Alzheimer's triggered/sped-up by prednisolone?

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syd_away
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Alzheimer's triggered/sped-up by prednisolone?

Post by syd_away »

Hello and thank you for having me :-) I am a 55-year-old 3/4 female living in the UK. I assume the "4" bit comes from my mother - sadly she is in a care home in a mid-late stage of Alzheimer's decline, and her mother was also affected (strangely, both her older siblings, in their 90s, are fine).

I was wondering if I could start by asking if anyone could help make sense of the following? My mother was functioning normally until the age of 81 (about 2014), when she was diagnosed with painful polymyalgia rheumatica, and prescribed steroid medication which I think was prednisolone. Almost immediately her short-term memory was shot. The change was so quick and dramatic we all assumed it was the side-effects, and if we could taper her off the drug she would go back to normal. Well her PR did clear up and she was tapered off it, but unfortunately her cognition never improved. Soon afterwards she was diagnosed with Alzheimer's after a scan showing temporal lobe atrophy, and since then the classic pattern of decline.

I've since spoken to the family GP who said something like "steroids don't cause dementia, but the can bring out dementia that's already there". I'm not totally sure what this means. Mum was showing some signs of very mild cognitive decline for about a year previous to these events, but really very mild - just a slight slowing in her ability to absorb new information (ie. you might have to repeat something before she "got" it). And then she starts the steroids and wham, about 5 years of decline happen overnight.

I've tried googling this, and the results seem to suggest the cognitive effects of prednisolone are reversible. I did find this one interesting abstract for a very old paper from an obscure journal, on rats: https://pubmed.ncbi.nlm.nih.gov/3842382/

I expect like many here I've been leaping down various rabbit-holes trying to work out the cause of Alzheimer's, latching on to (and abandoning) various theories. Not sure if the above experience could shed any light?

Thanks in advance for any insight, and sorry for the long post!
SBee
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Re: Alzheimer's triggered/sped-up by prednisolone?

Post by SBee »

syd_away wrote:Hello and thank you for having me :-) I am a 55-year-old 3/4 female living in the UK. I assume the "4" bit comes from my mother - sadly she is in a care home in a mid-late stage of Alzheimer's decline, and her mother was also affected (strangely, both her older siblings, in their 90s, are fine).

I was wondering if I could start by asking if anyone could help make sense of the following? My mother was functioning normally until the age of 81 (about 2014), when she was diagnosed with painful polymyalgia rheumatica, and prescribed steroid medication which I think was prednisolone. Almost immediately her short-term memory was shot. The change was so quick and dramatic we all assumed it was the side-effects, and if we could taper her off the drug she would go back to normal. Well her PR did clear up and she was tapered off it, but unfortunately her cognition never improved. Soon afterwards she was diagnosed with Alzheimer's after a scan showing temporal lobe atrophy, and since then the classic pattern of decline.

I've since spoken to the family GP who said something like "steroids don't cause dementia, but the can bring out dementia that's already there". I'm not totally sure what this means. Mum was showing some signs of very mild cognitive decline for about a year previous to these events, but really very mild - just a slight slowing in her ability to absorb new information (ie. you might have to repeat something before she "got" it). And then she starts the steroids and wham, about 5 years of decline happen overnight.

I've tried googling this, and the results seem to suggest the cognitive effects of prednisolone are reversible. I did find this one interesting abstract for a very old paper from an obscure journal, on rats: https://pubmed.ncbi.nlm.nih.gov/3842382/

I expect like many here I've been leaping down various rabbit-holes trying to work out the cause of Alzheimer's, latching on to (and abandoning) various theories. Not sure if the above experience could shed any light?

Thanks in advance for any insight, and sorry for the long post!
Hello syd_away and a warm welcome to the community!
I am truly sorry to hear about your mother and the pain she has endured with polymyalgia rheumatica as well as her diagnosis of Alzheimers. Your determination to understand the potential links between your mum's medication and the cognitive effects she has experienced is admirable...I think we all try to seek answers and try to put forth a sense of optimism when faced with situations like this. So, please know you are supported here in this community and not alone!

