have a history of illnesses such as Alzheimer’s disease and other forms of dementia. People with a family history may wonder whether a marker in their blood or brain could indicate an increased likelihood of developing the disease.
Hearing and vision impairment are also risk factors associated with dementia.
However, according to Dr. Burhan, there are also lifestyle-related risk factors that may be addressed through positive changes, including:
- High blood pressure
- Type 2 diabetes
- Depression
- Smoking
- Excessive alcohol consumption
- Social isolation and loneliness
Addressing these factors may help reduce the risk of dementia.
What Treatments Are Available for Early Alzheimer’s Disease?
There have been encouraging advances in the treatment of Alzheimer’s disease. Researchers can now identify biological markers associated with the disease and have developed treatments designed to remove amyloid, a protein that can accumulate in the brain. Amyloid buildup is associated with inflammatory processes and other changes in the brain.
Dr. Burhan explains that two drugs have been approved in Canada to target and remove amyloid from the brain. Identifying Alzheimer’s disease early may allow eligible patients to access these treatments. Researchers are also studying people who have amyloid-related changes in their brains but have not yet developed symptoms.
Other research is exploring the possibility of modifying genes or developing a vaccine to prevent the disease from progressing.
At present, however, available drugs do not prevent or reverse Alzheimer’s disease. Instead, some treatments can slow its progression. According to Dr. Burhan, the treatments discussed in our interview have shown the potential to slow the disease by approximately 10 months or reduce the rate of progression by about 30 per cent.
Can Exercise and Cognitive Training Help Protect Brain Health?
One of the important things to consider is that the brain is highly neuroplastic.
Our brains have the ability to change and adapt throughout life. During the first eight years of childhood, many neural connections develop and are remodelled. In adulthood, neuroplasticity continues, although the process becomes less robust as we age. It never completely stops, however, meaning we retain the capacity to build new connections and develop ways to compensate for changes in brain function.
According to Dr. Burhan, cognitive training and physical exercise designed to build new connections are evolving areas of research. Activities that encourage new learning, along with physical activity and adequate sleep, may help support brain health as we age.
Dementia cannot currently be stopped or reversed with available drugs. However, early detection, lifestyle changes and appropriate treatments may help slow the progression of Alzheimer’s disease.
FAQ
What are the earliest signs of dementia?
According to Dr. Amer Burhan, possible warning signs include persistent difficulty remembering recent conversations, keeping track of appointments or recalling names, particularly when these changes differ from a person’s usual abilities.
How can you distinguish normal forgetfulness from a possible sign of dementia?
Occasional lapses can result from distraction or having too much to think about. Dr. Burhan recommends paying attention to problems that become persistent, consistent and noticeably different from a person’s usual behaviour.
Can a blood test detect Alzheimer’s disease before symptoms appear?
Dr. Burhan discusses the p-tau217 blood biomarker as a tool for identifying biological changes associated with Alzheimer’s disease. A biomarker result is not, by itself, equivalent to a diagnosis of dementia.
Can early treatment slow Alzheimer’s disease?
Dr. Burhan explains that amyloid-targeting therapies have demonstrated the ability to slow disease progression in eligible patients. These treatments do not currently reverse the disease.
What can people do to reduce their risk of dementia?
Dr. Burhan discusses managing blood pressure and diabetes, addressing hearing and vision impairment, stopping smoking, limiting excessive alcohol consumption, addressing depression and reducing social isolation as areas worth considering.
