Transcription:
Raising Awareness About Alzheimer's Disease

Bill Klaproth: (Host) Alzheimer's is a progressive disease that destroys memory and other important mental functions. So what are some of the symptoms, available treatment, misconceptions, and resources available? Well, let's find out with Dr. Jess Rhee, a clinical neuropsychologist, and Dr. Sachin Dave, a board-certified general neurologist, and clinical neurophysiologist, as we discuss raising awareness about Alzheimer's disease. This is the SolutionHealth Podcast from SolutionHealth. I'm Bill Klaproth. Dr. Rhee and Dr. Dave, thank you so much for your time. So Dr. Rhee, for someone who says, "I'm having a harder time remembering things, do I have Alzheimer's disease?" My loved one seems to be having a harder time remembering things. Do they have Alzheimer's disease?" What steps need to be taken?

Dr. Jess Rhee: (Guest) First, I want to comment on whether or not the person has Alzheimer's disease, there's a lot of workup that needs to be done before you jump to that conclusion. There are many different things that can cause memory problems. So usually people talk with their primary care physician, and typically the primary care physician will refer that person to a specialist, either to a neurologist first or someone like me, a neuropsychologist, to do the cognitive testing to try to figure out if whatever memory issue that person is noticing is normal for their age or not.

Host: Got it. So there are other things that can cause memory lapses. Maybe there's a chemical imbalance in the body, or somebody is under extreme stress or other factors that may mimic the signs of Alzheimer's. Is that right, Dr. Rhee?

Dr. Rhee: That's absolutely right. So typically, there will be standard blood work that can be done to figure out if there's maybe some sort of thyroid disfunction for example, or vitamin B12 deficiency, or vitamin B deficiency. And then also mood can really affect memory. If someone's feeling very depressed, that can affect someone's ability to concentrate. If they're having trouble concentrating and taking everything in, then they're not going to remember things later. So there are a lot of different things that need to be considered before you jump to a conclusion that, I think this person is showing the early signs of Alzheimer's disease.

Host: That's good to know, as most people jump right to the conclusion of Alzheimer's disease if they start to notice any memory lapses. So Dr. Dave, can you explain to us what is exactly Alzheimer's disease?

Dr. Sachin Dave: (Guest) Yeah. So Alzheimer's disease is a type of dementia. It's one of the most common types of dementia. It's a neurodegenerative, condition that occurs due to accumulation of, amyloid plaques in the neurons. It's more common after the age of 65, but there are certain cases where it could be early-onset as well.

Host: And Dr. Rhee, I think there's always confusion on, what is Alzheimer's and what is dementia? So can you tell us, what is the difference between those two?

Dr. Rhee: Oh, absolutely. I get this question a lot. So dementia is a symptom of a disease. Demen- what dementia means is that someone is having a lot of cognitive problems. It could be memory problems, or maybe they're having a lot of trouble, with their words. And the cognitive symptoms are severe enough that it's affecting someone's ability to easily and independently carry out everyday activities like managing their bills or managing their medications, so typically the way to think about it is, the most common form of dementia is dementia due to Alzheimer's disease. You can also have dementia due to Parkinson's disease, dementia due to frontotemporal lobar degeneration. That's another progressive brain disease. But my point is that there are many different types of dementia.

Host: So Alzheimer's then falls under the umbrella of dementia?

Dr. Rhee: That's right, yes.

Host: Okay, got it. And then Dr. Dave, what does the term mild cognitive impairment mean?

Dr. Dave: So when, a person has, cognitive, decline, memory problems, other sort of cognitive, difficulties, but that's not affecting the independent functions yet, that will fall into mild cognitive impairment, category. Which is not dementia yet. And it may or may not progress into dementia, but would be important to be monitored.

Host: And as you age, there is a degree of mild cognitive impairment that is normal, is that correct?

Dr. Dave: Yes. But that would not be called mild cognitive impairment. It could be more age-appropriate cognitive changes, rather than impairment.

Host: So then if someone is diagnosed with Alzheimer's disease, what are the treatments that are available, Dr. Rhee?

Dr. Rhee: Typically for the mild stage of Alzheimer's dementia, the medication that is typically prescribed is something called Aricept. But sometimes people have stomach problems or other side effects like vivid dreams is another one that I've heard about. And so there are other medications in that same class that have a different side effect profile. But typically Aricept is the one that's usually tried first, and then as the disease progresses, to more moderate or middle-stage Alzheimer's dementia, then typically there's a second medication that's added that's called Namenda. But Dr. Dave, I'll defer to you on that one.

Dr. Dave: Oh, sure. So when we come to the treatment for Alzheimer's, it is actually a collaboration of multiple different people, including neurologists, neuropsychologists, social workers, primary care physicians, and sometimes psychiatrists as well. When it comes to the medications, as Dr. Rhee just suggested, there are two main groups that are available. One is called acetylcholinesterase inhibitors, which have three medications in that, category. One was mentioned by Dr. Rhee, Aricept. There are two more, and they are alternative. So if somebody has a side effect on one, we can always try and change it to another one. Aricept is usually, by far the most commonly used medication in that group. And that's approved for mild to moderate to severe form of, Alzheimer's. The other one is Namenda. The drug name is memantine, which is approved more for moderate to severe form of, Alzheimer's. But this is just the medication, and there are a lot of other things that's included into the treatment, and that includes addressing other medical health issues. Chronic pain, for example. Sleep issues. Mental health, conditions that may come with dementia, or may have been present before that, including depression, anxiety, sometimes, behavioral changes. So it's not only the medication, it requires a multi-dimensional approach.

