Scott Webb (Host): Though there's some memory loss that's to be expected with age, memory loss that accompanies cognitive decline or personality changes in ourselves or loved ones may require seeing a Neurologist. And joining me today to tell us more about the field of neurology and how she helps patients who are suffering from memory loss is Dr. Tommassina Papa-Rugino. She's a Neurologist with Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, thanks so much for your time today. We're going to talk about memory loss and everything sort of involved with that and how you help folks. But before we get there, tell us a little bit about the specialty of neurology.

Tommassina Papa-Rugino, MD: Neurology is a specialty that takes care of the nervous system and that involves the brain as well as the peripheral nervous system like muscles and nerves. And we deal for diseases of both of both, whether it's something like seizures, multiple sclerosis, that involves the brain or memory loss, for example, or things that involves the peripheral nervous system, such as muscle disorders, peripheral neuropathy.

Those are the majority of symptoms that we take care of in an outpatient settings. Of course, in inpatient settings, there's things a little bit more serious like strokes and the like.

Host: Yeah, so it's a gamut, a wide range of things. And let's talk more specifically about the types of diseases that you help manage for patients.

Tommassina Papa-Rugino, MD: Sure. The diseases, again, in an outpatient settings are a little bit different. They involve more chronic illnesses like Parkinson's disease, multiple sclerosis, memory loss, seizures, neuropathy, things that people usually can have some sort of treatment for or we can, they can learn to adapt to. And it's more a matter of chronic illnesses as opposed to the acute illnesses that you see in hospital settings.

Host: Yeah, I see what you mean. Sort of a hospital and acute and outpatient, uh, more chronic type stuff. So let's talk about patients themselves, people themselves. What are some of the specific indications of actual memory loss versus, let's say, memory lapse or forgetfulness or just being really stressed out and having a hard time collecting our thoughts. Like how can we identify true memory loss?

Tommassina Papa-Rugino, MD: Well, you have to remember, there are some normal age related memory loss that really doesn't cause any disruption in our daily life. And I think most of us are familiar with those. For example, we suddenly forget a person's name, but recall it later on in the day. Or we forget where we placed something, whether it's keys or, for example, my phone. I always forget where put down my phone. But we can go back and sort of retrace our steps and then later on, we find whatever it is that we lost. So these changes in memory are generally manageable. They don't really affect your ability to work, live independently, or maintain a social life.

So most of these, we usually attribute those to getting older. And I think most of us can state that we have had, you know, these things where we either forget the name of somebody, or we lose whatever it is in our hands, or sometimes, you know, we're looking for like glasses, and we have them on top of the head.

So those are things that can occur naturally. So the issues become, if you're having memory problems, when do you need to talk to your healthcare provider? So, of course, when people think of memory loss, they always think of the word dementia. So, like Alzheimer's dementia, I mean, one of the things to remember is that there's a number of conditions, not just Alzheimer's, that can cause memory loss in older patients.

But if we think of dementia, dementia is really more than simply memory loss. It really describes a set of symptoms, not just in the impairment in memory, but also impairment in reasoning, in judgment, in language, in sort of what we consider our thinking skills. And usually dementia begins gradually and worsens over time.

And unlike simple forgetfulness, it does begin to impair a person's ability to work, to have some social interaction and relationship. So one of the early signs I think of memory loss that disrupts your life, which is really, you know, when you should start to think about seeking an opinion or a medical opinion or a neurological opinion, when you find that you ask the same question repeatedly, and a lot of times it's usually reported by family and family members, you forget common words when speaking, or for example, you mix words up.

For example, instead of saying, let's take this to the table, you start saying, let's take this to the bed. So you start replacing things that, you know, you wouldn't normally do and doesn't usually make sense. You take longer to complete familiar tasks. For example, let's say you're a great chef and you can follow a recipe really easily, and then suddenly you find that you're having really difficulty in completing something that you've done all the time. Misplacing objects and not just things like not forgetting where you put your phone or your keys, but for example, putting a wallet in a kitchen drawer. Or, putting a phone in the refrigerator.

