Tony Bennett Discloses Alzheimer’s Disease Dx

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Music legend Tony Bennett, 94, has just broken his silence about a big secret. In an interview for AARP, Bennett revealed that he was diagnosed with Alzheimer’s disease 4 years ago!

Although he’s been able to work over those four years, the toll on his mental faculties has become increasingly noticeable. Although he still recognizes his family members, both his short-term and long-term memory have deteriorated dramatically. Interviewer John Colapinto noted Bennett gazing at his lavishly illustrated book, “Tony Bennett Onstage and in the Studio” (2018). “He stared into its pages not with the air of warm reminiscence but like a man struggling to recall why these images seemed familiar.” His wife, Susan, added that Tony is “not always sure where he is or what is happening around him. Mundane objects as familiar as a fork or a set of house keys can be utterly mysterious to him.”

Between 2018 and early 2020, Bennett recorded a second album of duets with Lady Gaga, a follow-up to the Billboard’s Top 200 pop and rock number one album with Gaga in 2014. Previously known for being a “meticulous and hard-driving perfectionist in the studio,” Tony was much more subdued during the new recording. In raw documentary footage of the recording sessions “he speaks rarely, and when he does his words are halting; at times, he seems lost and bewildered.” In addition, Gaga, who considers Bennett to be “an incredible mentor, and friend, and father figure” is seen breaking down in tears as Tony sings a solo passage of a love song.

The album is due to be released this spring. But although both singers are in superb voice, Bennett will be unable to do promotional interviews. Susan and Bennett’s son Danny (who has also been his business manager for the past 40 years) jointly decided it was time to break the silence about his diagnosis so that as many fans as possible will hear what will most likely be his last record. In addition, they hope the album may signal a more hopeful message. Neurologist Gayatri Devi, MD, who diagnosed Bennett in 2016, points out: “He is doing so many things, at 94, that many people without dementia cannot do. He really is the symbol of hope for someone with a cognitive disorder.”

Alzheimer’s Disease

Alzheimer’s disease (AD) is an age-related, non-reversible brain disorder that develops over a period of years. Initially, people experience memory loss and confusion, which may be mistaken for the kinds of memory changes that are sometimes associated with normal aging. However, the symptoms of AD gradually lead to behavior and personality changes, a decline in cognitive abilities such as decision-making and language skills, and problems recognizing family and friends. AD ultimately leads to a severe loss of mental function. These losses are related to the worsening breakdown of the connections between certain neurons in the brain and their eventual death. AD is one of a group of disorders called dementias that are characterized by cognitive and behavioral problems.

According to the CDC, Alzheimer’s disease is the sixth leading cause of death among U.S. adults (it may actually be the third highest cause of death as its prevalence is underestimated, as noted below) and the fifth leading cause of death among those age 65 and older.

In 2014, an estimated 5.5 million Americans 65 and older had Alzheimer’s disease. This number is projected to nearly triple to 14 million people by 2060.

In 2010, the costs of treating Alzheimer’s disease were estimated at $159 to $215 billion. By 2040, these costs are projected to reach at least $379 billion and could surpass $500 billion annually.

Because the risk of developing Alzheimer’s disease increases with age and more people are living longer, the number of people with this disease is expected to increase significantly in coming decades. Dementia, including Alzheimer’s disease, has been shown to be under-reported in death certificates and therefore the proportion of older people who die from Alzheimer’s may be considerably higher.

Underlying Pathology

There are three major hallmarks in the brain that are associated with the disease processes of AD.

  • Amyloid plaques, which are made up of fragments of a protein called beta-amyloid peptide mixed with a collection of additional proteins, remnants of neurons, and bits and pieces of other nerve cells.
  • Neurofibrillary tangles (NFTs), found inside neurons, are abnormal collections of a protein called tau. Normal tau is required for healthy neurons. However, in AD, tau clumps together. As a result, neurons fail to function normally and eventually die.
  • Loss of connections between neurons responsible for memory and learning. Neurons can’t survive when they lose their connections to other neurons. As neurons die throughout the brain, the affected regions begin to atrophy, or shrink. By the final stage of AD, damage is widespread and brain tissue has shrunk significantly.

10 Warning Signs

1. Memory loss that disrupts daily life: forgetting events, repeating yourself or relying on more aids to help you remember (like sticky notes or reminders).

2. Challenges in planning or solving problems: having trouble paying bills or cooking recipes you have used for years.

3. Difficulty completing familiar tasks at home, at work, or at leisure: having problems with cooking, driving places, using a cell phone, or shopping.

4. Confusion with time or place: having trouble understanding an event that is happening later or losing track of dates.

5. Trouble understanding visual images and spatial relations: having more difficulty with balance or judging distance, tripping over things at home, or spilling or dropping things more often.

6. New problems with words in speaking or writing: having trouble following or joining a conversation or struggling to find a word you are looking for (saying “that thing on your wrist that tells time” instead of “watch”).

7. Misplacing things and losing the ability to retrace steps: placing car keys in the washer or dryer or not being able to retrace steps to find something.

8. Decreased or poor judgment: being a victim of a scam, not managing money well, paying less attention to hygiene, or having trouble taking care of a pet.

9. Withdrawal from work or social activities: not wanting to go to church or other activities as you usually do, not being able to follow football games or keep up with what’s happening.

10. Changes in mood and personality: getting easily upset in common situations or being fearful or suspicious.

Prognosis

In very few families, people develop AD in their 30s, 40s, and 50s. This is known as “early-onset” AD. These individuals have a mutation in one of three different inherited genes (APP or PSEN2) that causes the disease to begin at an earlier age. More than 90% of AD develops in people older than 65. This form of AD is called “late-onset” AD, and its development and pattern of damage in the brain is similar to that of early-onset AD. The course of this disease varies from person to person, as does the rate of decline. In most people with AD, symptoms first appear after age 65.

The causes of late-onset Alzheimer’s disease are less clear. The late-onset form does not clearly run in families, although clusters of cases have been reported in some families. This disorder is probably related to variations in one or more genes in combination with lifestyle and environmental factors. A gene called APOE has been studied extensively as a risk factor for the disease. In particular, a variant of this gene called the e4 allele seems to increase an individual’s risk for developing late-onset Alzheimer’s disease.

Treatment

Currently, there are no medicines that can slow the progression of AD. However, four FDA-approved medications are used to treat AD symptoms. These drugs work by regulating neurotransmitters that transmit messages between neurons. The drugs help individuals carry out the activities of daily living by maintaining thinking, memory, or speaking skills. They can also help with some of the behavioral and personality changes associated with AD. However, they will not stop or reverse AD and appear to help individuals for only a few months to a few years. Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) are prescribed to treat mild to moderate AD symptoms. Donepezil is also approved to treat severe AD as well. Another AD medication is memantine (Namenda), which is indicated for moderate to severe AD symptoms.

Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.

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