Transcription:
Understanding Dementia

Bill Klaproth (Host):  As people age, memory impairments become a big concern. Specifically, dementia. So, what are some of the common misunderstandings of the disease and what are the early warning signs to look for? Well let’s find out with Dr. Melanie Lising, a Neurologist at MarinHealth. This is the Healing Podcast from MarinHealth. I’m Bill Klaproth. Dr. Lising, thank you so much for your time. It is great to talk with you. So, first off, can you quickly share your background with us?

Melanie Lising, MD (Guest):  Yes. Thank you for having me first of all. I am a Neurologist which is a medical doctor that specializes in neurologic disease. And I have a subspecialty training in movement disorders which deals with various neurodegenerative diseases amongst other things.

Host:  Wow, that’s really an interesting field to be in. So, let’s talk about dementia now. Dementia is such a broad category. Often people don’t know what it includes. Can you clarify what dementia includes for us?

Dr. Lising:  Dementia I like to explain to my patients is an umbrella term that describes not just a single disease, but overall a wide range of medical conditions including Alzheimer’s Disease that cause abnormal brain discharges that can trigger decline in cognition or the way someone thinks and that are severe enough to impact their day to day life and independence.

Host:  And then Dr. Lising, what causes dementia?

Dr. Lising:  That’s a great question. Simply put, you can think of it as damage to brain cells or degeneration of cells. And this is what will interfere with how the different areas of our brain communicate. This is in the case of neurodegenerative diseases but as I mentioned, dementia is an umbrella term that can include other medical conditions that can impact and affect our cognition and those causes can be variable as well such as reversible causes which are usually screened for your initial evaluation.

Host:  So, then there’s a lot of confusion it seems like between Alzheimer’s and dementia. It seems like they are almost used interchangeably. So, how does dementia differ from Alzheimer’s or is Alzheimer’s a form of dementia?

Dr. Lising:  So, you’re right, Alzheimer’s disease is a form of dementia. And it does account for 60 to 80% of the cases, but there are other causes of dementia and this can range from other neurodegenerative diseases, in addition to vascular dementia and reversible causes of dementia such as thyroid disease, vitamin deficiencies and even depression. So, if there are more than one type of cause for the dementia, then that would be called mixed dementia. So, Alzheimer’s is just a form of dementia.

Host:  So, then can you share with us the different types of dementia?

Dr. Lising:  Sure. The most common one that everyone is very familiar with is Alzheimer’s dementia and the ones that are more rare that fall under the category of neurodegenerative disease are these other conditions such as dementia with Lewy Body or other dementias like Parkinson’s or Huntington’s. Vascular dementia is also a common cause which is consider non-neurodegenerative potentially can be altered by lifestyle changes and in terms of the non-neurodegenerative types, there is like I mentioned earlier, depression, medication side effects, thyroid or vitamin deficiencies.

Host:  So, there are many different types of dementia it sounds like. You said Alzheimer’s accounts for 60% of the dementias out there. You mentioned one vascular dementia. I don’t think I’ve heard of that and it sounds like some of these dementias you also mentioned thyroid too; it sounds like if you go in for a test, or an evaluation, there may be a chemical imbalance, or something that’s also physically wrong that might be causing the dementia that if you pinpoint that and correct it, you can also correct the dementia. Is that true?

Dr. Lising:  Yes. So, this is where it’s important to understand that dementia is an umbrella term and that there are other causes, other than neurodegenerative disease that can present with impairment in people’s cognition and how they think. And so, vascular dementia is considered a type of dementia that is not neurodegenerative but is related to changes in the vessels in the brain such as little mini strokes that can happen over time that you aren’t necessarily aware of. And with these little changes in the brain, over time, they can accumulate and disrupt communication of the different areas of the brain similarly to how a neurodegenerative condition like Alzheimer’s or Parkinson’s dementia or Huntington’s dementia can which is more related to degeneration or brain cell damage due to neurodegeneration.

And in terms of other reversible causes, that is exactly right in terms of screening for vitamin deficiencies, or metabolic disturbances that could of just been out of balance and can manifest as memory issues or cognitive issues that can be corrected and improve the symptoms that you presented with that may be concerning for dementia.

Host:  Well I think that’s good news as people age, and they start forgetting things now and then like we all do; I believe many people go right to oh my God, is this the beginning of Alzheimer’s. So, it’s always good to go and get evaluated and know before you go to the worst case scenario. But where does it generally start? What are the earliest signs or symptoms we should look for?

Dr. Lising:  Yeah, that’s a great question. And I think it does vary from patient to patient and it’s so different in each person. And I tell patients to keep in mind that it’s a spectrum. It starts with I can’t remember something or coming up with the right word or name, having difficulty you – performing tasks and then when it starts to become more persistent on a day to day basis, or when it starts to impact more than their normal aging is when it starts to manifest as more of an early sign of or symptom of cognitive decline. And specifically, the things you want to keep note of is memory loss that disrupts daily life, forgetting an appointment constantly, that’s not just one time or going on a familiar route to the grocery store and you get lost or disoriented. You know you’ll have patients who will have challenge in planning or solving problems such as managing their finances or paying bills. You also have patients that might complain of difficulty with other more familiar tasks that we do on a day to day basis like using a microwave or following instructions of a recipe.

And so, it really can vary but more often, the early signs ah – are observed by family members who say maybe we should get you checked. That’s usually how patients will present.

Host:  Okay so, that’s really good to know. So, speaking of that, what should someone do when they or a family member/caregiver see the early signs?

