Guest: Dr. Heather M. Snyder
Guest Bio: Dr. Heather M. Snyder- Director of Medical and Scientific Operations at the Alzheimer’s Association.
Segment Overview: Dr. Snyder discusses findings presented on July 17, 2013 at the Alzheimer’s Association InternationalConference in Boston, Massachusetts, which suggest that Subjective Cognitive Decline (SCD) may be the earliest indicator of Alzheimer’s disease. We discuss these early warning signs and what doctors and patients should be looking for.
Health Professional Radio – Alzheimers Association
Emily: You’re listening to Health Professional Radio. This is Emily, and my guest today is Dr. Heather Snyder. She is the Director of Medical and Scientific Operations at the Alzheimer’s Association. Dr. Snyder, thanks so much for speaking with me today.
Dr. Heather Snyder: Thank you for having me. It’s a pleasure.
Emily: I’m curious about…last week at the Alzheimer’s Association International Conference in Boston, there were five studies presented. Is that correct? That suggested that subjective cognitive decline may be the earliest indicator of Alzheimer’s disease?
Dr. Snyder: Well, there were actually quite a few studies that were looking at, that subjective cognitive decline or an individual’s self-reported perception on the change in their memory. But there were five that were featured, looking at the correlation of an individual’s perception of a change in their memory or a change in their pattern of their memory, with other markers of Alzheimer’s disease. One of these studies looked at brain changes associated with Alzheimer’s disease using imaging.
One study looked at a known genetic link…a genetic risk factor of Alzheimer’s disease, the apolipoprotein E4. Then several studies actually looked at, did an individual’s self-identified change in their memory correlate with the increased risk of a decline in memory, in one study in six years and one study in eight years.
Emily: I see. In 2012, there were the COBRA [sp] studies about subjective cognitive decline. What did we know before these studies?
Dr. Snyder: I think this is really one of the first times that we’ve seen a number of these studies come together, and look at what are the links to subjective cognitive decline to that first identified change in an individual with these other factors related to Alzheimer’s disease, as well as looking over a period of time and connecting the subjective cognitive decline with a quantitative change in an individual’s cognition.
Emily: I see. All of these things that we’re now able to measure with advancements in brain imaging and understanding of genetics and so forth, are pointing to a correlation between those measurable factors and the subjective cognitive decline that a patient has come in to their doctor and reporting. Is that what you’re saying?
Dr. Snyder: It’s starting to build up that evidence. Possibly this type of thing, this subjective cognitive decline of an individual’s self-awareness of a change in their behavior, may be an early clinical marker that we could use in a physician’s office. We’re not quite at that point yet. We’re not quite at the point that we’re able to identify what are those factors that would be indicative, but it is the idea that we can…more research can really help identify that first clinical finding and quantitate [sp] it a little bit further.
Emily: We hear so many people talk about having senior moments, or having changes in memory that relate to forgetting someone’s birthday, forgetting the name of an acquaintance. That is so common. Are those kinds of moments cause for concern?
Dr. Snyder: I think we all have moments where we forget things. I lost my keys this morning, for instance. But it’s more of a change in pattern. It’s a change, something that you consistently see, a change in your behaviour. For instance, if you park your car in the same parking lot every time, but you start to forget the parking lot that you parked your car in. Or you lose your keys, but you actually forgot what your key is for. That might be more of a cause for concern, to seek a health care evaluation.
Emily: I see. On the Alzheimer’s Association website, it lists some myths about Alzheimer’s. I was interested that the first one is that memory loss is not a normal part of aging. But then, as I look at the warning signs that are published about Alzheimer’s disease, and I see things that sound really severe, even among a list of supposedly early warning signs …
For example, disruptions of daily life such as the one you described, not being able to remember where you park your car each day or what your car keys are for. That sounds, to me, like a much more telling memory loss than simply forgetting little details. Is there a difference between short term and long term memory loss that we should be worried about?
Dr. Snyder: There are definitely differences between short-term and long-term memory loss, although I think related to subjective cognitive decline, the important thing is a change in pattern, a consistent change in pattern about…you might be forgetting a name of somebody that you met last weekend and you can’t place them.
But if that’s something that you’re consistently doing…I spoke with an individual that was … he was an executive at a company. For him, he can post a lot of emails, a lot of memos, and he started noticing he had an increasing difficulty with word retrieval when he was writing those emails or memos.
