Normalizing conversation

7 million people in the United States are affected by Alzheimer’s Disease with a new case of dementia and Alzheimer’s diagnosed every 65 seconds; by 2060, that number is expected to double. Data from 2025 showed that Alzheimer’s is the sixth leading cause of death in the United States.

With a perceived stigma around dementia, Greg Woods, Alzheimer’s Disease and Related Dementias Program Coordinator at Iowa HHS, visited the Osceola Public Library last week to provide information about dementia and Alzheimer’s and offer hope and resources to people either struggling with the disease or know someone who is.

About dementia

Dementia is an umbrella term for a category of diseases that affect how the brain thinks beyond an occasional bit of struggle or forgetfulness.

“In order to classify as a dementia, it has to interfere with daily life,” Woods said. “Crucially, many dementias are progressive, which means they get worse over time.”

With over 100 different types of dementia, Alzheimer’s makes up 60-80% of all dementia cases; other types of dementia include Lewy body dementia, frontotemporal dementia and vascular dementia. What sets Alzheimer’s apart, Woods said, is how it affects the brain.

A healthy brain has wrinkles and neurons traveling together. In a brain affected by Alzheimer’s, the brain itself is smaller and the neuron structures have lost definition. The first areas of the brain to be affected are those that store memories, but often the whole brain will end up being affected by the disease.

“[Scientists] believe that these brain changes can begin up to 20 years before anybody shows any symptoms,” Woods said. “Now, that’s a long, long window where some of those brain changes could be happening, but the person is not showing any signs and symptoms.”

Alzheimer’s was first discovered and described in 1906 by German physician Dr. Alois Alzheimer. He treated a patient, Auguste D., who was exhibiting classic signs and symptoms at the time thought to be associated with senility. Auguste was, however, too young to be afflicted by what was believed to be just a geriatric malady.

After Auguste died, Alzheimer took slices of her brain tissue to study under a microscope and found what came to be known as two hallmarks of Alzheimer’s - plaques made up of amyloid protein and tangles made up of tau protein; both start in the brain as healthy proteins. The amyloid plaques were noted as “big, ugly clumps” of matter hanging out in between brain cells, while neurofibrillary tangles were found forming inside of brain cells. Woods said debate still remains which comes first - does Alzheimer’s cause the plaques and tangles or does the duo cause the disease.

The result of these proteins gone wrong? Death of brain cells causing the shrinking of the brain.

Woods pointed out that is natural for the brain to begin to slow as one gets older.

“It can have trouble trying to remember something, or it takes an extra beat to figure something out. That is normal aging,” he said.

What is not normal is when you don’t know what to do when it is something you have done all of your life - getting completely lost on your route to work, finding your car keys and not knowing what they do or you arrive at work and don’t know what you do.

“That doesn’t mean you necessarily have dementia, but that is out of the norm of what the brain should do,” Woods said. “That would be an example of a reason to get checked out.”

Some people may develop mild-cognitive impairment, which may have other causes behind it that can be reversed.

Risk factors

Woods spoke on the two biggest risk factors for developing dementia and Alzheimer’s, neither of which can be prevented - aging and DNA.

“The older a person gets, the higher their risk gets for developing dementia at some point in their life,” he said. Past age 65, every five years a person’s risk for Alzheimer’s doubles.

However, Woods pointed out that not every older person will develop dementia or Alzheimer’s, and some younger people, those under age 65, will develop the disease.

The second most common risk factor is one’s genetics.

“The more close relatives a person has - they have dementia - the higher that person’s risk is going to be,” Woods said. Close relatives would be siblings, parents or grandparents who have the disease, but Woods noted again it’s not a guarantee that everyone with a family member suffering from dementia will develop it themselves.

Woods shared that of everyone living with dementia right now, two-thirds are female, even when taking into consideration that statistically women live longer. Different races are also found to have different levels of dementia, with African-Americans being twice as likely to develop Alzheimer’s as compared to Caucasians, while Latinos are one and one-half times more likely to develop the disease. On race, Woods said that neither group had been researched much in the past which leads to more unknowns as to why they have higher instances of dementia, but researchers are working to change that.

“We have some catching up to do. Thankfully, they are now, they are getting research quite a bit because if we can figure out what sets them apart, that can help everybody with the disease,” Woods said.

So, what can you do to try to reduce or minimize your risk of developing dementia? The top changeable factor is blood pressure.

“Scientists found that the closer you can get that top number to 120, the lower your risk is going to be rather significantly even compared to 130 or 140,” Woods said, noting that lower blood pressure has other health benefits outside of dementia risks.

