Maggie McKay (Host): Welcome to Arbor Health and Life podcast. I'm Maggie McKay. With me is Dr. Mark Hansen, Chief Medical Officer and primary care physician at Arbor Health, as we talk about Alzheimer's and dementia. Thank you so much for being here today.

Mark Hansen, MD: Thank you, Maggie. It's a pleasure to be on here.

Host: Well, this is a topic that so many people are interested in and that I always feel like we could learn more about, so I'm excited to learn more from you today. Let's start with, you know, people often use the terms Alzheimer's and dementia interchangeably. What is the difference and how are they related?

Mark Hansen, MD: Yeah, that's a good question. This topic comes up a lot because, as you said, so many people are interested in Alzheimer's and dementia because it's a scary diagnosis. It's a prevalent diagnosis. And in fact, if you're age 45, one in five women can expect to get Alzheimer's in their lifetime, and one in 10 men can. So, it's a significant disease.

We use the term dementia as a broad term. I like to call it brain failure. So, your brain is an organ, just like your liver is, your kidneys are, and when the brain starts to fail and not work as well, globally, we call that dementia. Alzheimer's is a subset of that. But for most cases, it's okay to blur that, because of all the causes of dementia, which could be strokes, it could be alcohol-related dementia. There's a few other rare kinds of dementia. But about 75% of the cases of dementia that we see are Alzheimer's dementia.

Host: And what are the early signs of Alzheimer's and also dementia? How can families or caregivers tell the difference between normal aging, like you said, and something more concerning? Like, you know, a lot of people say, "Oh, I forgot where I put my keys," but that's not what we're talking about, is it?

Mark Hansen, MD: Yeah. I'm glad that you asked that question, because it's a difficult one to sort out sometimes. As we get older, our brains slow down, and we will misplace the car keys more often, we'll forget someone's name a little bit more often. And if we have a family member or acquainted with somebody with Alzheimer's, every time we have one of these episodes, it scares us. And so, I think everybody's always questioning could this be the first sign of it?

It's normal to have the brain slow down. It's normal to have these little moments, we sometimes call them senior moments. Where it becomes more of a concern is sometimes I say, "If you lost the car keys, don't worry about it. If you find the car keys and you don't know what they're for, then you should be worried." So, Alzheimer's and any kind of dementia is more likely diagnosis if those little memory lapses start to interfere with your daily life.

Another way is you might forget what day of the week it is. And later in the day you can remind yourself, or you might forget what you ate for lunch yesterday, and later in the day you'll recall it. With Alzheimer's, you won't recall that. So, you'll have those senior moments, but they never come back to you, or you can even have clues. People can say, "Well, I'll tell you what you ate yesterday. You know, it had gravy on it." And you'll say, "Oh yeah, it was mashed potatoes," or whatever. With Alzheimer's, the clues usually don't help you. So if clues don't even help you recall, that's a time to be more concerned.

Host: So, is it fair to say Alzheimer's is more serious?

Mark Hansen, MD: Yes. It's a sign of a disease rather than just normal aging.

Host: And you mentioned people get worried when maybe someone in their family has Alzheimer's, and then they get forgetful and they think, "Oh, no, is it hereditary?" Is it?

Mark Hansen, MD: There are cases that are hereditary. We found some genes. One gene is called the APOE gene. And if you carry that gene, you have a genetic predisposition to Alzheimer's. If you carry two copies of that gene, your risk is about 10 times that of the normal population. If you carry one copy of the gene, you're about three times the risk.

But what's sort of interesting to me and maybe hopeful, but also a clue that this is more complicated, is you can have the gene and never get Alzheimer's, or you can also not have the gene and you can get Alzheimer's. So, the gene and genetic testing, which is becoming much more prevalent and easier to get is still only a piece of the puzzle. It's not a complete answer to the diagnosis.

Host: Dr. Hansen, who else is most at risk for developing Alzheimer's disease or another form of dementia? Are there ways to reduce that risk?

Mark Hansen, MD: Yeah. This is the part that I like. I like focusing on these things. Just like I said, your brain is an organ just like your liver, your kidneys. So, it starts to make sense on how to reduce the risk of dementia, just the way you take care of your body in general.

The things you do to take care of your liver, your kidneys, any other organ, your heart, in a sense translates to taking care of your brain, and that is eating a healthy diet. A diet that has more green leafy vegetables is especially shown to be protective. Higher vitamin D levels are protective, D as in dog, the sunlight vitamin. And sunlight in small amounts is protective even above and beyond the vitamin D.

So, a lot of people as they age are not out in the sun as much, and you don't want too much sun exposure and risk skin cancer, but little doses are probably healthy. But along with that would be exercise, avoiding obvious toxins, excessive alcohol, anything. Really, it kind of boils down to anything that's unhealthy is going to be unhealthy for your brain.

