Alzheimer’s disease, a progressive neurodegenerative disorder that affects millions worldwide, has a long preclinical stage. It potentially begins decades before clinical symptoms become apparent.

But as our new research suggests, blood biomarkers in combination with self-reported memory concerns could offer an early clue to how Alzheimer’s disease develops across the life course.

This means midlife could be a critical window for promoting brain health.

For our study, we used data from the world-leading Dunedin Study at the University of Otago, which has been following a cohort of people for more than 50 years.

We found a certain protein known as pTau181 was associated with self-reported concerns about memory and thinking skills.

Notably, study participants were only 45 years old at the time of assessment. People typically aren’t diagnosed with dementia until their 70s or older.

In recent years, we’ve seen advances in pharmaceutical treatments for Alzheimer’s disease. However, these are not cures. At best, they slow disease progression but they don’t preserve or restore cognitive function lost during more advanced stages.

It is likely these treatments work best when taken early, which makes it more important to identify the earliest signs of Alzheimer’s disease.

Preventing dementia

Different types of dementia can look similar during the early stages of disease, but the treatment and course of progression differ significantly for each type of dementia.

In the past, Alzheimer’s disease could only be definitively diagnosed postmortem, or more recently with invasive testing such as a lumbar puncture. But researchers are now working on identifying blood biomarkers that could offer a minimally invasive way to identify people at higher risk of developing Alzheimer’s disease.

Detecting Alzheimer’s disease in its earliest stages could provide an opportunity for prevention and offer the greatest benefits for brain health and ageing.

This may involve lifestyle changes, such as supporting people to be physically active and continuing to engage in social activities, and addressing modifiable risk factors such as hypertension or hearing loss.

Preventive approaches work more effectively the earlier they are implemented. Studying middle-aged populations is therefore important for identifying early risk profiles for Alzheimer’s, long before the disease would be diagnosed.

When forgetfulness becomes a sign of disease

As people get older, they often notice their memory isn’t as good as it used to be.

Forgetfulness is common and usually benign as people age. But in some people, these memory issues may indicate something else is going on.

Recent research shows subtle subjective changes in cognition often occur long before diagnosis and might be the first moment the disease is felt.

Screening for biological markers, in combination with subjective reports of memory function, could help distinguish the earliest signs of Alzheimer’s disease pathology from normal ageing.

Proteins such as pTau181 are much higher in people with Alzheimer’s disease, but we don’t know yet when this protein begins to accumulate.

Our findings add to the growing evidence that the earliest signs of dementia may show up long before diagnosis. They also show that self-reported cognitive concerns may be an early warning sign for Alzheimer’s, even in midlife.

Interestingly, we didn’t find that the pTau181 biomarker was associated with MRI brain scan measures or cognitive test performance at age 45.

There are at least two possible explanations for this.

Perhaps pTau181 increases during the earliest stages of Alzheimer’s disease, when people first start to notice their memory worsening but no changes are shown yet in MRI scans. Or it could be that elevated pTau181 is not related to Alzheimer’s disease risk in midlife, and the protein is only useful for detecting Alzheimer’s in older adults.

We don’t know enough yet, but will be following the same group of people as they get older to continue this research.

Ashleigh Barrett-Young, Research Fellow in Brain Health, University of Otago

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A long-term relationship with a GP – one who knows you and your history – improves your health and even reduces your chance of dying prematurely.

This type of trusted relationship is particularly important if you have a serious or chronic (long-term) condition or multiple conditions. It is also important for trauma survivors, who should not need to retell their story over and over.

However, there are times when you may feel uncomfortable with your current GP. The first step is understanding why, then knowing what to do about it. Here are some reasons you might consider finding another one.

1. Your needs have changed

It is common to change GPs at pivotal times in your life. You may feel uncomfortable discussing your sexual health needs with the “family GP” who has known you since you were a child, or who still sees your parents.

If your family is having children, you may prefer a GP who does antenatal care, or sees a lot of children, so they can more readily empathise with your needs as a young parent. Perhaps your current GP doesn’t share your ideas about health care and parenting, or the practice isn’t particularly child friendly.

You may have appreciated your GP’s practical, straightforward and efficient consultation style for past sports injuries, but find this approach unhelpful when struggling with your mental health.

So you may look for a GP who better meets your current needs.

2. You want another GP who is expert in your illness

Good GPs can get “up to speed” on a variety of conditions, while still keeping the whole person in view. But sometimes, you will have a very specific need that leads to seeking a GP who is expert in that area. An example may be a GP who specialises in skin checks, or a GP who is expert in ADHD (attention deficit hyperactivity disorder).

However, you still need a generalist GP who looks at your other health-care needs. This generalist GP may well be the one who picks up early Parkinson’s disease or bowel cancer while your other GP is focused on your reproductive system or mental health.

3. You want a GP who is more aligned with your values

People differ in the type of relationship they want with their GP. You might be seeking a true partnership, where you both bring your expertise into decision making and you have the final decision. At the other end of the spectrum, you may feel more comfortable with your GP taking a more assertive role. Your needs and preferences may change over time.

Sometimes, your GP doesn’t seem to accept your views on health care. You might feel uncomfortable discussing the role of complementary medicine, or preventive health care, or your decisions to accept or reject certain treatments.

So you may seek a GP who is more aligned with your attitudes and practices.

However, GPs have their limits when it comes to accommodating your preferences. They cannot always supply your preferred medication, referral or other service, for professional, regulatory, legal or other reasons.

4. There has been a fracture of trust or confidence

Everyone makes mistakes. Sometimes, those mistakes are so serious you cannot go back to that doctor. However, there are errors where the relationship can be repaired.

A good GP will explain why an error happened, show how they (and the practice) will rectify the error, and what systems are now in place to make sure it doesn’t happen again. A sincere apology and equally sincere desire to make things right can strengthen a relationship and restore trust.

Sometimes you can feel unheard during a consultation, or the GP can seem distracted. The GP may sincerely apologise, and explain why. They are human, and can be unwell, exhausted by an untenable workload, or simply recovering from a particularly challenging consultation earlier in the day.

However, if there is a pattern of feeling the GP doesn’t hear you, makes frequent minor errors, or simply doesn’t seem to be providing the sort of professional service you expect, you may lose trust. If you feel uneasy or judged, you may need to step away from that GP.

How to break up with your GP

Good GPs understand a partnership with you is important. If you cannot maintain a relationship with them that is open, honest and safe, it is time to move on.

If your needs have changed, but you still value the GP for their care, you can send a thank you card and explain you have chosen to transfer to another doctor. The practice staff can forward your records to a new practice, for which there may be a small administrative fee.

If there has been a rupture in trust or confidence, and the issue is relatively minor, the practice manager will be able to advise how to make a written complaint to the practice.

If the problem is more serious, and you wish to make a formal complaint about a breach of trust that has implications for patient safety, you can report this to the Australian Health Practitioner Regulation Agency.

If the problem is about the GP practice, you can report it to the relevant health-care ombudsman or commission in your state or territory.

Louise Stone, Professor of General Practice, University of Adelaide

This article is republished from The Conversation under a Creative Commons license. Read the original article.