And then not simply something that, you know, you're doing because you're like doing a million things and you're in a hurry. This is just something that you're just doing multiple times. For example, getting lost while walking or while driving. Now, you know, if you're driving in a familiar area, of course, we all have, we all get lost, but you know, we all have GPSs in our cars these days or on our phone, but this is getting lost in a familiar area, in an area that you have gone over multiple times and you usually you know, do it without even thinking about it.

And the other thing that we have to remember is that mood and behavior also play a part in dementia. And so if suddenly you're having changes in mood or behaviors for no apparent reason. Not like getting upset because there is stressful situation, but you suddenly get these mood changes for no apparent reason. Everything is going okay and suddenly you become agitated or it's just outside of the norm of your behavior.

Host: Yeah, definitely. And you mentioned earlier, there could be some other causes of memory loss for folks. It isn't always Alzheimer's and dementia. There could be some other things going on. What are some of those other diseases that can affect memory loss?

Tommassina Papa-Rugino, MD: Of course, a variety of medical diseases can affect memory. You can have even metabolic abnormalities, things like vitamin B12 deficiency, thyroid abnormalities, or you can have anything like illnesses; whether systemic illnesses such as infection or, other medications such as cancer medication. So there's a lot of things that can affect memory. So what you're really looking for is something that affects cognition, which is a little bit more than memory. I mean, even something more recent, for example, we do know that people who have had COVID; they complain of this brain fog, you know, after the illness.

Yeah. And, that's not necessarily a dementia is just as associated with a viral syndrome. So one of the things to remember, particularly in older patients, is that any kind of infection, or even something like a urinary tract infection, can truly maybe bring out an underlying memory problem. And, you have people that can go into a hospital where they are outside of their routine, they don't get enough sleep, particularly in the hospital is the worst place to get any sleep, you know, with, with, with monitors going on, with nurses coming on. And so any of those things can also affect your memory.

So a lot of metabolic infections, that you usually don't think of can affect your memory. And the other thing is that when people think of things that can cause memory loss or progressive damage to the brain, such as a dementia, you have to remember that there are also different types of dementia. You know, people always go, well, I know he has dementia or she has dementia, but do they have Alzheimer's? And it's like, no, there's always this thing that usually patients try to differentiate between, you know, dementia of the Alzheimer's type and other dementias. The thing is when we diagnose people with dementia, we also have to remember that there's a lot of different types of dementias.

Host: Yeah. Many types, of course. And just wondering, Doctor, is there anything that we can do, right? So when we think about family history and genetics and what factor those things may play in cognitive decline or memory loss. But is there some behavior and lifestyle things? Is it early diagnosis? I guess I'm wondering, you know, what can we do to sort of prevent these diseases and disorders that are associated with memory loss?

Tommassina Papa-Rugino, MD: A lot of times, you know, unfortunately there is a certain degree of memory loss and dementia that is just genetic, and a lot of times there's very little we can do with that. But of course we always try to make the point that, you know, a healthy lifestyle is a healthy brain, just like we do for physical ailments, you know, in other words, exercise, eating properly. They did studies years ago in reference to many supplements, and there weren't that many supplements that seemed to make that much of a change as far as the memory or dementia was concerned, except for one thing that was really very important and that is social interaction. Now, if you're not a people person, you know, it becomes a little bit more problematic.

Host: Yeah, if you're an introvert and you're just not a people person, right?

Tommassina Papa-Rugino, MD: Yeah, exactly. But, you know, we thought even if you think about the entire time of COVID, when we were telling people to stay away from other people, to isolate themselves, we didn't just see a steep decline in children, but we also saw a steep decline in memory in older patients. Because human beings are social beings, are social animals.

And one of the things is that if you're introverted, if you stay home and watch TV all day long, you know, the TV is not talking to you. If it is, it's a different problem, but you're usually, that's not a social interaction. So, being with other people, talking about recent events, talking about things that we usually do in social interactions is very important.