I did a quick search in the wiki for prednisolone and found a reference to prednisone and its impact on blood sugar. While I do not have a specific answer to your question, other members may have some background/expertise who can better speak to your inquiry.

In addition, I can direct you to some other site tools/resources that may be of interest:

The Primer is a detailed and informative resource written by a practicing M.D. with ApoE4/4. It includes information about the biochemistry of the ApoE4 gene and offers a variety of research-based prevention strategies.

The How-To Guide offers tips on how to navigate forums and respond to posts including how to quote members (use the quotation icon in the upper right of any post) so they get an email notification of your post. It also demonstrates how to use the Search function for topics, and how to subscribe to topics of interest in the forums.

Finally, Our Stories posts stories of other community members including those who may be facing similar challenges as your own. It is encouraging to know that you are not alone and that others can empathize and even inspire you to find strength during your difficult moments! This community is truly supportive and caring of its members, and we hope you will find comfort in knowing this.

I hope you find these tools useful as you begin to explore the site. Please feel free to reach out if you need additional support!
Take care and be well.

Warmly,
Sue
SBee
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circular
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Re: Alzheimer's triggered/sped-up by prednisolone?

Post by circular »

syd_away wrote:Hello and thank you for having me :-) I am a 55-year-old 3/4 female living in the UK. I assume the "4" bit comes from my mother - sadly she is in a care home in a mid-late stage of Alzheimer's decline, and her mother was also affected (strangely, both her older siblings, in their 90s, are fine).

I was wondering if I could start by asking if anyone could help make sense of the following? My mother was functioning normally until the age of 81 (about 2014), when she was diagnosed with painful polymyalgia rheumatica, and prescribed steroid medication which I think was prednisolone...
The first thing I'd like to offer is a caution against assuming that the parent with AD is the one who delivered a 4 to a 3/4 child, especially in the absence of genetic results of the father. There was recent AD in three members of my family on one side and one member two generations back on the other side. So I had made the assumption that as a 3/4 I inherited the 4 from the side with more AD and more recent AD. But it turned out the parent without the strong family hx of AD had one copy of 4, not the one with the strong family hx of AD. AD genetics are extremely complex. I now hypothesize that there's some other genetic smoking gun on the vulnerable side of the family and perhaps sufficient protective genes on the other, but maybe that's not even correct.

Next up, my mother went on chronic steroid administration and I'd never wondered whether they had contributed to her cognitive decline. However, there were many scenarios when the dosage had to be increased and she became very confident and more energetic than on normal days at maintenance doses. I'm guessing that when the doctor said that cognitive decline can become more apparent on steroids, it could have to do with the confidence and energy steroids are known to induce leading to more self expression and thus others get more exposure to the cognitive aberrations that were already there. That's just my speculation du jour.
ApoE 3/4 > Thanks in advance for any responses made to my posts.
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SusanJ
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Re: Alzheimer's triggered/sped-up by prednisolone?

Post by SusanJ »

syd_away wrote:Soon afterwards she was diagnosed with Alzheimer's after a scan showing temporal lobe atrophy, and since then the classic pattern of decline.
Sorry you are seeing such an alarming, drastic decline.

Try searching on "steroid dementia", because prednisolone is a steroid. Here's a link to what PubMed has on the topic:

https://pubmed.ncbi.nlm.nih.gov/?term=% ... ementia%22
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Re: Alzheimer's triggered/sped-up by prednisolone?

