Rarely are the steps to prevent Alzheimer's disease and dementia discussed thoroughly. On this week's episode, Dr. William Shankle, a neurologist specialized in the diagnosis, treatment and management of Alzheimer’s disease, discusses how management of lifestyle and other health conditions can reduce the rate of accumulation of Alzheimer’s disease in the brain.
Guest: Dr. William Shankle, Medical Director, Shankle Clinic, Newport Beach, California.
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Show Notes
Dr. William Shankle is the medical director of the Shankle Clinic in Newport Beach, California.
Transcript
Nathaniel Chin: Welcome to Dementia Matters, a podcast, presented by the Wisconsin Alzheimer's Disease Research Center. Our podcast is here to educate you on the latest research, caregiver strategies, and available resources for fighting back against Alzheimer's disease. I'm your host, Nathaniel Chin. Thanks for joining us.
Welcome back to the Dementia Matters. I'm pleased to introduce Dr William Shankle. He specializes in the diagnosis, treatment, and management of patients with cognitive impairments due to Alzheimer's disease and other dementias. He cofounded the Alzheimer's Research Center at the University of California in Irvine in 1987 and served as its clinical director for 10 years. Since establishing the Shankle Clinic in 1997, Dr Shankle has seen more than 10,000 patients with dementia. I'm honored to have you here. Welcome, Dr Shankle.
William Shankle: Thank you.
Nathaniel Chin: To begin, you have diagnosed and treated an extraordinary number of people with Alzheimer's disease or another cause of dementia, and this has been done over years and years. What have these experiences taught you about Alzheimer's disease that many people do not understand or realize about the disease.
William Shankle: One thing about Alzheimer's disease is that people usually associate Alzheimer's disease with a severity called dementia, whereas Alzheimer's disease is an accumulation of certain molecules or proteins in the brain that doesn't cause any symptoms for approximately 30 to 50 years. And the association between the terms Alzheimer's disease and dementia leads to the fear of having it. And in general, people avoid finding out whether they have these proteins in the brain until they are so impaired that they can no longer function on their own. If we treated Alzheimer's disease like diabetes or high blood pressure, where we routinely get a checkup for memory after about 45 years old, we would be able to identify Alzheimer's disease while people are still functioning normally. So if we as an educational group could educate doctors and the public that Alzheimer's disease is a preventable condition in terms of preventing severities, that people don't want the memory loss, the dementia, then they might be more prone to check their memory annually and detect it while they're still normal.
Nathaniel Chin: So what you just said is very profound and it's not in the traditional view, but I think a part of that is because you're very particular about your use of the term Alzheimer's disease versus a syndrome or a condition like mild cognitive impairment and dementia. So do you believe that we can actually delay or prevent those syndromes of mild cognitive impairment and dementia?
William Shankle: The answer is unequivocally yes. And for example, in genetically identical twins, there are two national studies from Scandinavia where they looked at all genetically identical twins in the country and they found that the age of onset for a pair of twins for Alzheimer's could differ by up to 15 years for about 13 percent of the entire population of identical twins who developed Alzheimer's. And I go, well, if they differed by 15 years in their age of onset, it certainly wasn't because of their genes, it had to be something else. And so we're learning a lot about lifestyle. You know, that lifestyle can in fact alter the development of the symptoms. It can alter the accumulation of the molecules of Alzheimer's disease.
Nathaniel Chin: And I do want to talk to you about the risk factors that we need to address, but do you think we can prevent Alzheimer's disease, the disease process.
