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The brain
Unlocking the mysteries of mental illness

By CATHY BREITENBUCHER 

July 2014

Weighing in at about 3 pounds, the brain is the body’s supercomputer. It controls everything we do consciously, like walking or eating, and unconsciously, such as breathing. It tells our eyes when to blink, our hearts when to beat. It coordinates our senses and moods.

For all its myriad capabilities, though, one function of the brain stands out. "Thinking is the most sophisticated thing your brain does," notes Dr. Piero Antuono, professor of neurology, pharmacology and toxicology and director of the Demetia Research Center at the Medical College of Wisconsin. "It’s the first thing to go when you have an extra glass of wine, the minute you have a headache or the flu, or take a sleeping pill or anti-allergy medicine."

Working to unlock the mysteries of the brain is sophisticated stuff, too. Read here about the national impact Milwaukee area health providers are making on complex problems like dementia and behavioral health.

Facing Alzheimer's

The statistics can be terrifying: 5 million people in the United States with Alzheimer’s disease, and more than 16 million Americans projected to have it by 2050.

But what if lifestyle changes could halt that trend? After all, we’ve seen heart disease deaths decline during the past 45 years, thanks to prevention efforts and better care. Research is showing that the brain reserves we need to stave off dementia are built during a lifetime of physical activity, cognitive stimulation and healthy eating — all factors we can control. "Postponing the onset through healthy lifestyles is pretty cheap intervention," says Dr. Piero Antuono.

It’s important to work on preventing Alzheimer’s because there currently is no cure. Even testing for the disease remains in flux. "More than half of the information we find published in scientific papers is debunked within a year," says Antuono. "We always say, ‘Time will tell.’"

So, the work goes on. Antuono, for example, is studying how to use MRIs to identify those at future risk for dementia. Down the road, everyone might get a baseline MRI, just like they now get a screening colonoscopy at age 50. By then, Antuono hopes, effective drugs will have been developed. "If you have a family history, certain genes and an abnormal MRI, you would begin treatment before you get memory impairment symptoms — when you’re 50 or 55 instead of when you do get memory problems at 70," explains Antuono.

But why do people get Alzheimer’s? No single cause has been identified, says Antuono. Scientists suspect a damaging protein called beta-amyloid is the culprit. It can begin accumulating in the brain about 20 years before a person shows symptoms of memory loss. In some cases, it can be produced in massive amounts due to an abnormal gene, leading to early onset Alzheimer’s (which sidelined legendary basketball coach Pat Summitt at age 59.)

However, some people accumulate beta-amyloid in the spinal fluid before it even reaches the brain and eventually forms the clumps that break the connections between brain cells.

A two-year clinical trial at MCW is testing a man-made amyloid antibody — in effect, an Alzheimer’s vaccine — in patients with mild cognitive impairment. "These are people who are still working, active and have no trouble doing all the hundreds of things we do every day," says Antuono. "They have a measurable decline, and we know it’s the very, very tip of the iceberg of something that’s going to get worse over the next two, three or five years. The idea is to stop it before it progresses to Alzheimer’s."

Other research focuses on protein tau, which is found in brain cells themselves. It can derail the cells’ ability to communicate with each other, contributing to the death of the cells. While tau is commonly associated with Alzheimer’s disease, concussions and traumatic brain injury as seen in professional athletes are believed to be involved in the creation of tau, according to Antuono.

Last fall the National Institutes of Health announced $45 million in new Alzheimer’s funding to test early interventions and explore new therapies. But public and private research dollars lag behind many other health conditions.

Antuono calls Alzeheimer’s "a women’s disease," given that two-thirds of people with the disease and two-thirds of the Alzheimer’s caregivers are female.

"Breast cancer hits women in their 30s, 40s and 50s, and it rallies our emotions to do something about it, because it’s unjust for somebody to have to die at such a young age," he says. "When it hits people in their 70s and 80s, people are going to die of something anyway, and there’s not that sense of urgency."

Check for Symptoms

When memory loss disrupts daily life, it may be a symptom of Alzheimer’s. Use these examples provided by the Alzheimer’s Association to help you decide if you need to check in with a doctor.

