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Being unaware of memory loss predicts Alzheimer's disease, new study shows



While memory loss is an early symptom of Alzheimer's disease, its presence doesn't mean a person will develop dementia. A new study at the Centre for Addiction and Mental Health (CAMH) has found a clinically useful way to predict who won't develop Alzheimer's disease, based on patients' awareness of their memory problems.

People who were unaware of their memory loss, a condition called anosognosia, were more likely to progress to Alzheimer's disease, according to the study, published in the Journal of Clinical Psychiatry. Those who were aware of memory problems were unlikely to develop dementia.

"If patients complain of memory problems, but their partner or caregiver isn't overly concerned, it's likely that the memory loss is due to other factors, possibly depression or anxiety," says author Dr. Philip Gerretsen. "They can be reassured that they are unlikely to develop dementia, and the other causes of memory loss should be addressed."

In other cases, the partner or caregiver is more likely to be distressed while patients don't feel they have any memory problems. In Alzheimer's disease, lack of awareness is linked to more burden on caregivers. Both unawareness of illness (anosognosia) and memory loss (known as mild cognitive impairment) can be objectively assessed using questionnaires.

The study, believed to be the largest of its kind on illness awareness, had data on 1,062 people aged 55 to 90 from the Alzheimer's Disease Neuroimaging Initiative (ADNI). This included 191 people with Alzheimer's disease, 499 with mild cognitive impairment and 372 as part of the healthy comparison group.

The researchers also wanted to identify which parts of the brain were affected in impaired illness awareness. They examined the brain's uptake of glucose, a type of sugar. Brain cells need glucose to function, but glucose uptake is impaired in Alzheimer's disease.

Using PET brain scans, they showed that those with impaired illness awareness also had reduced glucose uptake in specific brain regions, even when accounting for other factors linked to reduced glucose uptake, such as age and degree of memory loss.

As the next stage of this research, Dr. Gerretsen will be tracking older adults with mild cognitive impairment who are receiving an intervention to prevent Alzheimer's dementia. This ongoing study, the PACt-MD study, combines brain training exercises and brain stimulation, using a mild electrical current to stimulate brain cells and improve learning and memory. While the main study is focused on dementia prevention, Dr. Gerretsen will be looking at whether the intervention improves illness awareness in conjunction with preventing progression to dementia.

5 Tips for Getting the Most Out of Your Healthcare

There are many differences between China’s healthcare system vs. U.S healthcare system. Besides finding a health insurance that works best for you as well as a trustworthy primary care doctor, you will have to make doctor’s appointment, and deal with complicate insurance bill. In order to help you get the most out of your healthcare, Leslie D. Michelson, the CEO of Private Health Management, offers tips in his new book “The Patient’s Playbook”, for how get the most out of medical care and how to make the system better work for you from the ground up

1. Develop a strong bond with your primary care physician. Do you trust and respect your primary care doctor and feel comfortable telling her secrets that affect your health? When you develop a good relationship with your primary care doctor, you’re forging a bond with someone who will be invested in your wellbeing for the long haul—and who will be dogged about getting you in for the preventative exams that are right for you. If you don’t have a primary care physician, you are driving without a seatbelt.

2. Take emergency inventory. Make lists for yourself and your family members with the following: 1. Diagnoses and any major surgeries; 2. Allergies; 3. All drugs and supplements you’re taking; 4. A roster of your physicians; 5. An emergency contact person. Keep this information in your wallet or purse—which is the first place an emergency response team will look in the case of an unconscious patient.

3. Measure twice, cut once. Diagnostic error contributes to the death or disability of 80,000 to 160,000 Americans each year, according to a 2013 Johns Hopkins study. Before agreeing to surgery and other treatments, have your pathology, labs or scans re-read by independent pathologists or radiologists to be sure you have a correct diagnosis. Then consult with an expert in your condition—for example, not a general neurologist, but a multiple sclerosis specialist—to at least hear a different take on your disease and treatment options.

4. Recruit a healthcare quarterback. If you woke up tomorrow to learn you had a potentially fatal disease, who’s the person you most trust to be at your side during doctor visits, taking notes and asking questions you might not be thinking of? People always say, “How can I ask anyone to do that? I’m uncomfortable with the idea of dragging my cousin to my appointments.” But you probably have asked a friend or family member to serve as the guardian of your children should that become necessary.

5. For significant problems, go to significant medical institutions. Community hospitals are terrific institutions that can do great things, but for complex issues and procedures—pancreatic, esophageal, neurosurgery, lung surgery, big cancer operations, endocrine surgery or cardiac operations, for example—you want to be cared for at a major institution that does high volumes of similar cases. And here’s a little-known quirk of our system: In medicine, it frequently doesn’t cost any extra to get better quality care. Most Americans live within 100 miles of a major metropolitan city. Almost every large city has an academic medical center or distinguished hospital that is in-network, with specialists and surgeons who take Medicare and most kinds of insurance. Unlike clothing, airlines or hotels, a higher cost doesn’t necessarily mean a higher quality in medicine. Many people may find it difficult to travel for care. But if you’re facing a serious disease or need technically demanding procedures, consider going to the closest large hospital, which is more likely to have the experience and expertise necessary to get you the best outcome.