Selected Podcast
Alzheimer’s and Dementia – What’s the Difference
James Ellison, MD MPH, who represents the Swank Center for Memory Care and Geriatrics, Delaware’s only outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia or other neurocognitive disorders, discusses Alzheimer’s and Dementia. He shares the differences that helps us to understand our aging brains and treatment options for older Adults with Neurocognitive Disorders.
Featuring:
Dr. Ellison’s clinical specialties include the assessment and treatment of neurocognitive disorders and mood disorders in later life. His research interests have addressed cognitive and behavioral aspects of these conditions and he has served as a site Principal Investigator in multiple trials of new medications for the treatment of Alzheimer’s Disease. He is also the Editor in Chief of the Journal of Geriatric Psychiatry and Neurology and the author and/or editor of several books about psychiatry.
Dr. Ellison moved to Delaware in 2015 to become the first Swank Foundation Endowed Chair in Memory Care and Geriatrics. His objective in this role is to enhance the care of older adults with neurocognitive disorders in Delaware by increasing their access to state of the art diagnostic tools, clinical assessment and treatment approaches, caregiver support resources, and research trials. He is privileged to work as a geriatric psychiatrist embedded in an interdisciplinary consultation team that includes geriatricians, social workers, a neurologist, and a nurse practitioner devoted to this shared goal of treating people with mild to severe cognitive difficulties and related emotional and behavioral conditions. His program, the Swank Center for Memory Care and Geriatric Consultation, is Delaware’s only dedicated outpatient program serving this purpose.
Dr. Ellison is the proud father of two college-age young men who share his passion for community service. His partner, Kate, works as McLean Hospital’s fitness director in Belmont, MA. When not working, Dr. Ellison enjoys attending concerts, playing the violin, reading, and looking for time to keep fit
James Ellison, MD
Dr. Ellison was born in Minnesota and raised mostly in California, but higher education opportunities lured him to Boston, where he trained to be a psychiatrist at the Massachusetts General Hospital, Subsequently, he spent several decades working as a general and geriatric psychiatrist in several hospitals in or near Boston. He also received a Master of Public Health degree from the Harvard School of Public Health. Throughout his career, he has developed and led clinical and research programs while also promoting education of the public and of his professional peers. He has worked in diverse settings including emergency psychiatry services, inpatient and outpatient clinical settings, managed care, and private practice. Since 1999, he has focused on mental health issues of older adults.Dr. Ellison’s clinical specialties include the assessment and treatment of neurocognitive disorders and mood disorders in later life. His research interests have addressed cognitive and behavioral aspects of these conditions and he has served as a site Principal Investigator in multiple trials of new medications for the treatment of Alzheimer’s Disease. He is also the Editor in Chief of the Journal of Geriatric Psychiatry and Neurology and the author and/or editor of several books about psychiatry.
Dr. Ellison moved to Delaware in 2015 to become the first Swank Foundation Endowed Chair in Memory Care and Geriatrics. His objective in this role is to enhance the care of older adults with neurocognitive disorders in Delaware by increasing their access to state of the art diagnostic tools, clinical assessment and treatment approaches, caregiver support resources, and research trials. He is privileged to work as a geriatric psychiatrist embedded in an interdisciplinary consultation team that includes geriatricians, social workers, a neurologist, and a nurse practitioner devoted to this shared goal of treating people with mild to severe cognitive difficulties and related emotional and behavioral conditions. His program, the Swank Center for Memory Care and Geriatric Consultation, is Delaware’s only dedicated outpatient program serving this purpose.
Dr. Ellison is the proud father of two college-age young men who share his passion for community service. His partner, Kate, works as McLean Hospital’s fitness director in Belmont, MA. When not working, Dr. Ellison enjoys attending concerts, playing the violin, reading, and looking for time to keep fit
Transcription:
Melanie Cole: Welcome. This is Christiana Care's Podcast series. I'm Melanie Cole, and today we're talking about the difference between Alzheimer's disease and dementia. Our speakers in this podcast series represent the Swank Center for Memory Care and Geriatrics, Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia or other neurocognitive disorders. Joining me is Dr. James Ellison. He's the Swank foundation endowed Chair in Memory Care and Geriatrics at Christiana Care. Dr. Ellison, it's such a pleasure to have you join us today. Tell us a little bit about Alzheimer's disease and how it's different than dementia.
