ASPEN It isnt noticeable at first. It starts with changes for which the brain can compensate, meaning no real impact on day-to-day functions or cognition.

But as time passes, the brain can no longer compensate for the damage its experiencing. Subtle problems with memory and thinking begin to pop up. Subtle turns to noticeable. Noticeable turns to difficulty carrying out everyday activities. Eventually, around-the-clock care is required.

This is the broad view progression from preclinical to severe Alzheimers disease, a degenerative brain disease that becomes worse with time and age, and is the most common cause of dementia, according to the Alzheimers Association.

In Colorado, an estimated 76,000 people are living with Alzheimers dementia, and that number is expected to increase 21% to 92,000 by 2025, a 2020 Alzheimers Association report states. As of July 2019, 14.6% of Coloradans, or about 840,000 people, were 65 or older, U.S. Census Bureau data shows.

While its been shown that living in higher elevation communities can lead to a more active, healthier lifestyle and even prolonged life, its less clear how living at high elevation correlates with degenerative brain diseases.

In short, the answer is complicated and not well researched.

As far as I know, there isnt a lot of evidence one way or another about high altitudes versus low altitudes for Alzheimers disease risk, said Dr. Huntington Potter, director of the Alzheimers and Cognition Center at the University of Colorado Anschutz Medical Campus. We cant say one way or another whether high altitude is a risk factor for Alzheimers.

At the Alzheimers and Cognition Center, which is part of the CU Anschutz Medical Campus and School of Medicine, clinicians and researchers are dedicated to discovering effective early diagnostics, preventions, treatments and ultimately cures for Alzheimers disease and related neurodegenerative disorders, according to its website.

For Potter, that means looking at biomarkers or diagnostic proteins in the blood that can help clinicians predict the disease earlier, conducting projects that look at the lifespan of people with Alzheimers disease, and other research that can quickly be translated to better care, treatment and hopefully a cure.

Right now, the center is studying a drug called Leukine, which preliminary data shows might improve Alzheimers disease in the short term, Potter explained. The center also is studying other drugs that attack the disease.

Leukine may be the first one we found that looks promising, but we have several coming up that look promising, as well, Potter said.

When it comes to looking at the potential correlation between living at high elevation and the risk for dementia-inducing diseases, Potter and Dr. Peter Pressman of the Alzheimers and Cognition Center said it would take great effort, time and funding to research.

Assistant professor for the Department of Neurology, Dr. Peter S. Pressman works in his office at the University of Colorados Anschutz Medical Campus in Aurora on Thursday, Sept. 10. Photo by Liz Copan / Studio Copan

Assistant professor for the Department of Neurology, Dr. Peter S. Pressman is pictured outside his office building at the University of Colorados Anschutz Medical Campus in Aurora on Thursday, Sept. 10.Photo by Liz Copan / Studio Copan

Assistant professor for the Department of Neurology, Dr. Peter S. Pressman works in his office at the University of Colorados Anschutz Medical Campus in Aurora on Thursday, Sept. 10. Photo by Liz Copan / Studio Copan

Assistant professor for the Department of Neurology, Dr. Peter S. Pressman works in his office at the University of Colorados Anschutz Medical Campus in Aurora on Thursday, Sept. 10. Photo by Liz Copan / Studio Copan

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Pressman, who is a behavioral neurologist and researcher with the center, said on top of securing and carefully selecting a large group of people living at elevation to participate in a study, researchers also would have to follow that group for about a decade to get meaningful results.

Its easy to fund a study for a few years, Pressman said. People give you money to do something for two to three years, but two to three years is not enough time for a process as slow as Alzheimers and dementia to really even pick up. Im not saying thats not possible. Its doable, but it would take some effort.

Dr. Brooke Allen, neurologist, founder of Roaring Fork Neurology in Basalt and medical director at Renew Roaring Fork, an assisted living and memory care center in Glenwood Springs, expressed similar thoughts.

As a part of any mild cognitive impairment or dementia evaluation, Allen said her team checks the oxygen level a patient has and considers the elevation at which that person spends most of their time.

Lower oxygen levels can contribute to people experiencing confusion, dizziness and mild short-term memory issues. But outside of looking at oxygen levels and how they could be contributing to symptoms, Allen said she doesnt consider elevation a higher risk situation.

Allen said she feels High Country residents 65 and older tend to be much younger than their age in terms of their lifestyle, which is a positive in terms of dementia prevention.

About four years ago, Allen and her team conducted a long-term preclinical Alzheimers trial as part of the Alzheimers Prevention Initiatives Generation Program, a study that looked at the effectiveness of preventative treatments for individuals between 65 and 75 who had no symptoms of dementia.

Allen said more than 250 people came in to participate in the study and all generally led healthy, active lifestyles.