Dr. Lising:  The important thing is to look for a pattern. One day here or there where they are forgetful is usually not too much of a concern. It could have been related to maybe they had a bad night’s sleep or they have a lot of stressors going on, but if it’s a consistent pattern of cognitive change or memory change, and you find that it is affecting your loved one’s day to day activities, things that family members will observe is like missing bills, or they get frustrated very easily or very moody because they find that the cognitive changes are affecting the way that they can act independently or do things independently.

So, observing I think is one thing and just keeping track of how these memory changes are affecting their loved one’s day to day function. And certainly if it’s affecting their safety, that’s a time to think about getting evaluated.

Host:  So, when should someone seek the evaluation? When they start to see the early signs or when it really starts to affect daily life?

Dr. Lising:  I would recommend when there is a concern of the signs of memory change, one of the best things that we can do is establish a baseline and see how the symptoms progress over time. So, having that early sign or symptom established at a point in time with a physician where they can evaluate and screen for any reversible causes potentially. It would allow for the proper evaluation to make sure there aren’t any other causes that are potentially reversible and that if this is indeed early signs of a neurodegenerative process such as Alzheimer’s; then we can intervene earlier than later and prepare patients and families sooner than later.

Host:  So, you mentioned the word reversible. Are there ways to help reduce or eliminate dementia symptoms or its progression?

Dr. Lising:  Yes. This is the million dollar question that all of our research and therapy is aimed at is trying to find what is causing this condition and unfortunately, right now, we don’t know the exact cause. There have been many theories about what causes Alzheimer’s and for neurodegenerative conditions, but these are not considered reversible conditions at this time. The one thing that can delay progression of disease or be considered disease modifying is exercise. And that stems from the thought that there is a connection between cardiovascular health and brain health and overall correlation in patients who exercise at least thirty minutes a day five days a week of some type of cardiovascular intervention. And they show that these patients for some reason, have a change in their disease progression.

And so that’s really the only thing that I strongly recommend and if there’s one thing patients leave my appointments with is that they need to make sure they are exercising.

Host:  That’s really good. Exercise. It’s something that we all can do. So, that’s a great point. Thank you for sharing that. We also hear about deep brain stimulation or other types of advancements. Can you just quickly share any information on that?

Dr. Lising:  As I mentioned earlier, there really hasn’t been any FDA approved therapies or interventions that can be treatments or delay the onset or progression of the disease. But people are looking at these interventions such as deep brain stimulation, or other disease modifying therapies, but all of these are really small clinical trials. And so, they are all still in the clinical trial phase and have not had enough data to support it as a therapy that we would recommend.

Host:  Well, we will keep our fingers crossed on that. As our population in the United States ages, we certainly will keep watching that space. So, let’s talk about now who this affects. Does dementia impact men and women equally?

Dr. Lising:  So, that’s an interesting question. The data shows that women actually have a higher lifetime risk of developing Alzheimer’s and we do know that the highest or the major risk factor for Alzheimer’s is age. And the reason that we think women have a higher lifetime risk of developing Alzheimer’s is because they just tend to live longer than men. In terms of impacting men and women equally, it’s seen more of a prevalence in women.

Host:  And you mentioned older adults. So, does this normally only happen to older adults?

Dr. Lising:  Yes. Age is generally the major risk factor but there are some rare instances where patients can develop Alzheimer’s or neurodegenerative disease younger and these tend to be conditions that are more genetic [00:12:49]. But generally, it affects older people.

Host:  And you were just mentioning genetics. What about other risk factors like ethnicity, or prior diseases or we hear about football players and CTE, people that have had multiple concussions. What about those types of risk factors?

Dr. Lising:  That’s a great question. So, yes, age is one of the biggest risk factors, family history, and genetics can play a role but definitely head injury has been shown to have some link with the risk of dementia in the future. There is that connection with you know your cardiovascular health, how well your heart is and will also manifest with brain health as well. And in terms of ethnicity, the same demographic prevalence can also be translated to patients developing dementia as well.

Host:  Okay well that makes sense. And just a couple more questions Dr. Lising. And thank you so much for your time. What about drug interactions? Can they have an impact, or can they be a cause as well?

Dr. Lising:  They can have an impact overall in cognition especially if they are medications that affect cognition such as patients who are on narcotics or a class of drugs called anticholinergics can give patients that change in how they think and process information. But it does not cause neurodegenerative dementias. It can maybe be a contributing factor for reversible cause of dementia or let’s say if someone who has Alzheimer’s and they get admitted to a hospital and they get exposed to a narcotic or some kind of drug that would alter their cognition, then yes, that would have an impact on their overall disease that would hopefully get them back to baseline once that medication or that drug interaction is removed.

Host:  And then last question Dr. Lising. And again, thank you for your time. When it comes to getting an assessment, who should do the assessment and what does that include?

Dr. Lising:  Yes. I would recommend that if there is a concern for cognitive decline or memory issues, usually the first line of evaluation is the patient’s primary care physician and if there is a concern, they usually get referred to a neurologist. The neurologist will make sure that there are no other potential causes for their cognition, establish a baseline with their physical exam, potentially get brain imaging to rule out any other lesions that could be contributing and oftentimes, these patients will also get referred to a neuropsychologist who will do more formal neuropsych testing that is a little more in-depth than the initial screen that is done in the office. That is usually what patients can expect in terms of who they will end up getting evaluated by for their condition.

Host:  So, start with your primary care physician, have a conversation with him or her and then potentially you’ll get referred to a neurologist. Well Dr. Lising, this has really been informative. Thank you so much for your time.

Dr. Lising:  Thank you so much.

Host:  That’s Dr. Melanie Lising. And to learn more, please visit www.mymarinhealth.org. and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is The Healing Podcast brought to you by MarinHealth. I’m Bill Klaproth. Thanks for listening.