Table of Contents
PART I: GETTING OLD
Introduction 3
Why Me, as the Author of This Book? 4
Why This Book, Now? 6
Chapter 1: The Effects of Aging on Memory 11
The Nature of Memory: Categories and Definitions 11
The Effects of Aging on Memory 15
So, What Does “Normal” Mean? 19
Cognitive Decline is Memory Loss’s “Evil Twin” 25
Age-Related Cognitive Decline (ARCD) 26
PART II: THE UNEVEN PATH TO DEMENTIA
Chapter 2: Subjective Cognitive Decline (SCD) 33
More Than Memory Loss 35
SCD: Its Role in the Study and Management of Dementia 36
Establishing SCD as a “New” Stage of Alzheimer’s Disease 37
Who Has Subjective Cognitive Symptoms? 39
Risk Factors for Developing SCD 40
Diagnosing SCD 41
Predicting SCD 45
Brain and Body Fluid Biomarkers in SCD 46
Genetic Markers in SCD (APOE4) 50
What Else Could It Be? 51
“Conversion Rates”: The Odds of Progressions Beyond SCD 52
SCD—Public Health Considerations 57
A Very Personal Summary of SCD 58
Chapter 3: Mild Cognitive Impairment (MCI) 61
Definition 61
MCI: “Official” Diagnostic Criteria 65
Neurocognitive Testing and MCI 66
The Role of AD Biomarkers in MCI 70
MCI: Prevalence and Risk Factors 71
The Progression of MCI to Dementia 71
The Differential Diagnosis of MCI 73
MCI Treatment 74
PART III: THE DEMENTIAS
Chapter 4: Alzheimer’s Disease (AD) and Other Dementias 79
Defining Dementia 79
Alzheimer’s Disease: The Basics 80
Biomarkers: The Biological Basis of an AD Diagnosis 87
The Six Stages of AD and their Descriptions 101
Neurocognitive Testing 104
Non-Traditional Measurements of Cognitive Decline 109
Risk Factors for Developing AD 115
Primary Prevention That Can Inhibit AD Development 132
Secondary Prevention: Slowing or Stopping AD 136
“Differential Diagnosis”: What Else Could It Be? 137
Alzheimer’s Disease: Progression and Prognosis 144
Coping with Alzheimer’s 146
Chapter 5: Current Treatments for Alzheimer’s Disease 155
Treatment Overview: Alzheimer’s Disease 155
Currently Available Drugs for Alzheimer’s Disease 160
To Be Avoided 179
PART IV: A GUIDEBOOK FOR THE JOURNEY
Chapter 6: Dealing With Today, Preparing For Tomorrow 197
Time for a Reality Check 198
First Steps for the Worried 198
When to Seek Medical Attention for Your Memory 199
What to Expect from Your Primary Care Provider 202
What to Expect from a Memory Specialist 204
Neurocognitive and Genetic Testing: Yes or No? 205
Biomarker Testing 206
Other Consequences of Testing 212
Bioethical Considerations 213
Coping with Failing Memory without a Diagnosis 215
Dealing with a “Likely Alzheimer’s” Diagnosis 223
Maximizing Outcomes after a Diagnosis 226
Identify and Avoid Unreliable Sources of Information 229
Advanced Directives (Your “Living Will” And “Polst”) 236
Getting on with Life After a Diagnosis 239
Caring for Those with Dementia 241
Activism 245
Conclusion: There Is Hope 248
Appendix I: Glossary 251
Appendix II: Resources 263
References 269
Index 341
About the Author 343