It’s probably not dementia if you …

Make a bad decision once in a while

Miss a monthly payment

Forget which day it is and remember later

Sometimes forget which word to use

Lose things from time to time

 

There could be a problem if you …

Consistently use poor judgment and make bad decisions

Can’t manage a budget

Lose track of the date or the season

Have difficulty having a conversation

Misplace things and can’t retrace steps to find them

Interacting With Alzheimer’s

Early stage Alzheimer’s patients and their families are benefiting from a growing array of social opportunities, helping them stay connected to the community and build friendships.

"The more we can learn and share with somebody else, the more we can help," says Harlan Mueller of Brookfield, whose wife, Gail, was diagnosed in 2011.

The couple, both 69 years old now, initially attended one of the many support groups sponsored by the Alzheimer’s Association Southeast Wisconsin Chapter.

Then, they helped launch a monthly Memory Café, where people gather once a month to converse in a casual setting.

"It gives us more time to be together, and be in an environment in which there is no stigma, no stress, no feeling stupid," explains Harlan.

The Muellers also attend SPARK! cultural events at local and regional museums, where docents and volunteers are specially trained to guide the experience for people with dementia and their caregivers. Another group activity they enjoy together includes a physical fitness component.

"They say it’s helpful to maintain socialization," says Harlan, "otherwise people get depressed and don’t want to go out or do anything. We need to show society what this disease is about, and we need to change the way people thing about it. That would definitely help everyone."

Memory Cafe Events

Brookfield: 3-4:30 p.m.,

Second Tuesday of the month, Panera Bread, Ruby Isle, 2205 N. Calhoun Road

Grafton: 2-3:30 p.m., third Thursday of the month, Flipside Cafe & Grill, 2074 Washington St.

Watertown: 10-11:30 a.m., third Wednesday of the month, Hessed’s Connection Cafe & Laundry, 1308 W. Main St.

A personal Journey

A life of public service, and decades of political battles won and lost — nothing could have prepared Martin Schreiber for the challenges of caring for a spouse with Alzheimer’s.

"You grieve for the loved one you once knew, you become depressed and you develop anxiety about what the future might hold — and you worry," says Schreiber.

"Every time there is a repeat question or a repeat experience, you know where Alzheimer’s is headed. It’s headed toward further incapacity, and it’s headed down toward the end."

The former Wisconsin governor has largely kept his wife’s illness out of the public realm. He says he thought "long and hard" before agreeing to be interviewed for this story.

His motivation in coming forward stems from wanting people to understand the toll exacted by dementia on not only patients, but their families, too. He also wants to spark a conversation with health-care providers, insurance companies and employers about the support caregivers desperately need.

"This is a very personal matter," he explains. "But I believe it’s worth it, because we’ve just got to jar the system so there’s more attention given to help with the coping and caring."

Life After Diagnosis

Elaine Schreiber, 74, was diagnosed about seven years ago, following some uncharacteristic, erratic behavior. Widely known as a gracious hostess, she had tried to make for friends a special German meal that she’d been serving for years, but left out some key ingredients.

And, she would get lost for hours while driving once-familiar routes. One day she ended up stranded, surrounded by orange barrels in a construction zone and trying to tell police officers where she had been trying to go.

"It just wasn’t like her," says Schreiber, 75, who met his future wife when they were freshmen at Milwaukee Lutheran High School.

When Elaine Schreiber was diagnosed with Alzheimer’s, she joined the ranks of some 50,000 people living with the disease in the 11-county area served by the Alzheimer’s Association Southeast Wisconsin Chapter.

It was devastating news for a proud woman who had raised four children during her husband’s busy political career and then gone back into the work force, in her late 40s, after his 1988 mayoral campaign had sapped the family’s finances.

After her diagnosis of Alzheimer’s, Martin Schreiber took on more of the cooking and cleaning chores at the couple’s Bay View home. He did the grocery shopping. He drove his wife everywhere she needed to go. He began spending less time running his government relations firm, and almost no time caring for his own health.