Next, Woods said keeping one’s brain active by continuing to

seek out new information and education has been shown to help in lowering rates of dementia when combined with other lifestyle changes. Staying socially active has been shown to also lower rates of dementia, with feelings of connection and support. Along with both of those, Woods said another modifiable risk that has begun cropping up in recent years is untreated hearing loss.

“The brain doesn’t like to be bored, so if there is a whole part of your brain… that is normally having signals coming into it through the ears and all of a sudden now it doesn’t, that part of the brain is not going to be very happy,” Woods said. In treating hearing loss, that often will correlate to an increase in one’s social activity.

Sleep is another important factor in reducing dementia risks.

“We’ve known for a long time, sleep is good for your health. That’s not new or shocking,” Woods said.

While on the hunt for a good night’s sleep, Woods cautioned against the use of “PM” type medicines, as they contain anticholinergic effects. The reason, Woods explained, is that those medicines remove the chemical acetylcholine found in the part of the brain that forms memories.

“That does help you fall asleep, yes, but it also hinders memory formation and that’s not a good double-whammy to have when you’re dealing with potentially risk for dementia,” he said. Instead, Woods suggested using natural sleep aids such as melatonin or the class of drugs that use orexin antagonists.

The final risk factor Woods mentioned involved the lungs, particularly smoking cessation.

“Scientists found that people who stopped smoking, within four to seven years their risk for dementia, which was elevated because they’re smokers, goes back down to the level of somebody who has never smoked.”

He said certain types of air pollution may increase the risk for dementia, but that research is still being conducted.

Overall, Woods said the suggested lifestyle changes to make one’s brain more resilient will be of benefit in the long-run to build up a cognitive reserve, which can be accomplished by challenging your brain to keep it constantly learning.

“The more robust you can make your brain by doing things that keep it active - by learning, by constantly staying social, by constantly doing these other things - you may have the start of the disease, but you’re not going to show symptoms for a lot longer, if at all, compared to somebody whose brain is not that resilient,” he said.

He said that early screening and detection can go a long way in treating dementia. Medicare offers an annual wellness visit that should include cognitive screening. Woods encouraged people to push for cognitive screening if not offered, as that way there is a baseline test to compare against in the future.

“Catching something early in a progressive disease makes things a heck of a lot easier than if it’s not caught until the disease progresses a long way.”

Resources

A study commissioned by the HHS through the University of Iowa found that just 38% of primary care physicians are in rural areas and Iowa only has six memory care clinics; neighboring Wisconsin has 40 memory care clinics. In general, Woods said that are 1,200 Iowans for every one family care doctor; 5,000 Iowans per neurologist and 15,500 Iowans for geriatricians. In Iowa, Woods said there are 62,000 cases of dementia, ranking sixth in the nation for populations 85+. And it’s not just those people afflicted by the disease who are affected by it.

“The caregivers, the family members, the friends - they’re all affected by this disease differently, but they’re affected nonetheless,” he said.

With about 100,000 caregivers in the state, Woods said 83% are unpaid, as many are family members or friends. Sixty-two percent reported they are in worst health since becoming a caregiver. Twenty-five percent of dementia patients live alone.

There are resources available around the state, including Area Agency on Aging; locally they are known as Connections Area Agency on Aging. With six agencies specializing in different counties, Woods said they only see about 3% of the state’s population each year.

“They help out with resources, they can connect you to whatever you need in this aging process,” Wood said.

Other resources include communityresourcefinder.org that shows support groups and other programs closest to the user by zip code. The Alzheimer’s Association offers a 24/7 helpline for anyone, not just those with Alzheimer’s. They can be reached at 800-272-3900 or found online at ALZ.org. Information can also be found by searching Iowa HHS Alzheimer’s or emailing Woods at greg.woods@hhs.iowa.gov.

In the end, Woods said there is reason to hope. While prior medications had only helped with symptoms, in the last two to three years great strides have been made in the medical field to go beyond that.

“They actually slow down the shrinkage of the brain. They slow down the damage, and they do that by making your immune system look at those big ugly plaques and go, hang on, that shouldn’t be here,” he said. “[They] try to remove it like it’s a bacteria, like it’s a virus.”

The drugs have been shown to slow Alzheimer’s down by up to 30%. Work is also ongoing for a diagnostic blood test to determine if a patient will develop Alzheimer’s. Infusions are available for some patients in early stages of cognitive impairment and dementia.

Overall, Woods said education and talking about dementia and Alzheimer’s can go a long way in not only bringing awareness to the disease, but also awareness to one’s own health.

“This is worth talking about,” he said. “By doing that, decreasing the stigma, normalizing the conversation - that’s going to make a huge difference.”