"Understanding the traditional hallmarks of Alzheimer's, including cognitive impairment and memory loss, are important; however, these study results also illustrate the significance of understanding that, in some people, changes in gait and balance may appear before cognitive impairment"
By Bob DeMarco
Alzheimer's Reading Room
Please read this and remember these words: walking, balance, and gait. It is likely that many of us will observe these problems in the elderly in the future. You might make a dramatic difference in someone's life by committing this research to memory.
I get asked frequently, what were the first signs of Alzheimer's in your mother, Dotty. I usually answer her behavior. My mother had become very negative and when I came to Delray Beach to investigate for 10 days, I learned that she had almost over night become very mean spirited. This was the "tip off" that something was dramatically wrong with my mother. This change in behavior was subtle at first. But then all of a sudden, it worsened dramatically. So that was the first official "sign".
When people ask me what to look for as an early sign, I will always include changes in behavior. Particularly meanness and paranoia.
However, both Joanne, my sister, and I noticed at least two years before I came to Delray Beach that my mother had a rather dramatic change in the way she walked. My mother started scraping her feet on the ground. When she was outside walking, or when my mother was walking on a hard floor her feet made a very distinctive "scraping sound". You couldn't miss it.
I mentioned this to my friends and associates and guess what every single one of them said, "she is getting old". As a result, I let it go. Keep in mind, I was still working in the fast lane.
When I came to Delray Beach, my mother was falling down all the time. When she fell, she couldn't get up on her own. When she fell, she wouldn't call out, she would struggle to get up on her own. Once she fell and broke her little finger, before that she fell in the parking lot outside and was laying there for about 20 minutes before I found her. It was dark outside, and she was "shaking like a leaf".
Guess what the doctor said when I told him? "She is getting old". Add me to the long list of Alzheimer's caregivers that have said, You're FIRED!
I have written before about walking, balance and gait. Right now, I hope you will read this research and commit to memory.
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Falls May Indicate Earliest Stages of Alzheimer's and Need for Further Evaluation
Falls are more common among individuals with the earliest signs of Alzheimer's, according to a study presented at the Alzheimer's Association® International Conference 2011 (AAIC 2011).
The study measured the rate of falls among cognitively healthy older adults with and without preclinical Alzheimer's – as measured by amyloid imaging using positron emission tomography (PET) with Pittsburgh compound B (PiB) – and found twice the risk of falls for people with higher levels of PiB on their scan.
In older adults, falls contribute to increased disability, premature nursing home placement and injury-related mortality. There are also higher health care costs associated with falls – more than $19 billion could be attributed to the direct medical costs of falls in 2000.
Older adults with Alzheimer's may be at higher risk for falls because of balance and gait disorders and problems with visual and spatial perception that are caused by the disease.
"Understanding the traditional hallmarks of Alzheimer's, including cognitive impairment and memory loss, are important; however, these study results also illustrate the significance of understanding that, in some people, changes in gait and balance may appear before cognitive impairment," said Maria Carrillo, PhD, Alzheimer's Association Senior Director of Medical and Scientific Relations.
"Growing scientific evidence suggests that 'silent' biological changes may be occurring in the brain a decade or more before we can see the outward symptoms of Alzheimer's. According to this study, a fall by an older adult who otherwise has a low risk of falling may signal a need for diagnostic evaluation for Alzheimer's," continued Carrillo.
Led by Susan Stark, PhD, Assistant Professor of Occupational Therapy and Neurology at Washington University in St. Louis, the 8-month study followed 125 older adults currently enrolled in longitudinal studies of memory and aging at Washington University's federally funded Knight Alzheimer's Disease Research Center (ADRC). All participants had PiB PET imaging and contributed samples of cerebrospinal fluid (CSF). Each participant was asked to record in a journal how many times they experienced a fall, which was defined as unintentional movement to the floor, ground or an object below knee level. Some of participants had preclinical Alzheimer's and some did not. With an average of 191 days of data collected for participants, the study found that 48 people experienced at least one fall. A positive PiB PET image resulted in a 2.7 times greater risk of a fall for each unit of increase on their PiB PET scan.
"To our knowledge, this is the first study to identify a risk of increased falls related to a diagnosis of preclinical Alzheimer's disease," said Stark. "This finding is consistent with previous studies of mobility problems among persons with very early symptomatic Alzheimer's or mild cognitive impairment. It suggests that higher rates of falls can occur very early in the disease process."
"In the near future, with continued research, we will improve our ability to detect and intervene early in Alzheimer's disease. With earlier detection, perhaps we can also lower the risk of falls, which can be disabling, expensive and even deadly in older adults," said Carrillo. "Additional research is urgently needed, for example to further explore the connection between motor deficits and falls as possible early signals of Alzheimer's.
Susan Stark, PhD, et al. Risk of falls among older adults with Preclinical Alzheimer's Disease. (Funders: U.S. National Institute on Aging, the Knight Alzheimer's Disease Research Center at Washington University).
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Original content Bob DeMarco, the Alzheimer's Reading Room