Dr. Ellison: Thank you Melanie for asking this question. It's a very important one that many people misunderstand. Alzheimer's disease is only one type of dementia and there are lots of other types of dementia, perhaps as many as a hundred different disease processes that can cause major neurocognitive disorder. But Alzheimer's disease is very special because it's the cause of two out of three cases of dementia in the United States and it's a very important cause of dementia. Now when we talk about Alzheimer's disease, we may sometimes not be talking just about dementia, but really more broadly about a disease process that involves the formation of cellular death from neurofibrillary tangles and senile plaques that take place in the brain. We've known about these neurologic and histologic changes for the past hundred years and we're still trying to figure out how they cause changes in cognitive functioning. But Alzheimer's disease refers now to that pathological process, whereas dementia refers to the clinical changes that take place towards the end of that process when a person loses their capacity to live independently as a result of this damage to their brain.
Host: Wow. Thank you for that explanation. Dr. Ellison, so many people have this question. Is dementia a normal part of aging? We hear about Alzheimer's and we hear that there is a genetic component. We hear all of these things about it, but we don't hear about dementia as that umbrella term. And is this a normal part of aging? Does everybody get dementia at some point?
Dr. Ellison: Many people do develop cognitive changes as they age, and some of these are normal. For example, it would be very normal to have the occasional senior moment as you age, to forget why you walked into a room, to get something, to take a moment to remember the name of somebody whom you hadn't seen for a long time. Things of that sort. And it takes longer to figure out the subtractions in your checkbook or, uh, remember things that are detailed. And it takes longer to learn new information as you get older. On the other hand, dementia, which as I said, is neurocognitive disorder, severe enough that one loses the capacity to live independently. That is not a normal part of aging that's estimated to affect, somewhere between five and 10% of adults in the United States over age 65.
Host: Wow. So are there stages, how do you diagnose whether someone has dementia or Alzheimer's? Are there stages that you look at? Asymptomatic, mild, cognitive? Tell us how these stages are helpful in use, in treatment options and or diagnosis.
Dr. Ellison: That's a great question and that brings us back to the idea of what is Alzheimer's disease specifically because Alzheimer's goes through a series of phases. First of all, there's an accumulation of plaques and tangles in the brain for decades during which a person is completely asymptomatic. Nobody would know that they have Alzheimer's disease. Later on, there's a stage that we could call mild neurocognitive disorder or mild cognitive impairment. And during that phase, a person gets along okay. They can manage to live independently and handle their responsibilities, but they become more dependent on reminders and the help from others, and various kinds of compensatory activities to help them keep going as well as they were. Then the stage of dementia develops when independence is lost and even dementia includes several different stages. In the earlier milder stages, people are forgetful. They may have some trouble with language, they may have some trouble with problem solving and other kinds of executive function. Later on, they lose the capacity to handle what we would call instrumental activities of daily living and even activities of daily living, like dressing, personal care, hygiene, preparing a meal. And ultimately in the final stage of dementia, people become entirely dependent on others and they can't manage even their bodily functions independently.
Host: Are there treatment options? Because I guess people are wondering why it's important to know what's underlying the memory loss a person is showing, and does that help you determine what type of care that they need?
Dr. Ellison: That's a very important consideration. As I mentioned before, there are many different kinds of changes in the brain that lead to cognitive decline. And when cognitive decline is serious, in some cases it may be treatable or preventable or even reversible. So for example, about 10% of people with significant cognitive decline have reversible conditions. Something like depression or hypothyroidism or an infection or an injury to the brain that can be treated with very good results. Then a large number of other individuals have conditions that are going to be progressive, but medical treatment may be influential in slowing that down. So it's important to detect early and to figure out what kind of process is causing the cognitive decline so that appropriate interventions can be made. But even if we can't slow down the process for everybody, knowing about it as early as possible is very helpful in planning ahead. For example, many people who have cognitive decline still live alone and increasingly over time, the safety of their living environment is more of an issue. They may be driving, they may be caring for a spouse who has medical problems or cognitive problems as well. They may be trying still to handle their finances and become vulnerable to scams. So for all of these reasons, it's really good to know as early as possible what's going on and as much as possible about why it's happening.
