Caitlin Whyte (Host): Welcome to Hally Healthcast, the wellness podcast from Hally Health, your partner in helping you live your healthiest life. Every episode on our podcast addresses a new topic important to your health and well-being, bringing in expert doctors, specialists, and other health experts who offer advice and answer your most pressing questions.

Today's episode is all about Alzheimer's disease. June is Alzheimer's and Brain Awareness Month, so it's the perfect time to learn more about this major health concern. Here with us is Dr. Daniel Llano. He's a neurologist at Carle Foundation Hospital in Urbana.

Welcome, Dr. Llano, and thank you so much for being with us today and sharing your knowledge. Let's begin with a better understanding about our topic. Unfortunately, many of us are already familiar with this condition through personal experience or family members who have been diagnosed with the disease, as more than 55 million people worldwide are living with Alzheimer's or dementia. We know that dementia is an umbrella term that covers many different kinds of cognitive decline, including Alzheimer's disease, and that it takes a heavy toll on lives and families. But what exactly is Alzheimer's, Dr. Llano? And why is it that we hear so much more about it than other forms of dementia?

Dr. Daniel Llano: So, Alzheimer's Disease is the most common form of dementia. The term dementia refers to the general process of loss of cognitive function that can occur in individuals. And by cognitive function, what I mean is one of the brain's thinking functions like language, memory, attention, spatial function, those kinds of things. And when somebody has lost those functions to the point at which they cannot do all of their own daily activities independently, then at that point, we say that they are suffering from a dementia. But dementia is a general term. Lots of things can cause dementia. Stroke can cause dementia. Trauma can cause dementia. But by far, the most common cause is Alzheimer's disease.

Now, Alzheimer's disease is characterized by a certain type of pathology in the brain, which we can only be 100% sure about once a patient has passed away and there's been an autopsy to look at the brain. And what we find in the brain in patients with Alzheimer's disease is that there are small deposits of proteins that aren't supposed to be there. Those proteins are called amyloid beta and something else called tau, sometimes called phospho-tau. These are proteins that deposit in the brain of Alzheimer's disease. We don't understand exactly where they come from, or why they deposit, or if even they're the cause of Alzheimer's disease, but they deposit in the brain, and associated with those deposits is the loss of connections between brain cells, and that's what is important for our cognition, so people who have lost those connections have worsening memory abilities and often more general thinking abilities.

Host: Well, thank you, Dr. Llano. That was a marvelously thorough explanation. Well, if Alzheimer's disease isn't the only form of dementia, what others should we be aware of? For example, we've heard something called FTD mentioned in pharmaceutical commercials. What is that?

Dr. Daniel Llano: Right. So, there are multiple other forms of dementia, as you mentioned. Frontotemporal dementia is a different type of dementia that affects a different part of the brain than Alzheimer's. Alzheimer's disease primarily affects the part of our brain that's important for memory. That part of the brain is known as the hippocampus. It's found deep in the brain in what's called the temporal lobe.

In frontotemporal dementia, as the name implies, it's the frontal parts of the brain, what's called the frontal lobe, and the frontal parts of the temporal lobe that are affected by that illness. And those parts of the brain are very important for regulating our behavior, our judgment, and our decision-making. So, patients who have frontotemporal dementia tend to have a unique profile. They tend to not have the significant memory loss, at least not early on, that patients with Alzheimer's disease have. What they mostly have are changes in their behavior and these can be very subtle and very difficult to distinguish between something else that could look like an early FTD, like depression or anxiety. And in fact, many of these patients, because they're just having some changes in their behavior, it's sometimes written off as just aging, you know, just person is getting crankier or more irritable just because they're older, or maybe they're taken to their primary doctor and the thought is, well, maybe this is something like depression or anxiety. And they start using medications for that rather than recognizing this as a degenerative disorder.

Host: Thank you for that illuminating answer, Dr. Llano. It reminds me that I've heard of another type of dementia that also goes by an acronym. Sadly, it's DLB, or dementia with Lewy bodies, the disease that the late actor and comedian Robin Williams was diagnosed with before dying by suicide about ten years ago. Can you tell us something about DLB, doctor?

Dr. Daniel Llano: So, dementia with Lewy bodies, or DLB, is another form of dementia that in some ways sits somewhere in between Alzheimer's disease and Parkinson's disease. The reason I say that is because they have shared pathologies and shared clinical symptoms. So, in terms of the, clinical symptoms, in dementia with Lewy bodies, patients will suffer from memory difficulties, similar to what's seen in Alzheimer's disease. And they also can suffer from motor difficulties, meaning stiffness in their arms and legs, tremors. They look a lot like Parkinson's disease patients, because of these movement difficulties. And in fact, if you look into the brains of people who have dementia with Lewy bodies, you find similar pathology to what you find both in Alzheimer's disease and Parkinson's disease.

In Alzheimer's disease, we talked earlier about amyloid beta plaques and phospho-tau tangles. So, you do find deposits of amyloid beta in the brains of patients with dementia with Lewy bodies. And you find something called Lewy bodies, which are full of something called alpha synuclein, which are also found in Parkinson's disease. It's not correct to say that these patients have both Alzheimer's disease and Parkinson's disease. But it is, I think, a reasonable starting point to recognize that there's an overlap between the symptoms in those two disorders.

