Transcription:
What is Dementia and How to Reduce Your Risk

This is Hello Healthy, a Dignity Health podcast. Here's Bill Klaproth.

Bill Klaproth: Bakersfield Memorial Hospital's team of renowned neurologists offer special expertise in a variety of neurological conditions and disorders, including dementia. So what is dementia and how do you reduce your risk? Well, let's find out what Dr. Theodore Popa, a neurologist at Bakersfield Memorial Hospital. Dr. Popa. Thank you so much for your time. Can you first start by sharing your background with us and your education?

Dr. Theodore Popa: Hi, thank you so much for having me. Briefly I attended UCLA for undergraduate and received a bachelor's of neuroscience there and then further education took me to the Midwest where I received a masters in medical imaging from Chicago medical school, and then medical training, which consisted of medical school and neurological residency training was at Toledo, Ohio at Medical College of Toledo.

Host: All right, so let's talk about dementia. Can you explain to us what is dementia?

Dr. Popa: Sure. That's a great question. So to try to dispel some myths surrounding dementia. It's not necessarily a normal part of the aging process. Normal aging exhibits, mild changes in cognition these are declines related to normal aging. They're kind of subtle, mostly affecting the speed of thinking and attentional control, but dementia represents a very clear decline from a previous level of mental functioning. And this decline has to be severe enough that it actually interferes with the person's independence and impacts their day to day functioning. Now some quick facts about dementia. It really doesn't know any social economic or geographic boundaries, and it's affected some of the most notable leaders and achievers, Ronald Reagan, Margaret Thatcher, even a Nobel prize winner, Charles Calvin, the father of fiber optics. He had dementia. Disease burden worldwide. We have an estimated 50 plus million people living with dementia. And within the United States alone, we have about 6 million people living with dementia.

Host: That's a lot of people. So Dr. Popa we hear about dementia and Alzheimer's, is Dementia Alzheimer's or is dementia the gateway to Alzheimer's? Can you explain that to us?

Dr. Popa: Yeah. Great question. So dementia is a very broad umbrella term and there's so many different kinds of dementia. It's not one thing. There are several routes to similar symptoms. Alzheimer’s has to be one of the predominant causes of dementia affecting approximately 62% of our patients with dementia. Alzheimer's causes problems as we know with memory, language, and reasoning. And a few of the cases they start earlier than age 65. We also have vascular dementia, which makes up the second largest group. And vascular dementia involves multiple strokes. And we see that that also impairs judgment cognition and memory. Then you have your mixed dementia, dementia with Lewy body frontal temporal dementia and a bunch of other conditions that contribute and cause dementia. So it's very broad nebulous kind of topic. And we have to do a lot of evaluation to tease out the exact causes. Importantly, we have a lot of reversible causes of dementia and, these include vitamin deficiencies, medical disorders, which affect the thyroid. Infections like HIV, meningitis, kidney failure, liver failure, all of these can contribute to, to dementia as well.

Host: So when you say it's reversible, if it is a vitamin deficiency or another mechanical function in the body that is not working properly, if you diagnose and find that problem and fix that problem, you can reverse the dementia like symptoms. Is that what you're saying?

Dr. Popa: Absolutely correct. If we find that the dementia is attributed to these, reversible causes. In many instances, if the condition isn't too far progressed, then we can try and actually reverse some of the deficits that we see and memory loss and cognition, absolutely. Medications as well cause a lot of dementia problems so we tease that out as well.

Host: We hear so much about sleep now can lack of sleep or poor sleep caused some of these memory reasoning language issues too? 

Dr. Popa: That's another great question. Sleep and sleep disturbances profoundly can actually give a picture of dementia. In particular, we have a condition called obstructive sleep apnea, which is associated with snoring, where the patients can stop breathing for minute amounts of time during sleep. But as you can imagine over the whole sleep period, it can actually start with the brain of necessary oxygen and blood. And this definitely increases the risk of dementia. And I like to screen all my patients for exactly these disorders.

Host:Wow. Okay. Well, this is really informative. So you said earlier generally dementia affects language, memory, reasoning. Are there symptoms we should look for in these three different buckets?

Dr. Popa: Absolutely. So what I tell my patients who are concerned when they bring up family members who they suspect may have dementia. I ask them to look for forgetfulness of recent events. If the patient in question has repetitive questioning, if they're forgetting recent conversations, if they're getting lost in familiar places, forgetting familiar faces. If there's a decline in planning, organizing, balancing the checkbook, even odd, inappropriate or compulsive behaviors that are new and we're very atypical of the patient previously, even repeated falls or loss of balance, dementia can affect so many aspects of our lives. And so there's a myriad of symptoms.

Host: And then when is it time to see the doctor? You said when and it starts to affect daily life?