Host: Such important points. And before we conclude, Dr. Ellison, do you have some red flags for listeners about some of those signs of cognitive decline? When you mentioned driving or bill paying, susceptibility to scams, what would you like listeners to know about things they should watch out for, for their loved ones that are living independently?
Dr. Ellison: Well, one of the biggest spheres as adults get older is that they're going to lose their memory and lose their independence. And so the first thing that I want to say is that not every slip of the memory means that a person's developing Alzheimer's disease. There are normal changes in cognition that shouldn't alarm us. On the other hand, there are signs of a more serious process that might be taking place and we should pay attention to those and not overlook them or discount them. The Alzheimer's Association publishes a nice list of 10 warning signs and among those signs are such things as having trouble remembering things that you did recently or the details of conversations that have taken place, having trouble learning new things or doing activities that you have been familiar with. Having trouble with your finances, a change in personality, and so on.
Host: Please give us your best advice, Dr. Ellison, incredible expertise you have, for listeners on when they feel it's time to consult with a specialist such that you have at the Swank Center for Memory Care and Geriatrics.
Dr. Ellison: Well, the Swank Center is an excellent place to go for an expert consultation, but really most of the care of neurocognitive disorders does and should take place in primary care. So very first place to start if they're concerned about memory or other cognitive functions, is by asking your primary care provider whether they can evaluate you for this. Then if there are problems, such as a complicated diagnosis, behavioral complications, issues about medications, diagnostic questions, these can all be addressed by a specialist like the Swank Center.
Host: Thank you so much, Dr. Ellison for joining us today. And that concludes this episode of Christiana Care's Swank Memory Care Podcast series. For an appointment at the Swank Center for Memory Care and Geriatrics. Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia or other neurocognitive disorders, please call (302) 320-2620. To schedule an evaluation. And to learn more about programs and services, you can also visit ChristianaCare.org to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Christiana Care Swank Memory Care Podcasts. I'm Melanie Cole.
Melanie Cole: Welcome. This is Christiana Care's Podcast series. I'm Melanie Cole, and today we're talking about the difference between Alzheimer's disease and dementia. Our speakers in this podcast series represent the Swank Center for Memory Care and Geriatrics, Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia or other neurocognitive disorders. Joining me is Dr. James Ellison. He's the Swank foundation endowed Chair in Memory Care and Geriatrics at Christiana Care. Dr. Ellison, it's such a pleasure to have you join us today. Tell us a little bit about Alzheimer's disease and how it's different than dementia.
Dr. Ellison: Thank you Melanie for asking this question. It's a very important one that many people misunderstand. Alzheimer's disease is only one type of dementia and there are lots of other types of dementia, perhaps as many as a hundred different disease processes that can cause major neurocognitive disorder. But Alzheimer's disease is very special because it's the cause of two out of three cases of dementia in the United States and it's a very important cause of dementia. Now when we talk about Alzheimer's disease, we may sometimes not be talking just about dementia, but really more broadly about a disease process that involves the formation of cellular death from neurofibrillary tangles and senile plaques that take place in the brain. We've known about these neurologic and histologic changes for the past hundred years and we're still trying to figure out how they cause changes in cognitive functioning. But Alzheimer's disease refers now to that pathological process, whereas dementia refers to the clinical changes that take place towards the end of that process when a person loses their capacity to live independently as a result of this damage to their brain.
Host: Wow. Thank you for that explanation. Dr. Ellison, so many people have this question. Is dementia a normal part of aging? We hear about Alzheimer's and we hear that there is a genetic component. We hear all of these things about it, but we don't hear about dementia as that umbrella term. And is this a normal part of aging? Does everybody get dementia at some point?
Dr. Ellison: Many people do develop cognitive changes as they age, and some of these are normal. For example, it would be very normal to have the occasional senior moment as you age, to forget why you walked into a room, to get something, to take a moment to remember the name of somebody whom you hadn't seen for a long time. Things of that sort. And it takes longer to figure out the subtractions in your checkbook or, uh, remember things that are detailed. And it takes longer to learn new information as you get older. On the other hand, dementia, which as I said, is neurocognitive disorder, severe enough that one loses the capacity to live independently. That is not a normal part of aging that's estimated to affect, somewhere between five and 10% of adults in the United States over age 65.