In addition, patients with dementia with Lewy bodies tend to suffer from other sometimes very troublesome symptoms. One of which is visual hallucinations. People will often have very vivid hallucinations. They may report that there are small animals running around their bedroom at night, and they can often describe to you in great detail what these animals look like. They may also have changes in their, what are called, autonomic symptoms, meaning blood pressure and heart rate. So, they can have blood pressure drops and blood pressure elevations. It can be very, very tricky to manage those blood pressure changes. And those blood pressure changes can be so severe that patients can even lose consciousness from them.

Then finally, patients with dementia with Lewy bodies will often have abnormal sleep. Sometimes what they'll do is while they're sleeping, they may move around a lot to the point that they may kick and punch their bed partner, oftentimes breaking furniture, you know, on the end table and their bed partner won't sleep in the same bed with them because they move around a lot so much.

So, this constellation of symptoms, memory loss, the difficulty with movement, the visual hallucinations, the blood pressure, autonomic changes, and these nighttime movements often come together in this diagnosis of dementia with Lewy bodies.

Host: Wow. Well, thank you for that, doctor. I never realized there were so many different types of dementia. Now, we've already learned about Alzheimer's disease and that being the most common type, but what's next? What's the second most common form of dementia and what about it should we be aware of?

Dr. Daniel Llano: Well, there's a little bit of controversy about that. It's a little hard to count these dementias sometimes because there's often overlap. When patients come to autopsy in large clinical series, they sometimes are found to have more than one pathology in their brain. But the most common copathology that we find in the brain of patients with dementia would be vascular disease. And when we think that the vascular disease is responsible for someone's dementia, then we call it sometimes vascular dementia, although more commonly nowadays, we call it vascular cognitive impairment.

So, these are patients who will sometimes have strokes, strokes that are distinct, they're seen on imaging, and maybe they cause somebody to have symptoms like weakness or numbness on one side of their body that also cause them to have cognitive changes. But more often, these are strokes that are seen on imaging that the patient never knew that they had. This is a very common phenomenon where somebody will come to see me because they've had some cognitive issues. We'll send them to get formal neuropsychological testing that sometimes points to a potential vascular cause. Then, we'll get an MRI of the brain. MRIs of the brain, you might know, are extremely powerful tools. They're very sensitive. They can pick up very minute pathology. And sometimes we'll take a look at the MRI and we'll see that a patient has had multiple small strokes in the past and never knew it, didn't have any symptoms that caused them to come to the hospital. But when we look at their scan, we see that all the little areas that connect up the front to the back of the brain, the left to the right side of the brain, they all have these little spots on them, for lack of a better word, little areas that have been damaged and that can cause a dementia as well.

Host: Very intriguing. Thank you, Dr. Llano. So, getting back to the theme of this month and this podcast, what does greater awareness of Alzheimer's disease and these other kinds of dementias that we've been discussing mean to each of our listeners today? Are there preventative measures we can take or screening tests available for these conditions? And does early detection of these conditions really make any difference?

Dr. Daniel Llano: So, yes to both. In terms of things that we can do to help prevent these illnesses from worsening, we don't yet have clear cut medication interventions that we know can slow the progress of these illnesses. We're making progress with Alzheimer's disease. There is a new medication, a monoclonal antibody against amyloid beta that there are high hopes may be a drug that will slow the illness down.

But what we do know is that, by far, the most powerful predictor of someone's worsening of their dementia, a group of predictors that is, are lifestyle factors. So, things like diet, exercise, sleep, these are all extremely important factors when it comes to protecting our brain. And then, managing the very common comorbidities that often come along with dementia, so things like high blood pressure, diabetes, high cholesterol, maintaining tight control of all of those can also protect our brains. So, the real value in early detection is often being able to really put forth extra efforts to try to ensure that all of these highly treatable risk factors are addressed.

Host: Thank you for that valuable information, Dr. Llano. One final question relating once more to this month's theme, that of Alzheimer's and brain awareness. Doctor, it's interesting that this month's theme promotes greater awareness not only of Alzheimer's disease and other forms of dementia, but also of our own brain and its health. How do you respond to that? What one main message about Alzheimer's and brain awareness would you want everyone out there to be aware of?

Dr. Daniel Llano: Well, this part's easy. By far, the most important thing that any of us can do to support our brain function is to get some regular exercise, physical exercise. We know that there's been many, many studies that have established that approximately two hours a week of aerobic activity, if you're doing that every day, it's about 15-20 minutes a day of aerobic activity, and it could be walking, it could be swimming, it could be on a treadmill, a rowing machine, whatever your body will allow you to safely do, we know that can help brain function and protect the brain from dementia. We don't know exactly how that happens, but the results are very clear and the results are better than any drug that any of your doctors could prescribe. So if I could urge listeners out there to do one thing, it would be to really take seriously getting some regular exercise. And I tell my patients, if I could write you a prescription for exercise, I would, because it's that important.

Beyond that, of course, healthy living in general. Maintaining a good heart healthy diet, making sure that you're getting all the sleep that you need at night. There's a lot that we have in our own capacities to help protect our brains that we will be well advised to pay attention to.

Host: Just a sensational summation, doctor. You've certainly given us a lot to consider and you've been an absolute pleasure to have on our podcast. Thank you so much for joining us and for all that you do every day at Carle Foundation Hospital for so many people and families.

That concludes today's Hally Healthcast. Tune in next time as we tackle yet another topic important for your health and well-being. And remember, Hally Health is your partner in helping you live your healthiest life. Visit hally.Com, that's H-A-L-L-Y.com, for resources, information, tips, and much more. Let us help keep you and your family healthy and well. Thanks for listening. We hope you tune in again.