Recent news highlights advancements in the understanding of Alzheimer’s disease: Increased information on biomarkers to be used for evaluation and diagnosis and recent studies on lifestyle factors or medications that do and do not correlate with Alzheimer’s disease.
It is helpful for family medicine physicians and other primary care physicians to be aware of this information to better help our patients and their families. When we have patients with strong family history of cognitive decline, they often will ask us for an early assessment or help with next steps and requests for treatment. Patients and their families want to understand what testing will be done by the neurologist they will likely be seeing.
Dr. Santina J. Wheat
An article published in Alzheimer’s and Dementia put forward a consensus statement by 11 European scientific societies on diagnosis and management of the disease. These societies defined work flows for processes to utilize biomarkers to diagnose Alzheimer’s disease. Although these work flows may help with diagnosis, they are not able to definitively rule out other causes of dementia. However, they may lead to consistency in how treatments are determined.1 More consistency will be helpful in counseling patients and their families on the next steps in the treatment plan.
Another study evaluated the correlation between lean mass and dementia. This study demonstrated a decreased risk of dementia in patients with higher lean mass. It is unclear from this study whether the higher lean mass is protective or if decreased cognitive function decreases the amount of lean mass. However, this study does provide hope in two possible ways: it provides potentially predictive information on who may be more at risk of declining cognitive function as well as a modifiable risk factor to address.2 Family physicians may use this as part of their counseling for patients who are concerned about their potential risk of dementia. It is yet another reason why we may counsel on healthy diet and weight-bearing exercise to help maintain lean mass.
Other associations related to dementia have been disproven. An article in Gastroenterology discussed the association between cognitive decline and use of proton pump inhibitors and H2 blockers – indicating that there is no association.3 Although there are reasons why we want to limit the use of these medications – particularly when they are not needed, it is a relief that they are not causing cognitive decline in patients.
Most of these studies provide information that is helpful for both family medicine physicians and patients. We are learning more about cognitive decline and Alzheimer’s disease. This gives hope to patients with strong family history that we may be able to reduce their risks. These studies also give us possible risk factors on which we can counsel our patients.
Developments in Alzheimer’s disease research are speeding ahead and give family physicians a bit more information to discuss with patients and their families as they face the challenging symptoms of cognitive decline. Future research, it is hoped, will help with treatment plans and modifiable risk factors to improve the outcomes for patients at high risk of cognitive decline.
Dr. Wheat is associate professor of family and community medicine at Northwestern University in Chicago. She has no conflicts of interest.
References
1. Massa F et al. Alzheimer’s and Dementia. 2023;19(S2):e062216.
2. Daghlas I et al. BMJ Medicine. 2023;2(1):e000354.
3. Mehta R et al. Gastroenterology. 2023 Jun 12. doi: 10.1053/j.gastro.2023.05.052.