Host: Wow. So are there stages, how do you diagnose whether someone has dementia or Alzheimer's? Are there stages that you look at? Asymptomatic, mild, cognitive? Tell us how these stages are helpful in use, in treatment options and or diagnosis.
Dr. Ellison: That's a great question and that brings us back to the idea of what is Alzheimer's disease specifically because Alzheimer's goes through a series of phases. First of all, there's an accumulation of plaques and tangles in the brain for decades during which a person is completely asymptomatic. Nobody would know that they have Alzheimer's disease. Later on, there's a stage that we could call mild neurocognitive disorder or mild cognitive impairment. And during that phase, a person gets along okay. They can manage to live independently and handle their responsibilities, but they become more dependent on reminders and the help from others, and various kinds of compensatory activities to help them keep going as well as they were. Then the stage of dementia develops when independence is lost and even dementia includes several different stages. In the earlier milder stages, people are forgetful. They may have some trouble with language, they may have some trouble with problem solving and other kinds of executive function. Later on, they lose the capacity to handle what we would call instrumental activities of daily living and even activities of daily living, like dressing, personal care, hygiene, preparing a meal. And ultimately in the final stage of dementia, people become entirely dependent on others and they can't manage even their bodily functions independently.
Host: Are there treatment options? Because I guess people are wondering why it's important to know what's underlying the memory loss a person is showing, and does that help you determine what type of care that they need?
Dr. Ellison: That's a very important consideration. As I mentioned before, there are many different kinds of changes in the brain that lead to cognitive decline. And when cognitive decline is serious, in some cases it may be treatable or preventable or even reversible. So for example, about 10% of people with significant cognitive decline have reversible conditions. Something like depression or hypothyroidism or an infection or an injury to the brain that can be treated with very good results. Then a large number of other individuals have conditions that are going to be progressive, but medical treatment may be influential in slowing that down. So it's important to detect early and to figure out what kind of process is causing the cognitive decline so that appropriate interventions can be made. But even if we can't slow down the process for everybody, knowing about it as early as possible is very helpful in planning ahead. For example, many people who have cognitive decline still live alone and increasingly over time, the safety of their living environment is more of an issue. They may be driving, they may be caring for a spouse who has medical problems or cognitive problems as well. They may be trying still to handle their finances and become vulnerable to scams. So for all of these reasons, it's really good to know as early as possible what's going on and as much as possible about why it's happening.
Host: Such important points. And before we conclude, Dr. Ellison, do you have some red flags for listeners about some of those signs of cognitive decline? When you mentioned driving or bill paying, susceptibility to scams, what would you like listeners to know about things they should watch out for, for their loved ones that are living independently?
Dr. Ellison: Well, one of the biggest spheres as adults get older is that they're going to lose their memory and lose their independence. And so the first thing that I want to say is that not every slip of the memory means that a person's developing Alzheimer's disease. There are normal changes in cognition that shouldn't alarm us. On the other hand, there are signs of a more serious process that might be taking place and we should pay attention to those and not overlook them or discount them. The Alzheimer's Association publishes a nice list of 10 warning signs and among those signs are such things as having trouble remembering things that you did recently or the details of conversations that have taken place, having trouble learning new things or doing activities that you have been familiar with. Having trouble with your finances, a change in personality, and so on.
Host: Please give us your best advice, Dr. Ellison, incredible expertise you have, for listeners on when they feel it's time to consult with a specialist such that you have at the Swank Center for Memory Care and Geriatrics.
Dr. Ellison: Well, the Swank Center is an excellent place to go for an expert consultation, but really most of the care of neurocognitive disorders does and should take place in primary care. So very first place to start if they're concerned about memory or other cognitive functions, is by asking your primary care provider whether they can evaluate you for this. Then if there are problems, such as a complicated diagnosis, behavioral complications, issues about medications, diagnostic questions, these can all be addressed by a specialist like the Swank Center.
Host: Thank you so much, Dr. Ellison for joining us today. And that concludes this episode of Christiana Care's Swank Memory Care Podcast series. For an appointment at the Swank Center for Memory Care and Geriatrics. Delaware's first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia or other neurocognitive disorders, please call (302) 320-2620. To schedule an evaluation. And to learn more about programs and services, you can also visit ChristianaCare.org to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Christiana Care Swank Memory Care Podcasts. I'm Melanie Cole.