Hoag Health Network

Orange County, CA

How an Orange County Doctor is Slowing Alzheimer's Progression in this Patient

By The Orange County Register

May 19, 2017

Like his father before him and millions of others, Ted Esau’s brain started to deteriorate in his late-50s.

Plaque was building up. Part of his brain was starting to shrink. Although invisible to everyone including himself, the first stages of Alzheimer’s disease were beginning to take hold.

But following a program of healthy eating, exercise, Food and Drug Administration-approved medication and monitoring, Esau is a relatively new phenomenon in the annals of Alzheimer’s — someone who is attacking the disease before it takes away memory and is seeing a halt in the disease’s progression.

Now 64, Esau is doing so well he co-manages a team of more than 100 people in the complex world of finance investment.

Sitting in his Santa Fe-style home in Mission Viejo, Esau smiles and gives credit to Dr. William Shankle, director of the Memory and Cognitive Disorders program at Hoag Neurosciences Institute in Newport Beach. Before treatment, Esau’s brain atrophy was 4.3 percent per year. For the last several years, it has remained at the normal aging level of 1 percent.

Shankle is extra careful to point out that Esau is fortunate — and unusual. His patient made sure to get tested before the usually progressive disease had a chance to make a significant dent.

Shankle has researched Alzheimer’s for more than three decades, is on the National Alzheimer’s Association grant review committee and his proactive approach is becoming mainstream. Places such as the Center for Alzheimer’s Research and Treatment at Boston’s Brigham and Women’s Hospital practice similar treatment.

The U.S. Department of Health and Human Services, too, echoes Shankle in reporting that a combination of early genetic testing, research, medicine and healthy behaviors is beginning to change the face of Alzheimer’s.

Growing disease

Esau and his wife are private people with two adult children and five grandchildren. They are going public to shine light on a disease that is often misunderstood and hidden in shame in the shadows.

Some 5.4 million Americans have Alzheimer’s, a number that will grow to 7.7 million within the next 13 years, according to the Alzheimer’s Association. Most Americans have a family member — or will have a family member — with the disease.

Alzheimer’s affects at least one in 10 people over the age of 65. It kills more than breast and prostate cancer combined. One in three seniors will die with Alzheimer’s or other dementia.

There is no cure. There is no way to reverse Alzheimer’s. But as Esau suggests, there are rays of hope.

More than anything, Esau hopes to encourage people to be tested for Alzheimer’s and that if they test positive, they follow medical advice. “I want to put others on this path.”

Esau works for the global accounting firm Ernst & Young. His wife is a psychotherapist who helped her husband seek Alzheimer’s testing at age 50 because of his father’s ordeal.

Esau’s dad was a West Point graduate, a Harvard MBA and a retired Air Force colonel. Alzheimer’s turned him into a wanderer. The colonel died at age 74 confined to a locked-down nursing home.

But that was a quarter-century ago, a time when relatively little was known about Alzheimer’s.

Scientists today continue to unravel why older adults suffer from the disease, the impact of things in the brain called plaques and tangles, how age is related to hippocampal shrinkage, the connection of genes known as apolipoprotein E.

Shankle allows that Esau’s gene type included apolipoprotein E genes from both parents. That made his risk for Alzheimer’s 10 times higher than for someone without the markers.

Still, there is progress.

Treatment helps

Shankle reports that with early treatment, 45 percent of patients have what he calls “a curable condition, they can go on with life as before.”

With simple changes in lifestyle, some people can reduce risk by 30 percent. With medicine and a healthy lifestyle, the doctor reports 33 percent to 60 percent of patients can delay symptoms for 15 to 20 years.

Esau volunteers he takes FDA-approved drugs such as Namenda, a prescription medication, and puts on an Exelon skin patch every night.

“I’ll get Alzheimer’s if I live long enough,” Esau chuckles wryly, “but hopefully I’ll live long enough to die of something else.”

Esau offers three golden rules that also are endorsed by the National Institute on Aging. First, eat healthy and keep cholesterol levels low. When it comes to Alzheimer’s, Esau says, “Cholesterol is like gasoline to a fire.”

The accountant says his father was a three-sport athlete at West Point, but admits that later in life he was more sedentary. “Dad was a meat and potatoes guy.”

Second, stay active. Esau skis and plays rigorous racquetball three days a week for as long as three hours.

Third, keep your mind active. Don’t retire into the couch and stare at television all day.

Shankle explains that such things as the state of someone’s marriage, their friendships and even their occupation can affect Alzheimer’s. He says the greater the stress level, the greater the risk of disease.

“There also are very good studies that show that lifelong learning helps increase connections in the brain,” Shankle says. He says he’s found that active minds in middle age can mirror brains of people in their 20s.

During a two-hour conversation, Esau shows no hint of forgetting anything. At all.

I wonder about the difference between normal forgetfulness and Alzheimer’s. The accountant warms to the question. “Walking into a room and wondering why you are there is normal.

“Walking into a room, picking up a set of keys and not knowing what they are for is Alzheimer’s.”

I will add for you worrywarts that science confirms that spacing out walking into a room is no big deal.

A study by a team of scientists at the University of Notre Dame in 2011 discovered something dubbed “event boundary” or the “doorway effect.” They found that the brain tends to compartmentalize things in a room and then leaves them there. In effect, it creates a new file — an empty one — when you walk into a new room.

Columnist as guinea pig

Shankle acknowledges it’s rare to see a patient’s cognitive performance return to normal. Still, the doctor notes, “Ted’s experience underscores the importance of early assessment and the impact of early intervention.”

Esau and Shankle report a series of grants in Orange County make testing accessible and inexpensive through the Orange County Vital Brain Aging Program.

I plan to visit the program soon and I’ll let you know what I learn and, gulp, how my brain is doing.

I just need to remember to keep my computer in the same room.

To view the original article from The Orange County Register, please click here.