I had the opportunity to interview Dr. Ariel Gildengers about the state of the art in diagnosis and treatment of Alzheimer's and related conditions. Dr. Gildengers is Professor of Psychiatry at the University of Pittsburgh School of Medicine. He is an active clinician, educator, and scientist. Over the past 20 years, Dr. Gildengers’ research has focused on understanding the long-term effects of bipolar disorder and its comorbidities on cognitive function and brain integrity in older adults, improving the treatment of older adults with bipolar disorder (OABD) and preventing depression and cognitive deterioration in older adults with mild cognitive impairment.
What is Alzheimer’s disease exactly, and what is causing the dementia? Alzheimer’s disease (AD) is the most common cause of dementia, accounting for more than half of dementia in the U.S. and worldwide. AD is typically characterized by loss of memory due to damage that begins in the medial temporal lobes of the brain and spreads to other parts of the brain as the disease progresses. AD is thought to begin decades before there are any observable symptoms. Over 6 million people in the U.S. have Alzheimer’s disease at an estimated $355 billion (2021) in costs to society (National Institute on Aging). Slowing disease progression would result in many fewer people living with AD in its most advanced stages, which require the highest level of care and incur the greatest cost.
While the pathology of AD has not been fully elucidated, central to the disease process is the abnormal accumulation of amyloid protein, which sets off a pathological cascade that leads to abnormal accumulations of tau protein, resulting in neuronal damage and dysfunction. Brain atrophy follows, with impaired memory and overall cognitive decline. Cognitive decline is associated with impaired everyday function.
Since the disease process likely begins decades before overt symptoms, there may be many points to........