Alzheimer's Progression Slower After 80: Study

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By Steven Reinberg
HealthDay Reporter

(HealthDay News) -- The deadly march of Alzheimer's disease is slower in people aged 80 or older than the younger elderly, researchers have found.

The risk of developing Alzheimer's disease increases with age, and by 85, the risk is about 50 percent. But those who develop the progressive brain disorder that late in life will experience a less aggressive disease than those whose symptoms appear at 60 or 70 years, according to investigators at the University of California, San Diego.

Lead researcher Dominic Holland from the university's neurosciences department said doctors will need to consider these findings when assessing older patients for Alzheimer's disease.

"Methods for early detection, which will rely on biomarkers as well as mental ability, will need to take into account the age of the individuals being assessed," he said. Because the "old" elderly may deteriorate at a slower pace than younger patients, doctors may not realize these people are suffering from Alzheimer's disease.

The findings also have implications for clinical trials evaluating potential Alzheimer's treatments and cost-of-care projections for different Alzheimer's patients, Holland and other experts say.

Currently, no effective treatments exist to slow or cure Alzheimer's disease, which gradually destroys brain cells and robs people of memory, and their ability to communicate and carry out everyday tasks.

The report was published Aug. 2 in the online journal PLoS One.

To study Alzheimer's disease progression, Holland and colleagues used data from the Alzheimer's Disease Neuroimaging Initiative study. They looked at more than 700 people aged 65 to 90, some with normal mental functioning, some with mild signs of dementia and others suffering from Alzheimer's.

Participants were tested every 6 or 12 months.

The researchers found that younger Alzheimer's patients lost their mental abilities faster than older patients.

These declines among younger patients paralleled the accelerated rate of brain tissue loss and the increase in a spinal-fluid indicator of Alzheimer's seen among the younger age group, compared with older patients, the study authors added.

The researchers aren't sure why Alzheimer's is more aggressive in younger patients. One explanation might be that the older patients have been declining at that slower rate over a longer time, with some unknown factor keeping symptoms at bay, they suggest.

Another possibility is that the older patients have dementia plus Alzheimer's, which might stall the full effect of Alzheimer's on the brain. But such a diagnosis must be made with an autopsy, which is the only way Alzheimer's is accurately diagnosed, Holland noted.

Alzheimer's disease currently affects an estimated 5.6 million Americans, and that number is expected to triple by 2050 as the baby boom generation ages.

The finding that the earlier one develops the disease, the more aggressive it is isn't good news for those younger elderly patients who will suffer the worsening loss of their mental abilities for a long time, Holland said.

Another expert said the findings may affect both health cost projections and clinical trials.

"This is an extremely important paper with implications for both the projections of cost of care for Alzheimer's disease and for planning clinical trials," said Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center at the Mount Sinai School of Medicine in New York City.

If the clinical picture in the over-85 population is milder than what is typical in younger populations, those older patients would remain independent longer, and the projections for the economic burden to the health care system should be adjusted, he said.

"The annual cost now is $200 billion in the U.S.; the projection is $1 trillion annually by 2050," Gandy said.

"Maybe that $1 trillion is really only $500 to $750 billion. Still catastrophic, but it is worth considering this in projection," he added.

Equally important, if the rate of decline is slower in 85-year-olds than in 65-year-olds, that must be taken into account when recruiting for clinical trials, Gandy said.

For example, if all the patients receiving a drug were over 85 and all the patients receiving an inactive placebo were much younger, it might appear the drug was working when, in fact, the populations were improperly matched, Gandy pointed out.

"We have known that we wanted populations to be as identical as possible, but we didn't really know of this specific phenomenon before," he said.

More information

For more information on Alzheimer's disease, visit theAlzheimer's Association.

Validation Therapy Used in Dementia Care

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eHow

Caring for a person with dementia is difficult. Knowing about dementia makes the job easier. Validation therapy helps a caregiver to take care of a dementia patient because it relies on the patient's feelings. Emotions are one of the last things to be lost in a person with dementia. Although not all aspects of validation therapy work for every person with dementia, understanding the concept of it is useful to the dementia caregiver.

Dementia

Dementia, a brain condition, is characterized by a group of symptoms that cause changes in the functioning of the brain. The changes have to do with thinking, perception and learning. These changes affect decision making, judgment, memory, spatial orientation, thinking, reasoning and communication. This condition interferes with daily life because of the seriousness of the changes in the brain. Behavior and personality problems most often occur. As we age, the likelihood of developing dementia increases. Validation therapy helps control problem behavior.

The Dementia Sufferer's Reality

Time, for a person with dementia, can be the present at one moment, the past at another and the future at another. Time has absolutely no continuity.
People with dementia know what they know at any given moment. Accepting the dementia world is difficult for caregivers. You cannot force those with dementia to accept the real world. Caregivers need to accept the dementia world. This makes their job much easier.
Dementia patients pick up on the feelings being expressed. For a caregiver it is how you say things, not what you say.

Validation Therapy

Naomi Feil, a social worker, designed validation therapy to help dementia sufferers. It relies on the patient's emotions. Feil reported in her book "The Validation Breakthrough" that after six months of using validation therapy once a week, persons with dementia showed improvement in eye contact, walking and behavior. Her theories explain why people with dementia behave the way they do.
History of Validation Therapy
Feil developed validation therapy between 1963 and 1980 for older people with cognitive impairments. Initially, this therapy did not include those with dementia. Applying validation therapy in dementia care occurred in the early 1980s. Validation therapy attracted a good deal of criticism from researchers. Many studies have been conducted over the years with no proof that it is effective in dementia care. Feil strongly believes that validation therapy works. Validation therapy in dementia care may work in your particular situation.
Principles of Validation Therapy
Validation therapy classifies individuals with cognitive impairment, or pre-dementia, in one of four stages. These stages are mal-orientation, time confusion, repetitive motion and vegetation.
The therapy is based on the general principle of validation and treating people who have dementia with genuine respect and legitimatizing the expression of their feelings.Treat each person with dementia as an individual. Even the most disoriented person has value. Improper behavior happens for a reason.
When more recent memory fails, people with dementia try to restore balance in their lives by retrieving earlier memories. Painful feelings that are expressed, acknowledged and validated by a trusted listener diminish. Painful feelings that are suppressed gain strength.
Empathy builds trust, reduces anxiety and restores dignity.
Caregiving With Validation
Some parts of validation therapy work for most people with dementia. You, as a caregiver, must discover what portions are effective for the person you are taking care of.

Here are some hints.

Never argue with a person who has dementia, because he believes what he is seeing and feeling is real. Logic does not work. Instead, agree with the individual with dementia. Then steer him to something else. In other words, refocus and redirect his feelings and actions.

This works best when you know the present interests of a person with dementia. Knowing what triggers bad behavior is also helpful. You must be a detective and a stretcher of the truth.

Here is an example: A person with dementia is asking to go home because he thinks that he left the front door open. You as a caregiver know this information is not true. Tell the dementia sufferer that you will call his niece to shut the front door. Then pretend to call the niece. If the dementia patient still insists on going home, tell him that we will right after we set the table and eat supper or another thing you know he will want to do. The trick is to nip agitated behavior in the bud before the dementia patient gets too upset and needs medication to calm him down.