I am a Pediatrician, daughter of a woman with AD. Of course, since my mother's diagnosis I have been giving Alzheimer's a lot of thought. I can't help but compare Alzheimer's to Coronary Artery Disease and type II diabetes. Although the symptoms of all these diseases usually start later in age, the disease process starts much earlier.

In pediatrics, we often try to identify risk factors and prevent or delay diseases seen in Adults(not alway successfully).

I would be interested in any studies that could help us identify risk factors very early. I honestly believe that the medicines we are using now are started much too late!!!

Dear Betty: I am an RN who spent over two decades as Administrator of Case Management.

My mother has FrontoTemporal Dementia. I have thought about the different types of dementia, recognition, prevention, etc., but have yet to see definitive multiple studies which are absolute and in concert with one another re the issues you have raised.

Risk factors. There are the genetic issues. In that case, at this point, one can attempt to forestall with excellent health, diet, exercise and solid approaches to managing Type II Diabetes and hypertension.

I think that for many people, Type II Diabetes goes undiagnosed for a long time. Also, the management approach can sometimes be inconsistent by primary care physicians.

I know that until my mother developed FTD, I was not at all "hyper-aware" of dementia overall. What an education I have since received!

A long career as an RN, Grad School - nothing, and I do mean nothing, prepared me for what I would be dealing with for my mother.

My mother had rheumatic fever as a child. She has severe mitral valve regurgitation. She threw clots and had many TIA's and several small strokes. Unfortunately, these took their toll on the frontal and temporal lobes of her brain.

There are so many different types of dementia other than AD. Sometimes this fact gets lost in the shuffle.

I think you are quite correct in that the disease has already been brewing much earlier than when the diagnosis has been made. This was true in my mother's case.

I would venture to say that now, when I look back, my mother's changes were occuring for literally years prior to her concrete diagnosis when her symptoms were finally readily evident.

Being a Pediatrician, education of families would go a long way in prevention. Most people do not realize how preventable diabetes is; or at least how readily managed. I don't think that most people are educated to the fact that Diabetes is in most ways, a disease of the microvascular system.

All those myriad tiny vessels in the brain, ripe for occlusion and certainly a primary causative factor in onset of dementia.

Looking at the family health and lifestyle, looking at family history and then taking it from there.

Incidentally, when my husband was diagnosed with Type II Diabetes, I contacted every single medical center in the cities around us as well as the Diabetic Association. Know what? Not one single Certified Diabetic Instructor anwhere!

I live near Los Angeles and we have many fine medical centers. Not a one with a Diabetic Program. That did shock me. Of course, logic tells me that since it is not revenue producing, it is not a priority.

What a shame.

Best of wishes in your practice and for the good thought and efforts on behalf of your little patients. You are a very fine and thoughtful physician.

I saw your anguish in trying to deal with your personal questions about AD.
I know that you have had your experience in medicine, and we all have our niches, but it's easy to get current great information from a seminar. A few days ago I attended one held in Chicago from a lecturer who travels from AZ and specializes in AD and PD. She has Ph.D and lectures to RN's, DDS's, OT's, RPh's, etc.
Laura Pawlak does the national circuit for INR out of Concord, CA. for CME's. Their phone is
1-877-246-6336. I think her material is well presented, up to date, and bargain priced.
I assume she might do a seminar in NC sometime.

Fortunately, my only experience with AD and PD have been with my own patients.
I hope I've given you a useful lead to your
difficult questions.