Host: And then Dr. Dave, what are some of the other things that people living with Alzheimer's or care partners may notice, and how do they deal with that?

Dr. Dave: So one of the first things, will be, change in the behavior. It may or may not be noticed by the patient themselves. It could be as simple as apathy, not caring for things that were real important, for the patient before. It could be anxiety, it could be education, and sometimes hallucinations, sleep dis- disturbance, what we call sundowning, more behavioral changes in the evenings and later in the night. These are in the spectrum of behavioral changes, that may be noticed by the family members. There I think, uh, approach would be to, one, have a good social environment. Second, treating, with appropriate medications for Alzheimer's. Usually sedatives or any other mental health, medications are avoided as far as possible, due to possible, side effects. And if needed, obviously, consultation with the psychiatrist can be considered at that point.

Host: So Dr. Rhee, what about the person that says, "I really don't think I have Alzheimer's disease, but my family is worried. Why do I need to go through all this testing?" What do you say for someone saying that to themselves?

Dr. Rhee: So one thing I like to say to my patients is that, sometimes it's hard to notice changes in ourselves. And sometimes family members will notice changes before we do. But either way, it's helpful to get a cognitive baseline to just see where things are at in terms of memory or retention or language. And if everything's in the normal range, great. Then you just have a baseline that if, in the future, if there are changes, then you could come back for a repeat evaluation and have those results compared to the baseline. But if the results come back showing that it does look like there are memory difficulties that are abnormal for a person's age, then it will be great to have identified that early so that different, for example, lifestyle changes perhaps could be made, or other interventions could be recommended.

Host: Got it. When you say language, what do you mean? Remembering words, that type of a thing?

Dr. Rhee: Changes in someone's ability to easily come up with their words is another very common symptom of Alzheimer's disease. Well, It's very subtle at first, but as the disease progresses, someone might have trouble remembering the name of something, and it might take them longer than usual to remember what it is.

Host: And then Dr. Dave, for someone who says, you know, "My mother had Alzheimer's disease. Are there steps I can take now to prevent myself from the same outcome, or slow the onset?" What do you say in that instance?

Dr. Dave: So it all depends on the age when this question was asked. As Dr. Rhee mentioned, earlier we start, better it is. So a very common thing for me to say would be a healthy lifestyle. And what that means is regular exercises, dietary changes, regular sleep, taking care of, vascular risk factors that may include high blood pressure, diabetes, cholesterol problems. If somebody's smoking, I would really encourage and emphasize to quit smoking. Address mental health problems, depression, anxiety, other issues. And be very, active socially, physically. More recently that has been more and more interest in the Mediterranean diet pattern, so that can be implemented. But overall, just positive lifestyle changes, that will be recommended. And again, it all depends on what comorbidities, what other factors the person has who is asking this question.

Host: That makes sense. So Dr. Rhee, what are some common misconceptions about Alzheimer's disease that we should know about?

Dr. Rhee: So at least one that I can think of is that Alzheimer's is just a normal part of aging. And that's not correct. So about one in 10 people age 65 and older have Alzheimer's disease. But if you think about that's just 10% of people who are 65 and older. So this is not something that everybody is going to have as they grow older. In fact, I've had the pleasure of working with a number of people in their late 70s, early 80s, actually some people in their early 90s who are cognitively just fine. So that's at least one important misconception that I'd like to clear up.

Host: Yeah, that is an important one. And then Dr. Dave, is Alzheimer's disease fatal?

Dr. Dave: I think it is, not directly fatal. It's not like cancer, for example, which is going to cause that on its own. But it has a lot of, complications that can come along with that. Complications being, for example, fall, urinary tract infection, aspiration, pneumonia, these kinds of things. So proper day-to-day care, as well as, proper monitoring, for these kinds of risk factors, would be important.

Host: And then Dr. Rhee, for someone diagnosed with Alzheimer's disease, what about clinical trials someone can participate in? Where would they find information about that?

Dr. Rhee: Yes. So the resource that I'd like to share is, from the Alzheimer's Association. They have, a matching survey to help people see if they, qualify for any clinical trials. So that address is www.alz.ord/trialmatch.

Host: Alz.org/trialmatch. And then Dr. Dave, what are some books someone can pick up to read about Alzheimer's?

Dr. Dave: I would rather suggest going through the Alzheimer's Association website. Have a lot of information separate from, that is American Academy of Neurology. Also, National Institute of Aging, NIA, has a lot of information about that. In terms of books, there is one book, by Mayo Clinic, that can be of, use. It's Mayo Clinic Guide to Alzheimer's Disease. And there is another one, 36-Hour Day. This one I have not read myself, but it is suggested as one of the top, in the list of, reading. But I would really, focus more on, authentic websites or authentic organizations like Alzheimer's Association, NIA, or AAN.

Host: And then lastly Dr. Rhee, are there any other resources someone can look into to find some help?

Dr. Rhee: Just to reiterate Dr. Dave's point, I definitely think that the Alzheimer's Association website is the primary resource. So www.alz.org. another really great resource is ServiceLink, that offers a lot of practical information about, logistics like potentially finding financial assistance for caring for a loved one who's living with dementia. That website is www.servicelink.nh.gov. So that would be another great resource.

Host: Absolutely. Well, Dr. Rhee and Dr. Dave, thank you so much for your time. This has really been informative and insightful. Thank you both for your time.

Dr. Rhee: Thank you so much for having me.

Dr. Dave: Sure, thank you very much.

Host: That's Dr. Jess Rhee and Dr. Sachin Dave. And for more information, please visit solutionhealth.org. And if you've 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 SolutionHealth Podcast from SolutionHealth. Thanks for listening.