"You don’t even notice the transition of going from loving spouse to full-time caregiver," he says.

About four years ago, he discontinued his daily workouts at the Milwaukee Athletic Club, and put on 20 pounds. Soon he was short of breath; doctors couldn’t agree on why. He even was hospitalized. "After a couple hundred thousand dollars of medical treatment, it began to dawn on me that my problems were not necessarily medical-related," Schreiber recalls. "Some key people with knowledge of Alzheimer’s said if I didn’t begin to take care of myself, I’d be dead before Elaine, and then she’d be in the nursing home."

Schreiber knew then that he needed time away from his care-giving duties. Finding the right help, however, was a struggle. He tried to bring in help at home, but his wife wouldn’t stand for it. Next, he enrolled her at St. Ann Center for Intergenerational Care, hoping she would rediscover her love of swimming there, but it wasn’t the right fit. Finally, he found a day program that fit — at the Jewish Home and Care Center — allowing her to receive services in a structured environment and giving him the respite he needed to return to healthy habits.

"She attends what we call ‘classes.’ She takes her college notebook with her every day," says Schreiber. "I make sure I get my exercise in and get some time alone. I look forward to picking her up each day."

The former first couple has become involved with the Alzheimer’s Association well beyond support groups. Three years ago, Elaine appeared at the Southeast Wisconsin chapter’s fundraiser walk to thank the participants.

Her husband is working to urge local companies to join the association’s Alzheimer’s Workplace Alliance, which promotes wellness activities and corporate policies that support a work-life balance. So far, about 20 companies in the area have signed on.

Schreiber says doctors who diagnose dementia need to focus on caregivers as well. "I believe it would save millions and millions of dollars in health-care costs for the caregiver, and also improve the quality of life for both the patient and the caregiver," he explains. "It would improve the productivity of the caregiver at their place of employment."

The couple — married 53 years in June — still get together with close friends, eat out and attend concerts and plays. They get frequent visits from their children, even the two who live several states away, and their 13 grandchildren. But Elaine’s slide into confusion continues. While she still knows family members when she sees them, she often asks her husband how many children they have and cannot remember which one is the parent of a particular grandchild. "She is," says Schreiber, "a very wonderful, loving, caring, confused person."

Brain Boosters 

Brain Food

Plan your meals around Alaskan sockeye salmon, sardines, tilapia, herring, walnuts, pumpkin seeds, ground flaxseed and leafy greens — all sources of omega-3 fatty acids. Spice things up with turmeric or ginger, and load up on colorful fruit and vegetables for anti-inflammatory benefits. Cook with sage to aid word recall, or mix rosemary oil into salad dressing to improve brain performance. But here’s the reality check: "A sprinkle of cinnamon on your doughnut will not turn it magically into a health food," says Dr. Anna Lamnari, internal medicine physician with Wheaton Franciscan Medical Group.

Run to Happiness

Do strenuous exercise for at least 20 minutes and you might experience the "runner’s high." Even longer workouts can trigger the release of pain-killing chemicals, such as endorphins, that allow you to push past your normal boundaries. "It creates a positive reinforcement loop," says Ironman triathlete Dr. Scott M. Dresden, medical director of Aurora Occupational Health and Wellness. Some studies even show regular exercise to be as effective as anti-depressants.

Be Present

Focus on being more "present" and be a Steady Eddie, rather than amplifying the busy-ness of your day-to-to activities. It’s called mindfulness, and while it has its origins in yoga and other meditative experiences, it’s being introduced in health-care settings and schools, too. Experts say it can reduce blood pressure, improve pain management and decrease anxiety, among other benefits. "It is fundamentally about relating to our situation as it is, and with kindness, rather than with the kind of aggression associated with yet another attempt at trying to ‘fix’ ourselves or others," says Donald Roth, psychologist with Wheaton Franciscan. Start with five to 10 minutes a day of sitting meditation, mindful stretching, breathing exercises or yoga — a mindfulness class can provide valuable feedback.

 







 


This story ran in the July 2014 issue of: