Alzheimer's: What the New York Times Missed

By David Shenk

Lawrence Altman is an excellent medical reporter for the New York Times, with a long and distinguished history. Yesterday, he added to his considerable body of work with a story clarifying the issue of when President Reagan's Alzheimer's disease first became apparent. The article comes in the wake of recent suggestions from Reagan's son Ron that the president may have had the Alzheimer's in the White House. (Short answer: he didn't).

Altman's piece is solid. But it also made me cringe three times as it glossed over dated descriptions of the disease, passing up easy opportunities to improve basic public understanding.

Altman's three misses:

1. Diagnosis.

Altman writes:

The disease occurs most frequently after 70, but it can strike younger people...diagnosing it with certainty requires a brain biopsy, rarely done while a patient is still alive.

This is still technically true, but it's so dated that it is like writing about car safety without mentioning seat belts or air bags. The public needs to understand that there have been enormous clinical advances in non-biopsy diagnosis over the last fifteen years: experienced Alzheimer's professionals can now diagnose the disease with more than 90% accuracy through a variety of mental status tests and brain scans. Further, though there is currently no cure for Alzheimer's, there are good reasons to get diagnosed as early as possible.

2. Stages.

Altman writes about Reagan:

The disease's course undulated as it progressed...Soon after the diagnosis, Mr. Reagan was told to give up horseback riding, one of his favorite hobbies. A strong swimmer in his youth -- credited with 77 rescues as a lifeguard in Illinois -- he now had to wear water wings while a nurse and security agent propped him up in the shallow end of a pool at home. He picked up magnolia leaves that fell from an overhanging tree or that a security agent tossed his way.

As the fog of Alzheimer's thickened, the father no longer recognized the son.

This, again, is like a 1950s description of Alzheimer's; it leaves giant, confusing gaps and some inaccuracies. Alzheimer's does not undulate; it steadily progresses. The stages are very predictable (if not clearly demarcated), because they result from the plaques and tangles proliferating through more and more regions of the brain. Alzheimer's does not transform strong athletes into clumsy weaklings in the early stages; such physical decline occurs (slowly and steadily) toward the later phases.

If caregivers and families are able to understand Alzheimer's as a series of rather predictable stages, they can be much better prepared.

3. Heredity.

Altman writes:

Alzheimer's hereditary patterns are not precisely known. Ron Reagan said he is aware that he is at risk for the disease.

Again, this is is technically true, but there's so much more to convey, even in the space of a few sentences, because so much is now known about the genetics of Alzheimer's. Only a handful of families carry a very rare gene that will guarantee the onset of Alzheimer's. The Reagans are very unlikely to be in this group. The other 99.9% of us face murkier risks associated with a number of other genes. And as far as we can tell, no person carries a guaranteed genetic immunity to the disease. In recent years, geneticists have identified several specific genes that seem to raise people's risk of getting Alzheimer's -- genes which are turned on and off by external factors, which then helps bring on the disease. Getting tested for these genes, as of now, confers no practical benefit. It won't tell you that you're immune; nor will it tell you that you will probably get the disease. It also won't tell you how to lower your risks. No matter your genetic profile, the best known way to lower your risk of Alzheimer's is the same for everyone: eat a heart-healthy diet, try to reduce stress, and regularly exercise your body and your mind.

This article available online at:

http://www.theatlantic.com/national/archive/2011/02/alzheimers-what-the-new-york-times-missed/71543/