By JUDD MATSUNAGA, Esq.
Every so often, my sister will drive me crazy. She’s intelligent enough, i.e., a doctor. But she’ll ask me a question about the law, or about real estate. I’ll reply with a simple and obvious answer to her question. But she’ll keep on asking the same question, multiple times, in different ways, hoping to get a different answer. After 20 minutes of going around and around with her, my frustration — never mind my temper — goes through the roof.
This was quite different from when my 90-plus-year-old father with beginning Alzheimer’s started asking me the same question repeatedly. He wasn’t trying to get me to give him any particular answer. He just didn’t remember that he asked me the same question just a few moments ago. I’m sure my dad was trying to keep me happy when I would go to visit by making conversation. Although perhaps, at some level, it felt safer to him to cover up his memory problems by saying something.
Since I had heard Alzheimer’s might be genetic, I was (and still am) concerned. According to the Alzheimer’s Association website (www.alz.org), one of the strong risk factors for Alzheimer’s is family history. Research shows that those who have a parent or sibling with Alzheimer’s are more likely to develop the disease than those who do not have a first-degree relative with Alzheimer’s.
Furthermore, those who have more than one first-degree relative (parent, grandparent, or sibling) with Alzheimer’s are at an even higher risk. When diseases tend to run in families, either heredity (genetics), environmental factors, or both, may play a role. Not to scare anybody, the Alzheimer’s Association also says that having a parent, brother or sister with Alzheimer’s increases your risk but doesn’t mean you will develop Alzheimer’s.
Perhaps even more disturbing, the greatest known risk factor for Alzheimer’s and other dementias is increasing age. Most individuals with the disease are 65 and older (I’m 64½). After age 65, the risk of Alzheimer’s doubles every five years. After age 85, the risk reaches nearly one-third. While age increases risk, it is not a direct cause of Alzheimer’s, nor are these disorders a normal part of aging.
But wait! This is not intended to be a depressing, “bad news” kind of article. On the contrary, this article is to share some really good news, some very encouraging news. Did you know that the first FDA-approved therapy to address the underlying biology of Alzheimer’s disease was approved in June 2021? This could mean more time for individuals to actively participate in daily life, have sustained independence and hold on to memories longer.
Aducanumab (Aduhelm) has received accelerated approval as a treatment for Alzheimer’s disease from the U.S. Food and Drug Administration (FDA). It is the first therapy to demonstrate that removing beta-amyloid, one of the hallmarks of Alzheimer’s disease, from the brain is reasonably likely to reduce cognitive and functional decline in people living with early Alzheimer’s.
Aducanumab is designed to target and remove specific forms of beta-amyloid. Amyloid is a protein that clumps into sticky brain plaques, which may contribute to cell death and tissue loss in areas of the brain particularly important for memory, thinking, learning and behaviors. The brain goes on creating beta-amyloid, but aducanumab decreases the amount. Its removal is reasonably likely to reduce cognitive and functional decline in people living with early Alzheimer’s.
Even if you’ve heard that Aducanumab is “controversial,” the FDA has recently accepted Lecanemab, called Clarity AD, under the accelerated approval pathway (https://www.prnewswire.com, July 5, 2022). Developed by Eisai, a pharmaceutical company in Tokyo, and Biogen in Cambridge, Mass., Lecanemab is a monoclonal antibody designed to clear clumps of protein from the brain that many think are a root cause of Alzheimer’s disease.
Here’s the key: To be a “candidate” for these treatments, early intervention is critical. The FDA specified the treatment should be initiated in patients with mild cognitive impairment (MCI) or mild dementia stage of disease. In other words, if you have late-stage (severe) Alzheimer’s, you’re probably not a candidate for this treatment. So, if you or someone you know is noticing changes to memory or thinking, it’s important to share your concerns with your doctor.
You may ask, “What kinds of changes?” Although the Alzheimer’s Association has a list of the “10 Early Signs and Symptoms of Alzheimer’s,” the following are some that I wanted to point out as some are personal to me. Please bear in mind that these are warning signs. If your parent (or yourself) is showing any of these signs, please don’t assume that they definitely have Alzheimer’s because there are other medical conditions that can cause these signs.
The first that I’ll cover is poor short-term memory. I noticed this at 64 years of age. For example, I bowl in two senior leagues. I’ll bowl, then sit down while I wait for my next turn — usually just a few minutes. More often than not, I won’t be able to remember where I stood or how the ball reacted on my last shot just a few moments before. Now, people often think that this is normal with aging, but actually (according to the Alzheimer’s Association website), it’s not.