Dr. Popa: Actually, whenever there is a question. If there's a question that the individual that is in question is exhibiting these symptoms, right now we have new guidelines to screen patients at 65. This is actually the new standard of care. It's actually mandated by Medicare as well. So if your doctor isn't necessarily asking you some formal questions, like the mini mental status exam, or the Montreal cognitive assessment, you can always be referred to a neurologist such as myself and will undergo some quick standardized questionnaires to kind of see where the patient has their baseline. And then we'll interview the family very carefully. Because all these little things can add up to a picture of dementia that should be evaluated absolutely.

Host: Right. And then those tests are those the first steps to a diagnosis? And I think you said earlier that diagnosis is kind of complicated cause there's a lot of different factors involved, but is that the first step to diagnosing is that test first?

Dr. Popa: Yes, that and the actual interview with, family members and the patient. And that's why it's so important to try to bring a family member or to have one available, to speak over the phone with, to corroborate information, to assist in gaining additional insight into what problems the patient who is presenting to the office was having. So it begins with a series of very detailed questions and this is how the investigative evaluation process begins. And including these detailed questionnaires that you asked about. Absolutely.

Host: So you mentioned there are treatment options too, that can help. What are some of those treatment options for those who have received a diagnosis?

Dr. Popa: So it really depends on the dementia syndrome. There's a few medications and therapies that are available, unfortunately for Alzheimer's current medications, try to slow the process, but typically cannot fully reverse nor cure it. We've seen some mixed results with vitamin E and Alzheimer's that possibly may slow progression, but it may also increase cardiovascular disease. The main line of treatment is really getting to the nature, the source of the dementia, and then treating that particular dementia syndrome or dementia condition appropriately. A lot of our treatments are also multifactorial. They involve support systems with family, friends, social circle, support groups. We have a great Alzheimer support group here in Bakersfield and they have counselors actually available 24 seven, via the Alzheimer's association, very supportive group, and they really help our patients out tremendously.

Host: That's good to know that there is a group like that out there to help assist and support. So then I know a lot of people have this question, is there anything someone can do to help reduce their risk of developing dementia?

Dr. Popa: Absolutely. These are all very much common sense. Common sense things that they could do, but let's talk really quickly about the most common factors for dementia. First, we have age with every decade after age 60 the incidence of Alzheimer's doubles. We also see risk factors with low educational attainment, high blood pressure, especially in the middle age, middle age obesity, hearing loss, late life depression, diabetes, physical inactivity, smoking, and social isolation. So as you can see that if these are the risk factors, then the reverse of these risk factors can actually help prevent it. So exercise daily, daily exercise and aiming for at least 150 minutes per week is what I recommend to my patients. We also recommend a heart healthy, Mediterranean diet, and these are typically filled with the brain healthy food groups, like green leafy vegetables, vegetables of different colors, nuts, berries, beans, whole grains, poultry, olive oil, and seafood to an extent. We try to reduce and avoid simple sugars and sweets and avoid regular heavy consumption of alcohol and abstain from smoking. And also like to, help my patients consider that the mind is very much a muscle and that muscle can be exercised by active reading, cognitive puzzles, memory games, and even chess. And also social engagement is very important. Socialization with friends, peer discussion, shared activities, that kind of thing. And what can they do in terms of their medical issues such as blood pressure? Well, we're seeing more and more studies that normalization of blood pressure. And aggressive treatment of blood pressure even to below 120 systolic. So that's the top number of the blood pressure. Now we're able to show that even aggressive treatment of blood pressure can greatly reduce the risk of dementia. And then we have the medications that I briefly mentioned. There's certain medications that impact cognition and their termed anticholinergics and our patient’s doctors will absolutely know these medications and some of them are like Benadryl. You get to a certain dose of Benadryl every night, and that actually can lead to memory loss and dementia.

Host: Well, that's interesting. I didn't know certain medications could do that. All right. Well, you gave us a great list. Things we can do to help reduce our risk of developing dementia. Exercise, shoot for 150 minutes a week. Pay attention to a heart healthy diet. Exercise your brain with reading. Puzzles chess. So I heard that if you learn to play a guitar or piano or a new language that can help, is that right?

Dr. Popa: Oh yeah.

Host: Okay, good. And then pay attention to socializing. So that's good. So you want to be social and then aggressive treatment of blood pressure and watch out for certain medications that can promote memory loss. This has really been informative, a lot of great information here, Dr. Popa. Thank you so much for your time.

Dr. Popa: Thank you so much. It does mean great pleasure to discuss such a topic that's near and dear to my heart. Thank you again so much for having me. I appreciate it.

Host: That's Dr. Theodore Popa and for more information, please visit dignityhealth.org/bakersfield/neuro. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you.

This is Hello Healthy, a Dignity Health podcast. I'm Bill Klaproth thanks for listening.