Sometimes Brunilda Espinosa forgot to brush her teeth. So the 76-year-old from Surfside went to her doctor, who diagnosed her with mild cognitive impairment, or MCI, potentially a precursor to Alzheimer’s, the disease that took her mother in her 90s.
Espinosa took action. She joined a support group at Mount Sinai’s Wien Center for Alzheimer's Disease and Memory Disorders. And, to stay active, she returned to school.
While 20 percent of people Espinosa’s age have Alzheimer’s, the figure rises with age. Nearly 50 percent in their mid-80s have the disease. In Florida, more than 450,000 people have it. Those with MCI worry and wonder what they can do to delay or prevent the illness. In the near term, says Dr. Marc Agronin, a geriatric psychiatrist at Miami Jewish Health Systems and author of How We Age, the answer is not much.
In his 15 years as medical director of mental health and clinical research, Agronin says, “Not a single experimental effort has proven effective at making a difference. We may have some agents that slow the process down, but we have not found a cure.”
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Nor is one likely in Espinosa’s generation, experts agree. In 2014, the National Institutes of Health will spend about $566 million on Alzheimer’s research, compared with about $5.4 billion on cancer. In Florida, a bill wending its way through the Legislature proposes just $3 million for Alzheimer’s research — even though the state has one of the highest percentages of elderly residents in the country.
“Alzheimer’s research is probably 50 years behind cancer,” Wien Center medical director Dr. Ranjan Duara said.
For a disease called “epidemic” by the Florida Department of Elder Affairs, that leaves much of the support in Miami-Dade County to memory centers like the one Agronin oversees and two state-designated memory disorder clinics — the Wien Center and University of Miami’s Memory Disorders Center at the Miller School of Medicine.
Memory centers offer free cognitive workups that can reveal reasons for memory changes other than Alzheimer’s, from benign tumors to small strokes or depression, Agronin says.
He recalled a woman who’d been diagnosed with Alzheimer’s but showed none of the abnormal proteins associated with it on a brain scan. “Her profile wasn’t typical. I felt it could be her medications, so I adjusted them and she was back to her old self,” he says.
Memory centers and clinics also play an important role for pharmaceutical and healthcare technology companies to test new treatments. Increasingly, people with MCI are the focus of researchers’ attention because their memory changes are small and more likely to respond to interventions. Espinosa may forget where she placed her car keys, but she aced her paralegal courses at Florida International University and her prospects for improvement are good, doctors say.
Wien and other clinics will soon recruit normally functioning people who show signs of brain plaques for a study investigating a drug to slow the plaques’ effects on memory loss. And UM opened the Brain Fitness Pavilion in March at its downtown campus where it uses mind-game software approved by the Food and Drug Administration to enhance cognitive functions for healthy people as well as those with MCI.
At Miami Jewish Health, Agronin and his staff will soon invite people with MCI to participate in a clinical trial of a device that transmits electromagnetic pulses to the brain while the patient performs mental exercises known to light up specific brain functions. The device dramatically improved mild Alzheimer’s symptoms for up to five months in European trials in 2012.
Psychologists and neurologists can also relieve a tremendous amount of suffering with conventional medications, says Wien Center’s Duara, reducing symptoms by at least 50 percent or more to improve the quality of life.
And there is progress. Recently, Harvard researchers decided to look not at the protein clumps thought to destroy brain function, but at what allows some peoples’ brains to remain healthy despite the clumps. The study, published in the March issue of Nature, identified a protein known as REST that appears to protect the brain’s health. If it can do that for some, researchers think a new drug could increase REST for those who aren’t producing it naturally.
While the research and development continues, Alzheimer’s emotional and financial tolls weigh on Florida caregivers who provided $14.7 billion worth of unpaid care in 2013, according to the Alzheimer’s Association. William Maguire, 62, of Bay Harbor Islands, attends Espinosa’s support group at the Wien Center. He recently had to move his wife into a care facility after 10 years of caring for her at home.
“It’s painful to be separated from her,” he said.
Agronin, one of the few psychiatrists in South Florida who specializes in a geriatric population, says people with the disease can still live joyful lives for years — something that can elude even those who do not have Alzheimer’s.
“I work with people with memory impairment who are living healthy, meaningful lives, and with people who are not impaired, who are not,” he said.