Now, there are some supplements which are not going to be harmful. You know, people take a lot of vitamin B, they take a lot of vitamin C, but vitamin D as well, but, you know, none of those; unless you have really a deficiency, none of those have really been proven to help memory. What has been shown, again, besides social interaction, is things like, games, puzzles, anything that keeps your brain working.

Host: Yeah keeps it sharp.

Tommassina Papa-Rugino, MD: And that's, yeah, and that's why we object so much to people just watching TV that is just not, you know, doesn't keep your brain sharp. Particularly if you watch the same thing over and over again and being with people is something that's very important.

Host: Yeah, it is for sure. And maybe this is just anecdotal, but it feels like in all the podcasts I've done about memory and memory loss, that often it's not the actual person, uh, would be patient who recognizes or realizes that, that sort of forgetfulness and absent mindedness has turned into something more substantial. It's usually the folks around them, their family and friends and loved ones. So what advice do you have for those folks as they begin to recognize and acknowledge, Oh mom, oh dad, grandma, grandpa, they seem to be struggling and forgetting things and putting their wallets in the fridge and all of that type of stuff. What advice do you have for them as they begin to sort of figure out what to do and how to deal with this?

Tommassina Papa-Rugino, MD: Yeah, one of the major issues is that whenever we see families that come in and a lot of time we see children who bring one parent because something has happened to the other parent. And a lot of times as we get older, of course, we're married or with someone that always, you know, seems to sort of balance itself out. One spouse may sort of make up for some deficits that may be in the other spouse. And then suddenly, something happens and then either mom and dad suddenly have to take over whatever the other spouse was doing. And then suddenly it becomes a crisis, because you see dad or mom is not able to pay bills anymore, or they get into a car accident if they haven't been driving for a while, or they suddenly come to your house in the middle of winter, dressed like it's the middle of summer. And then you bring them to the doctor, and then, you know, you want something done and there's very little that we can do even at that point. So one of the things that I always talk with family is that you need to be prepared for what if in the future, you know,

Host: Sort of have a plan, right?

Tommassina Papa-Rugino, MD: Sort of have a plan, what happens if somebody, whether it's a companion, whether it's your spouse or whatever, somebody moves out or dies or something takes over where suddenly you have someone living alone and they're having a lot of difficulties. You have to start making plans and is this something that maybe start discussing things like, medical power of attorney, legal power of attorney. Is it time for, if it's possible for mom or dad, to move in with someone? Or is it time to look at things like assisted living or placement or having someone coming into the house?

And as our population ages, we're going to see that happening more and more. And a lot of times, children may just not be able to do that because you have that generation now that has to take care of parents at the same time that they may be taking care of children. And so they suddenly become the caregiver. And of course, there's a lot of stress on caregivers. So, that's also something to keep an eye on that just one person might not be able to take care of mom or dad by themselves simply because they may have other responsibility. So my feeling is have some sort of plan for the future. That's something that we all will have to do, you know, as we get older. We'll have to start thinking is there something that can be done with the family that you have available, or if the family is not available, is there other plans you can make?

Because a lot of times, and particularly when you look, at our population, you know, you have parents that may live in one area and then they may have, yes, four or five children, but they all live in different areas. And suddenly if something happens to one of your parents, then something you decide well, what are we going to do with mom and dad who's living alone? It may not be possible for you to visit them often. It may not be possible for you to have someone with them often. So this is why I always say, the family needs to sit down at some point, when everybody is doing well and say, you know, what are our plans if something were to happen?

And, this is for something that is more of a progressive illness, not something that's just a transient problem because, you know, you suddenly found out that you had a vitamin deficiency or you're hyperthyroid or there's something going on. This is something that just needs to be planned for long term care.

And so the things that I always stress, is at least have some plans or some ideas going on because when that moment comes, you when you usually end up seeing a doctor, it's either an emergency or it's something that has acutely happened and then you suddenly, that causes a lot more disruption.

Host: Yeah.

