July 20: Capt. Chesley "Sully" Sullenberger, who safely landed a US Airways flight on the Hudson River in 2009, today became the most recent high-profile figure in the last four weeks to reveal an Alzheimer's diagnosis.
Sullenberger’s news comes on the heels of similar announcements in the last month by ABC-NY News anchor Bill Ritter and actor Danny Glover. Each described a point at which they started forgetting the names of people and places, among other things.
Their stories echo the experiences of millions and reinforce a vital message from medical experts: early diagnosis is crucial.
For many, the journey to a diagnosis is fraught with uncertainty and delay.
"The data has shown that the average person comes to clinical attention five years after the symptoms start," says Dr. Rehan Aziz, a geriatric psychiatrist at Jersey Shore University Medical Center and associate professor of psychiatry and neurology at Hackensack Meridian School of Medicine. This delay can have significant consequences, as the newest and most effective treatments for Alzheimer’s are most impactful in the disease’s early stages.
"I think that folks should have a low threshold for presenting for formal evaluation," Dr. Aziz urges, "especially now that we have diagnostic biomarkers as well as FDA approved treatments for the very early stages of Alzheimer's."
The initial signs of Alzheimer's are often subtle and easily dismissed as normal aging. However, when memory problems start to impact daily living, it's a clear signal to seek a medical opinion.
"I think the more advanced skills such as maintaining finances, balancing checkbooks, falling prey to scams, those are areas where we start to see the first signs of impairment," Dr. Aziz notes.
Both Ritter and Glover have spoken about the gradual progression of their symptoms before their diagnoses. Their experiences highlight a common challenge in identifying early-stage Alzheimer's, particularly in high-achieving individuals.
"Especially for those who have very high cognitive reserve, it is much more challenging to distinguish between what can be subtle signs of mild cognitive impairment versus the process of normal aging," says Dr. Manisha Parulekar, division chief for geriatrics at Hackensack University Medical Center.
People with "high cognitive reserve" - often those with higher education and demanding careers like journalists or pilots such as Captain "Sully" Sullenberger—can unconsciously mask the early signs of the disease. Their well-honed problem-solving skills can compensate for initial cognitive decline, making it difficult for them and their loved ones to recognize that something is amiss.
"If I start having difficulty managing my calendar, which is my whole life... I have a problem. I need to go and get it evaluated," Dr. Parulekar says, offering a relatable example. "It's better to get evaluated and get a clean bill of health than just say that, 'Oh, this is just because I didn't sleep well last night.'"
Fortunately, the tools for diagnosing Alzheimer's have advanced significantly.
"The biomarkers have changed the game," Dr. Aziz states. "For the first time now, we have tests where we can definitively diagnose whether or not someone has Alzheimer's. Previously, we could only diagnose based on an autopsy."
However, the experts caution against misuse.
"Biomarkers are a diagnostic test, not a screening test," Dr. Parulekar clarifies, expressing concern over "worried well" patients without symptoms requesting the tests like a routine check-up.
The availability of new, disease-modifying anti-amyloid treatments offers hope for slowing the progression of Alzheimer's, Dr. Aziz explains.
"They're the first disease modifying treatments because they're actually targeting the disease itself. But the caveat is that they work best when they're started early," Dr. Aziz says.
This makes the message from public figures like Bill Ritter, who stressed the importance of not waiting to seek a diagnosis, all the more urgent.
In addition to medical treatments, both doctors emphasize the importance of lifestyle interventions in maintaining long-term brain health.
"Prevention is always the best approach," says Dr. Parulekar.
A healthy diet, regular physical exercise, managing hearing loss, and addressing depression are all crucial components of a comprehensive approach to dementia prevention and care.