I think in our valley, Ive experienced meeting those kinds of people and not thinking of altitude as a risk factor but as a lifestyle opportunity in a rural area like ours, Allen said about the people who participated in the study.

Looking at the potential correlation between living at high elevation and risk of degenerative brain diseases is not just a difficult feat for Colorado researchers. Little research with concrete findings exists nationally or globally.

One study published in 2015 by Dr. Stephen Thielke in JAMA Psychiatry looked at deaths attributed to Alzheimers dementia reported in 58 counties in California to try to determine whether rates of dementia were associated with average elevation of residence. The study found that the counties at higher elevation generally had lower rates of dementia mortality.

Additional work is needed to determine whether this relationship holds in other populations, the study notes.

But beyond this study, there isnt much conclusive evidence for or against a correlation, as emphasized by Dr. Brent Kious, a psychiatrist, assistant professor and researcher with University of Utah Health and the schools Department of Psychiatry.

Kious has studied the link between living at high elevations and major depressive disorder, anxiety and suicide, and he said he and his research team have been interested in the impact of elevation on the incidence and median age of onset of Parkinsons disease.

However, Kious said decrements in cognitive performance due to chronic exposure to moderately high elevation might not necessarily translate into an increased risk of dementia.

It is not clear whether altitude would affect those neurodegenerative processes or not, though there is some reason to think that they involve oxidative damage so relative hypoxia might slow them, Kious wrote in an email. He went on to note that relative and prolonged hypoxia, or a lack of oxygen, has been associated with dementia risk. In any case, a good epidemiological study of the association between altitude and dementia should control for things that might be associated with both.

Karen Eck, 60, of Silverthorne, picks tomatoes at the Timberline Adult Day Program garden in Frisco on Thursday, Sept. 10. Eck, who was diagnosed with early onset Alzheimers, attends programs three to four times a week at the center.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, waters tomatoes at the Timberline Adult Day Program garden in Frisco on Thursday, Sept. 10. Eck, who was diagnosed with early onset Alzheimers, attends programs three to four times a week at the center.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, poses for a portrait at the Timberline Adult Day Program garden in Frisco on Thursday, Sept. 10. Eck, who was diagnosed with early onset Alzheimers, attends programs three to four times a week at the center.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, enters the Timberline Adult Day Program in Frisco on Thursday, Sept. 10. Eck has early onset Alzheimers.Photo by Jason Connolly / Jason Connolly Photography

Karen Eck, 60, of Silverthorne, leaves the Timberline Adult Day Program garden in Frisco after watering tomatoes on Thursday, Sept. 10. Jason ConnollyPhoto by Jason Connolly / Jason Connolly Photography

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While theres not good data for or against high elevation as a risk factor for degenerative brain diseases, there is evidence that people living in more rural communities do not have the same access to dementia care and treatment as those living in urban areas.

According to the 2020 Snapshot of Rural Health in Colorado, produced by the Colorado Rural Health Center, 721,500 people are living in rural Colorado and 19% of the rural population is age 65 or older. Rural is defined as a nonmetropolitan county with no cities over 50,000 residents.

Chad Federwitz a gerontologist, or specialist in the study of aging, and manager of Pitkin County senior services said he hasnt seen any correlation between living at high elevation and dementia risk. Anecdotally, he does know that people move to Grand Junction or the Front Range if they have dementia because of a lack of care resources in the High Country.

Given the nature of our rural-ish community, we dont have the same resources, Federwitz said, referring to things like long-term assisted living and memory care options. You can go to Grand Junction or the Front Range and have pages and pages of resources as opposed to here.

While there are some dementia care resources in more rural Colorado communities, the Alzheimers and Cognition Center is working to do more to develop meaningful relationships with health care providers and dementia patients in the states mountain communities as part of its mission.

According to Pressman, who is heading this charge on behalf of the CU center, a lot of projects are in the planning stages but include virtually educating medical providers, nurse practitioners and primary care doctors on Alzheimers and general healthy brain aging as well as mutual, participatory research with rural Colorado communities and communities of color.

Pressman explained that a lot of research related to Alzheimers overwhelmingly is based on middle-class, well-educated, white participants. And so while researchers think they know a lot about the disease in general, they really only know about the disease related to this demographic group.

Through the centers outreach and efforts to better connect with underrepresented communities, Pressman hopes to conduct better science and better serve the larger Colorado community.

What motivates me is trying to do good work, trying to do good science and to make sure our results actually represent real life, Pressman said. We want to make sure were helping everybody, not just a niche group, and that our services are available equitably to as many people as possible.

Editors note: This is Part 2 of a four-part series on longevity in the High Country. The series is being produced in partnership with The Aspen Times, Glenwood Springs Post Independent, Steamboat Pilot & Today and Vail Daily. Read more at SummitDaily.com/longevity.

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The aging brain: Exploring the connection between neurology and elevation - Summit Daily News