Tommassina Papa-Rugino, MD: Than you had some sort of plans in place.

Host: Sure. Take us through when you have a conversation with someone so that you know this is not some sort of acute, as you say, transient thing, that this is a long term decline, whether it's, you know, Alzheimer's and dementia, whatever it might be, but while somebody's still there, right, while they're mostly still there, but you know that they're going to continue to decline, take us through that. I'm sure it's a lot of compassion and sensitivity, but take us through that conversation that you have with them as you try to explain what's going to happen to them.

Tommassina Papa-Rugino, MD: So a lot of times we start saying to patients, when did these memory problems begin? Were they recent memory problems? We try to eliminate anything that may cause a change in memory, like as I mentioned before, either metabolic or even something like alcohol, for example, even sleep apnea can do that. Also, you know, accidents, injuries, and then we begin to look at some of the medications. A lot of times people are on a lot of medication that actually can be making their memory worse. And, you know, some of the things that you we've heard a lot in the news about, of course, is like chronic use of Benadryl, some of the urinary medication. I mean, these can all, you know worsen your memory. So we begin to taper those off. And then a lot of people we do MRIs, we do all that blood work. But one of the most important things that we can do is actually what's called a neuropsychological evaluation. Neuropsychological evaluation is just a little bit longer of an exam.

It's usually done by a neuropsychologist. And it usually kind of tells us, it's this memory loss that we're seeing that is beginning to interfere with their activities of daily living. Where in this phase are we? Are we in a mild phase? Are we in a moderate phase? Where exactly are we? And then when we try to explain, there's a lot of support out there, both from the Alzheimer's Association, from the Caregiver Association, that can sort of lead into again, if there's some legal issues that you have to take care of, we start discussing some of those. Unfortunately, one of the issues with an older population we also have to address, more importantly, is driving.

Host: Yeah.

Tommassina Papa-Rugino, MD: We always hear those terrible stories of someone, you know, who hit a building or hit something because sometimes it's always an older person and so, we start asking those questions I mean, how comfortable are we with your driving? Let's try to drive only in familiar places. Let's try not to drive at night time, not to drive long distances. I mean one of the things as I said is we don't want to take driving away because that again eliminates all the social interactions that I just talked about but it's something that the family does have to keep an eye on.

So we start saying, there are organizations that you can do workshops at. There are some support groups that we can go to, but I do try to emphasize that this is a slow process, but again, to make some sort of plans. And then when we do decide that this is early on, there are some medicines that we have available, but one of the things to remember is that none of the medicines that we have available really cure this in any way. They just slow down the

Host: Slows it down or just sort of manages it. Right?

Tommassina Papa-Rugino, MD: It sort of manages a little bit. I mean, if there's some behavior issues that we have, we can also manage those, but these are all managing and slowing down medications. I mean, most of the medicines that we have had have been oral medication, which sort of changed the chemistry in the brain a little bit. Some of the newer medications are some of the infusion medication which sort of tries to deal at the amyloid or the protein in the brain that we think leads to Alzheimer's. But again, we have to prove that this dementia is Alzheimer's.

And again, trying to get the family involved as much as possible because at the end, or at any time, it's going to end up being a family decision. It's just not going to be a decision, just involving the patients, because there may come a time when the patient does need some placement.

And none of us likes to leave our homes or moving to different places, or to assisted living. So, this is something that we try to saying this may come to a point, but let's see what we can do to sort of slow this process as much as we can.

Host: For sure. Yeah. And just help their quality of life today for as long as possible, working with family, friends, loved ones. Doctor, I appreciate your compassion, your expertise today. I know that these are conversations that could be much longer. We just sort of scratched the surface a bit today, but really helpful. A lot of information and my mind's going to be kind of churning over things as I go through my day today, having had this great conversation with you. So thank you so much and you stay well.

Tommassina Papa-Rugino, MD: Thank you so much for having me.

Host: And learn more about memory loss at franciscanhealth.org and search neurology. 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 additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.