Q&A: Linking gait and sleeping with Alzheimer's

Subtle changes in gait and sleeping patterns in older people may be linked to Alzheimer's disease, according to research out today at the Alzheimer's Association International Conference 2012 in Vancouver, Canada. USA TODAY talked to Bill Thies, chief scientific and medical officer for the Alzheimer's Association, about these changes and other warning signs of the disease. Alzheimer's affects 5.4 million people in the USA, numbers that are expected to soar to 16 million by 2050 as Baby Boomers age. The disease is the second most feared, behind cancer.

Q: What are some of the characteristics of how gait might change?

A: Walking becomes slower or more variable. The research presented at the meeting is robust. These links have been suggested before, but this is the first science to support it. In several of the studies, gait changes were noted before cognition changes. One of the studies showed there was no link between walking and memory, but there is a link between walking pace and variability and executive function (a set of mental processes).

Q: If the changes are linked to Alzheimer's disease, what is occurring in the brain to cause the problem?

A: Walking relies on the perfect integration of several areas of the brain. The disease interferes with the communication between different regions of the brain.

Q: How do you know if changes aren't caused by another disease such as Parkinson's or arthritis?

A: That isn't an easy answer, but the current studies ruled out those diseases or found that people who had early stages of Alzheimer's might also have arthritis in a hip or knee as well, or other problems. The important message is to seek a professional's advice if you notice a change in gait. There are a lot of things that are early signs that aren't always diagnostic of Alzheimer's disease but should encourage you to want to get a complete evaluation from a professional.

Q: Can an untrained family member see the changes in gait or is a specialist required to detect it?

A: The changes might be very hard for a loved one to pick up, but even if you suspect a change, then find out what the underlying cause is by going to a specialist.

Q: What effect does sleep have on changes in the brain associated with Alzheimer's?

A: Researchers reported on Monday that cognitive health declines over the long term in some people with sleep problems. A large study done at Brigham and Women's Hospital in Boston, of 15,000 participants ages 70 and older, reported important findings. Sleep duration shorter or longer than the recommended seven hours might have an effect on cognition in older individuals. It's still not clear if sleep change is one of the risk factors or an early sign.

Q: What else did the study note about sleep and cognition problems?

A: Participants who slept five hours or less had lower average cognition than those who slept seven hours a day. Those who slept nine hours a day or more had lower average cognition than those who slept seven hours per day. And too little or too much sleep was cognitively equivalent to aging two years.

Q: What is one of the most common early warning signs of Alzheimer's disease?

A: Loss of interest is an early sign of the disease. I hear it over and over. People will say their husband or wife did something all the time and then over the period of a few months they didn't do it anymore. There could be a number of reasons why they stop doing something they love. But that change in interest and personality should move you toward getting a diagnosis.

Q: If a loved one stops doing something he or she loves, does that mean they have Alzheimer's?

A: Not necessarily. Depression could be another reason, but it is important to find out why they've stopped doing something and take the necessary steps to get them tested. This can happen years before they become demented.

Q: Can you be more specific about some of the things people will stop doing?

A: Very often, there's one person in the household who pays the bills. If you see them struggling to manage the finances, it is time to get a diagnosis. Following recipes and cooking might also be difficult for someone in the early stages of the disease.

Q: How do I find a doctor that can diagnose Alzheimer's?

A: The more practice a doctor has with Alzheimer's, the better he is going to be at diagnosing. Ask the doctor if he is comfortable making a diagnosis. And if he's not, ask him to recommend someone who can do it. It pays to have an early diagnosis.

States Pushing Medicaid Ruling to Cut Rolls Immediately

It’s true that states could, after 2014, reduce their Medicaid rolls without the potential consequences of losing their entire federal share of funding. But some states aren’t waiting until 2014.

The court, which upheld most of the law, struck down penalties for states choosing not to expand Medicaid. A few states are also trying to go farther, arguing that the ruling justifies cuts to their existing programs.

Within hours of the Supreme Court’s ruling on June 28, lawyers in the Maine attorney general’s office began preparing a legal argument to allow health officials to strike more than 20,000 Medicaid recipients from the state’s rolls�including 19- and 20-year-olds�beginning in October to save $10 million by next July.

“We think we’re on solid legal ground,” Attorney General William Schneider said in an interview. “We’re going to reduce eligibility back to the base levels in a couple of areas,” he said. Maine, like some other states eyeing cuts, earlier expanded its Medicaid program beyond national requirements.

Other states, including Wisconsin and Alabama, are expected to follow Maine’s lead, though there is disagreement over whether the high court gave the states such leeway. That could lead to battles between states and the federal government that could drag the health law back to the courts. New Jersey and Indiana also said they were evaluating the decision and did not rule out challenging the requirements.

This looks to me like an expansion of what the Court actually said. The Court’s ruling specifically regarded tying the Medicaid expansion to the initial program funding as unconstitutional. If the cuts contemplated now started before the expansion, that seems to fall under the same maintenance of effort rules that remain in place until 2014. This will take further litigation and a new ruling to figure out.

But it does show that states view the Medicaid program as something to raid, not something to nurture. They want to push the limits of the ruling to make as many cuts as possible. So suggestions that red state governors will not be able to pass up a “good deal” like the Medicaid expansion doesn’t match with this reality.

Meanwhile, given these statistics out of Texas, it’s not clear whether an expansion will really result in an expansion.

The number of Texas doctors willing to accept government-funded health insurance plans for the poor and the elderly is dropping dramatically amid complaints about low pay and red tape, showed a survey by the Texas Medical Association provided to The Associated Press on Sunday before its Monday release.

Only 31 percent of Texas doctors said they were accepting new patients who rely on Medicaid, the health insurance program for the poor and disabled. In 2010, the last time the survey was taken, 42 percent of doctors accepted new Medicaid patients. In 2000, that number was 67 percent.

Texas doesn’t have enough primary-care doctors to serve the size of the state or its rapid population growth. The doctors’ reluctance to take on new Medicaid patients comes at a bad time, since the new federal health care law proposes adding 6 million additional people to the Texas Medicaid rolls with the intent of ensuring every U.S. citizen has access to health insurance. The state ranks last in the nation in terms of percentage of people insured, with 27 percent of Texans without any kind of insurance, according to a March Gallup poll.

Obviously, having health insurance coverage that 31% of doctors will honor is better than having no coverage at all. But geographic distribution matters here. Texas is a big place, and a low-income resident, on the off chance that the state expands its Medicaid coverage, may not be able to find a doctor for many miles. The primary-care doctor problem is central to this debate. States predisposed to reject the expansion will justify it by saying they don’t have the resources to accommodate all these new eligible patients on the Medicaid rolls.