Now you should know that it is extremely common for short-term memory to be affected in early Alzheimer’s, but for long-term memory to be preserved for much longer. So for instance, my 90-plus-year-old dad with early Alzheimer’s is still able to remember his childhood or remember information that he’s known for a long time. But he’ll definitely have trouble remembering what he ate for dinner the night before.
Another sign of early Alzheimer’s that personally concerns me is trouble with speech and language. Fortunately for me, the Alzheimer’s website says that “sometimes forgetting names or appointments, but remembering them later” is “typical age-related change.” Now, anyone can have trouble remembering a word every now and then. We’ve all had those “Now what is it called?” moments. And they do generally become more common as we age.
However, if people can’t name an object that’s shown to them, or they use a descriptor instead of the name, that would be concerning. For example, if they say “the thing you sit on” instead of saying “chair.” It would also be concerning if they’re using a word that is not quite right, such as “book” to refer to a newspaper. That’s because early Alzheimer’s often affects the part of the brain that manages language. So one early warning sign is to start having trouble naming things or finding the right words for things.
Another warning sign is developing delusions, which are also called false beliefs. It’s often something that seems far-fetched or impossible to most of us, but to the person with Alzheimer’s, they can become quite convinced that this is true. My 90-plus-year-old uncle, before he passed, was convinced that another family member had stolen his car. The truth was he had given it away when he lost his driver’s license.
Delusions often have a paranoid flavor, meaning they involve suspicion and fear of harm from others, but that’s not always the case. Delusions are a little less common than the other warning signs, but every now and then you will hear about someone who hasn’t yet been diagnosed with Alzheimer’s, but who is telling a story that sounds bizarre, and likely to be delusional. So when that happens, pay attention because delusions can be a warning sign of Alzheimer’s.
Another warning sign of Alzheimer’s is accusing others, such as accusing others for taking things, stealing things, hiding things or misplacing things. In our last trip to Las Vegas, hotel security knocked on my room door. I opened the door and there was my uncle with hotel security. He said someone had stolen his gold watch from his hotel room. We walked down the hall to his room. Security opened the door and there was his watch, on the nightstand where he had left it.
I’ve heard many similar stories from family friends as well as family members of my elderly clients. In most cases, it’s the older person who has misplaced their belongings due to memory problems or confusion. But they either can’t remember that or they can’t really accept that. So they conclude that someone else has taken the item.
Another sign of early Alzheimer’s is getting lost while driving or walking. Getting lost in familiar surroundings is another concerning symptom that sometimes pops up early. It can be related to memory problems, but it can also be related to difficulties with spatial memory, or with recognizing familiar landmarks. Before my uncle’s driver’s license was revoked, I would drive with him to sharpen his driving skills. He’d get lost more often than not.
Another sign of early Alzheimer’s is uncharacteristic behaviors and/or changes in personality. So for instance, this is when things start to happen that leave others who know the person saying, “That’s so weird. This is so unlike them.” Sometimes it’s uncharacteristic spending or risk-taking or actions that reflect impaired judgment. Other times it might be a change in social appropriateness or how the person engages in socially.
Although sometimes feeling uninterested in family or social obligations is listed as “typical age-related change,” a person living with Alzheimer’s disease may experience changes in the ability to hold or follow a conversation. As a result, he or she may withdraw from hobbies, social activities or other engagements. They may have trouble keeping up with a favorite team or activity.
The last common warning signs of Alzheimer’s disease that I’ll cover is decreased or poor judgment. Individuals may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money or pay less attention to grooming or keeping themselves clean. What’s a typical age-related change? Making a bad decision or mistake once in a while, like neglecting to change the oil in the car.
In conclusion, if you or someone you know is noticing changes to memory or thinking, it’s important to share your concerns with your doctor — the earlier the better. But that, of course, can be tricky because often older adults with warning signs of early Alzheimer’s are lacking insight and they can’t see that they’re having problems that requires evaluation, or they may not want to go to the doctor, or tell the doctor for their own reasons.
If you are like most people, you’ve been trying to get them to understand. It’s normal to feel like if we can just get them to listen to our explanations, they’ll understand and agree. But here’s the thing — according to board-certified geriatrician Dr. Leslie Kernisan, this approach almost never works. She recommends, “You’ll need to stop focusing on things like explanations, getting them to listen, getting them to understand, or trying to get them to agree.”
“Instead,” she says, “switch to the focus on connecting. You’ll need to focus on activities and conversations that help you understand them. Your job is to figure out your parent’s understanding of the situation and how they feel about it. A connecting conversation is one in which the other person feels validated and supported.” (Source: https://betterhealthwhileaging.net/)
Judd Matsunaga, Esq. is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal inury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.