Post by NF52 »

syd_away wrote:...
I was wondering if I could start by asking if anyone could help make sense of the following? My mother was functioning normally until the age of 81 (about 2014), when she was diagnosed with painful polymyalgia rheumatica, and prescribed steroid medication which I think was prednisolone. Almost immediately her short-term memory was shot. The change was so quick and dramatic we all assumed it was the side-effects, and if we could taper her off the drug she would go back to normal. Well her PR did clear up and she was tapered off it, but unfortunately her cognition never improved. Soon afterwards she was diagnosed with Alzheimer's after a scan showing temporal lobe atrophy, and since then the classic pattern of decline....
A belated welcome, syd_away,

You and your poor mum have been in my thoughts for the last several days, since my mother had a very similar experience at age 80 after hospitalization for a bacterial infection called campylobacter. The sudden change after an already scary health crisis is deeply upsetting--and I can understand why seven years later you still need answers. I think your mum's GP was giving you a correct, if brief, answer, so did some digging for more. I've been fortunate to have some access to the work of lots of smart researchers while serving on some advisory boards and as a Consumer Reviewer for Alzheimer's grant applications. Two big take-aways I've learned are:

1. People over the age of 80 who are diagnosed with Alzheimer's based on changes in memory and thinking skills (and MRI results in some cases like your mother's) almost always have other diseases or issues in the background, like high blood pressure, vascular changes in the brain and heart disease, which reduces blood flow to crucial areas of the brain and can lead to loss of brain neurons.
2. Brain inflammation ("neuroinflammation") is like adding fuel to a forest floor that has been in a drought: The forest looked okay until the fuel started a raging fire. More and more researchers are studying what triggers inflammation in the brain and how it affects signals between cells that are essential for learning and memory.

Our mothers were both doing a great job managing the amyloid plaques and tau tangles that slowly accumulate in people with Alzheimer's disease for 15-20 years before any signs of cognitive impairment, causing the subtle changes you saw in her 70's. She may have been an amazing example of brain "resilience" until her immune system was attacked by polymyalgia rheumatica (PMR).
(Immune systems of those over 80 also appear to have less immune response to fight off COVID-19, the flu and other diseases.) The prednisone would have been used to treat the system-wide inflammation she was experiencing, since it is an anti-inflammatory steroid. I am guessing that it was simply not able to stop the "wildfire" in time to prevent her rapid change.

Rudolph Tanzi, PhD, director of the Genetics and Aging Research Unit at Mass General Hospital in Boston and a leading Alzheimer's researcher for decades, was quoted in a 2018 article explaining how inflammation causes the death of brain cells, which leads to the brain atrophy seen on your mother's MRI): “
Studies have shown that we can have many plaques and tangles in our brains with no symptoms, but when neuroinflammation kicks in, exponentially more neurons die and cognitive impairment leading to dementia is induced
. Alzheimer's Plus Neuroinflammation in a Dish

I hope it helps to know that it seems very unlikely that your mother's prednisone caused her dementia. Like my mother, it may have actually saved her life, but at a high cost. I am sure she would want you to know that you have made the years since 2014 so much easier with your love and caring.

Hugs from across the pond.
4/4 and still an optimist!
syd_away
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Re: Alzheimer's triggered/sped-up by prednisolone?

Post by syd_away »

Thank you all for your kind replies! Sorry it's taken me a while to respond (in the throws of job interviews which is slightly stressful, taking all my attention). These events I described happened a few years ago and mum is no longer in pain, and seems happy enough in her own world.

@circular, point taken about the genetics. Also I have observed the effect of steroids on my dad who had to take them during anti-cancer treatment - yes he went a bit doolally for a while, suddenly a bit crazy and full of energy, and then not able to think straight. But it reversed when he stopped taking them.

I'd been wondering if stress was a factor - and if prednisolone mimics stress hormones at all. But @NF52, the inflamation explanation makes a lot of sense. Perhaps early Alzheimer's pathology + inflamation, and then adding a load (natural or artificial) stress hormones into the mix as well, really does for someone who is pre-disposed. In my current job search, I think I will pick the job that looks live having the least amount of stress!
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