Host: And who would you say is most at risk for developing Alzheimer's or another form of dementia?

Mark Hansen, MD: People that have the gene are going to be in a higher risk group. And if you have a family history of it, that puts you in a higher risk group. But people who are diabetic, people with sleep apnea, we know that's another risk, obesity, sedentary lifestyle. You'll see there's a theme here. These are all things that put any part of your body at a health risk. It's putting your brain at health risk as well.

Host: What if someone notices memory changes in themselves or a loved one? What should they do? And what does the evaluation process typically involve?

Mark Hansen, MD: So if you see something that is starting to look more significant, like I said earlier, if you're having a memory problem that disrupts your day, you forgot an important appointment or you got lost, or there's something that you know you used to recall or know how to do and you can't do it, those are times to go in and get checked.

Unfortunately, a lot of people aren't aware of that in themselves, and it's a family member or a friend that's noticing that. But if you notice yourself or if you have a family member, that's a good time to go in and see your doctor. Usually in the office, we will do a screening memory test. It's like a little homework quiz with a dot-to-dot and recalling objects. It's a fairly simple thing, but it starts to show if parts of the brain aren't processing things like they should be.

Host: And you mentioned, going in and seeing somebody, but why is it so important to receive an early diagnosis even though currently there is not a cure?

Mark Hansen, MD: Yeah. I'd like to back up on one other thought or one other comment here too. And that is when a doctor first notices or when a doctor is evaluating, we are seeing you in the clinic maybe for a five or 10-minute visit. We see a small snapshot of what your life really is like. And I've seen in the community people who are starting to have more serious problems with their memory, and the doctor, me as a doctor, won't pick that up because you know how to answer the questions appropriately in the office.

And so, I listen to family members. They will notice some subtle personality changes. They'll notice the problem because they live with that person. It is important to come in and get the diagnosis. In some ways, this feels like a helpless disease because the treatments out there, they're evolving quickly, but they still aren't what we would like them to be.

But if you are coming down with Alzheimer's or have family that is, I think it's important, one, to try to optimize your health, reduce things that are ongoing risk factors, such as diabetes or sleep apnea or low vitamin D or things that we can treat. Depression often will make it worse, and we can treat that.

I think planning is helpful, getting a support team. It's important to start looking at advanced directive or living will, planning things out for your life should your brain become more incapacitated. Having the legal things in place for you just smooths the water for your survivors, if nothing else.

This is an evolving science. And so, there's new treatments coming out. So if you have the early diagnosis, you might be eligible to go in clinical trials. There are a few medications that will help the symptoms. There are still a limited number of things that really make a big difference as far as reversing the disease.

Host: So, you mentioned treatments, therapies, and lifestyle changes that could help someone living with Alzheimer's or dementia. And what would you say maybe one of the most common treatments or therapies or lifestyle changes you see in your practice that people are helped by that helps their quality of life?

Mark Hansen, MD: Right. So, there's a handful of drugs, medications that we use like Aricept, Exelon, Namenda. These are sort of band-aid therapy. They help temporarily. So, they may make life at home better and more functional for a while, but the disease keeps progressing. And so, they don't really stop that. So they're of limited use. Again, optimizing your health, controlling your sugars if that's a problem, treating depression, treating thyroid, all these little things. We look for every tool in the toolbox that could help. But each piece in itself, I think, comes together to make an important change.

Socializing is another really important thing. So, a lot of people, they're more isolated as they age and getting them connected, socializing is very stimulating to the brain.

Host: I do believe that is such a key component, because oftentimes you see people who have been kind of shut-ins maybe, I don't know if that's the right term. And then, once they get out with people, their whole mood changes, you know? You can just tell it's helped somewhat. What advice do you have for family members and caregivers who are supporting a loved one with Alzheimer's or dementia?

Mark Hansen, MD: I would say get in and see the doctor, get the resources. The National Alzheimer's site is alz.org. It's a very good resource. It has information. It links you also to support groups. I would look for support groups, because caregivers are burdened a lot by this. They ar taking on more and more.

Sometimes they don't even realize that they're taking over the household chores or the finances, or now they're driving where their spouse used to drive. So, all those burdens get shifted on to the household members. And reaching out for help, I think, is an important thing.

Host: Absolutely agreed. In closing, Doctor, is there anything else you'd like to add?

Mark Hansen, MD: I would just like to say the whole picture of your health helps your brain as well. So, I keep emphasizing it, but exercise, eating right, taking care of your health in general is also going to help your brain.

Host: Well, this has been so informative. Thank you so much for sharing your expertise.

Mark Hansen, MD: Thank you, Maggie.

Host: Again, that's Dr. Mark Hansen. To learn more, please visit myarborhealth.org. And if you found this podcast helpful, please share it on your social channels. Thanks for listening to Arbor Health and Life.