William Shankle: Disease process? I think that's a really good question, and I would say that we can prevent the accumulation of the pathology of Alzheimer's disease, we can prevent the accumulation of the misfolded proteins that cause Alzheimer's disease, if we can reduce its rate of accumulation. There's a very nice study by Montine [TJ, et al.] from Seattle, and they looked at a managed care population over 65 years old. They randomly sampled people, and they said we'd like you to submit to a memory test every year, and then, you know, when you die, we'd like to take your brain and look at it. And so what they found though was that the people who are cognitively normal, the year they died, 98 percent of them had Alzheimer's in their brain. They had the disease in their brain, but they were cognitively normal. The difference between the cognitively normal group and the group that were demented was that the demented group had three times as much Alzheimer's disease in their brain. And that leads me to believe that if we can reduce the rate of accumulation of these abnormal proteins that cause Alzheimer's disease enough, we can prevent reaching that threshold that produces symptoms. So we may have Alzheimer's disease in our brain, but we're functioning normally. So when I looked at the literature and asks the question, what things influence the rate of accumulation of the molecules of Alzheimer's? And it turns out that every chronic disease that's been studied increases the accumulation of these molecules if it's not well managed; things like traumatic brain injury, general anesthesia, all of these things can influence how rapidly we accumulate these molecules. So that may explain how genetically identical twins can differ by 15 years in their age of onset. And that to me is an approach toward preventing the symptoms. So I think that if we can detect people while they're functioning normally, that we can eliminate the dementia almost certainly, and there's a pretty good chance we might be able to eliminate the memory loss with a combined approach of lifestyle, supplements and the optimal medications.
Nathaniel Chin: Going back to these risk factors, what do you think are the most important ones for a person to address?
William Shankle: I divide them up into what your existing medical conditions are so that they're properly managed. And then we look at the level of physical exercise, and we look at the level of mentally stimulating activity. There’s some nice studies that actually show that a lifelong engagement in cognitively stimulating activities is associated with much lower levels of Beta amyloid. They showed in PET scans that people who engaged in regular mentally stimulating activities like reading books or going to plays and theaters, those things, they all have a way of reducing the level of, at least amyloid in the brain. I think that the cognitively active group had levels of amyloid the same as 20 year olds, whereas the cognitively couch potato group had levels of amyloid the same as people who are demented with Alzheimer's in that study. So yeah, I think there's the cognitive stimulation, the physical activity, the lifestyle. I believe your center here is world renowned for looking at diet, at issues of fasting, that also influence the rate of accumulation. So I think that all of those things can add up to delay that rate of accumulation so you don't cross the threshold.
Nathaniel Chin: I believe a part of our job as physicians is to motivate people to make these healthy lifestyle changes, but that's not an easy task. Do you find people are more motivated to address these chronic conditions because of the concern for mild cognitive impairment or dementia?
William Shankle: Yeah. So that's a good question. Usually, if you ask people who come to a talk or listen to a podcast before, they've listened to the podcast, would you be willing to check your memory to see if you might have a problem? And they say, no, I don't want to find out. And about 90 percent of people, what we found is that after hearing that 90 percent of what we find is treatable, maybe not curable, but treatable so that we can make your life a whole lot better just by checking your memory, most of them say, well, yeah, I want to take the test. Why not? It's a behavioral shift that happens. Once they know there's something they can do about it and that it makes a big difference to them, yeah, that makes a lot of sense to them.
Nathaniel Chin: Well then on the other side of this, how do you approach people whom you've diagnosed with mild cognitive impairment or dementia?
William Shankle: When I see a person with the symptoms of either Alzheimer's or some other cause of mild cognitive impairment or dementia, I try to actually be very pragmatic and I say, okay, this is what is causing this memory difficulty, and we met, we know that these molecules are in the brain, and we have things that will block further accumulation, we have things that will reduce the amount of those molecules, and we know from previous work that this will not only improve your cognition for at least two or three years, but at a very minimum delay the progression by 50 to 60 percent. And when you combine a lot of things like lifestyle and supplements and medication, we typically see about a 100 to 200 percent delay compared to the untreated course. So this means there's a very good chance that we can either eliminate the dementia, if you have mild cognitive impairment, or greatly reduce it so you will not be dependent upon others in the things that you've done all your life.
Nathaniel Chin: Well, with that, I'd really like to thank you for being on Dementia Matters, and I hope to have you on the next time you visit Madison.
William Shankle: I'd be delighted. Thank you very much.
Nathaniel Chin: Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health, and the Geriatric Research Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private, university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer's disease centers. This episode was produced by Rebecca Wasieleski and edited by Bashir Aden. Our musical jingle is "Cases to Rest" by Blue Dot Sessions. Check out our website at adrc.wisc.edu. You can also follow us on Twitter and Facebook. If you have any questions or comments, email us at dementiamatters@medicine.wisc.edu. Thanks for listening.