It was something that he noticed was a consistent problem that he was having during his work … his professional environment. That was actually what caused him to speak to his wife, and then seek a health care evaluation. I spoke with someone else last week that was saying he’s always forgotten where he’s parked his car, but he was actually forgetting the lot that he was parking his car in. Was it behind this particular store or was it behind this particular store at the mall? Things like that, that was more of a consistent and a pattern and a change in that behaviour.
Emily: Until this findings were reported, if an individual came to their doctor and mentioned things like that, was that considered just a normal part of the aging process?
Dr. Snyder: It really probably depends on the doctor and what other symptoms or what other aspects the individual may have described. I know I have family members, that they have had concerns in changes in their memory and they’ve gone to their health care professional. They’ve had a full workup or a full evaluation and this turned out to be something unrelated. But it is just, I think, depending on the health care provider, and it is important to ask those types of questions of your patient when you’re speaking to them.
Emily: Right. Will this change the conversation between doctors and patients? Will this change what doctors are listening for and what they consider reportable?
Dr. Snyder: Well, at this point in time, this is really still the beginning of gathering this research and really putting it into a framework. One of the studies that was presented at the Alzheimer’s Associations International Conference really looked at putting it in this international framework so that we can look at what are the quantitative factors, what are those specific changes that we could potentially look for? Is there an order, is there a timeline, when we might notice these changes, or what was more frequent or less frequent?
I don’t think we’re quite ready at this point in time to change clinical practice. But it you are concerned about yourself or a loved one, the Alzheimer’s Association would encourage you to seek a health care professional’s evaluation. If you are a health care professional and an individual is talking to you about their concerns or about changes in their memory, we would hope that those concerns would be taken to heart.
Emily: I see. There was a pretty incredible statistic that I read, that one in three seniors will die with Alzheimer’s or another dementia. Do you have any idea how many of those people will experience subjective cognitive decline, in advance of actually having the disease?
Dr. Snyder: Not quantitatively, although you could imagine that if this is one of the first clinical signs, anyone that goes on to develop Alzheimer’s disease would have had these early memory changes indicative of Alzheimer’s disease or related dementia.
Emily: Is there a change in the definition of the pre-clinical stage of the disease at hand?
Dr. Snyder: In 2011, the Alzheimer’s Association worked with the National Institute on Aging in the United States, and developed revised guidelines for how we diagnose Alzheimer’s disease. These are still in the process of being validated and qualified on an international landscape. But it puts forth the idea that Alzheimer’s disease is a continuum, and that what we’ve traditionally been calling Alzheimer’s disease is the later stages of the disease, or dementia due to Alzheimer’s disease.
There may be an intermediate stage where someone is having changes in their memory, changes in their cognition. Then there may actually be an earlier stage where some of the underlying biology is changing in an individual, but they’re not yet necessarily experiencing the cognitive changes associated with Alzheimer’s disease. That’s been called pre-clinical Alzheimer’s disease. You can find more information about those guidelines on our website at alz.org.
Emily: Thank you. The actual diagnosis of Alzheimer’s at this point comes along with a behavioral or a mental change, and not necessarily a change that’s measured through something like a brain scan?
Dr. Snyder: Correct.
Emily: I see. Okay. Will that change?
Dr. Snyder: I think time will tell. There is a number of ongoing research efforts looking at what are the changes in biomarkers and underlying biological factors associated with Alzheimer’s disease. The revised guidelines that were put forth in 2011 really set forth that stage.
But there’s this underlying biological change that we could potentially detect in the earliest stages before someone has a change in their cognition. When there is that therapy, that can stop or slow the progression of the disease, we can identify someone at that earliest stage.
If we think about it, it’s like heart disease. We know now with high cholesterol or high blood pressure, that someone is at an increased risk for developing heart disease. There’s lifestyle or drug intervention that a physician can provide. It’s that same type of idea, that we can identify what might be those earliest changes and intervene when there is that therapy available.
Emily: Wow. I know a lot of people will be looking forward to that day. Thanks so much for speaking with me. This is Health Professional Radio. This is Emily speaking with Dr. Heather Snyder. She is the Director of Medical and Scientific Operations at the Alzheimer’s Association. Dr. Snyder, thanks for your time.
Dr. Snyder: Thank you, Emily.