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Caring for Alzheimer’s Disease

Alzheimer's is primarily a disease of aging, although it can occur in younger adults. One in 10 people over the age of 65 — and nearly half of all people over 85 — have Alzheimer's.

Roughly 5 million Americans have Alzheimer's disease and the prevalence of Alzheimer's disease is increasing, perhaps because of increased awareness of its symptoms or because people are living longer. Memory loss is the first and primary symptom of Alzheimer's disease.

In the disease's early stages, patients become forgetful — misplacing car keys, forgetting to take medications, not remembering how to drive to familiar places. As the disease progresses, patients often cannot remember what they did earlier in the day, or even five minutes before. In later stages, patients do not recognize loved ones and have difficulty taking care of themselves.

Listen as the experts from Cleveland Clinic give you the most up to date information on Alzheimer's and how to care for a loved one that has this disease.

We're Talking About Your Health with Cleveland Clinic!
Caring for Alzheimer’s Disease
Featured Speaker:
Jagan Pillai, MD, Cleveland Clinic Neurocognitive Specialist
Jagan Pillai, MD, PhD, recently joined Cleveland Clinic Lou Ruvo Center for Brain Health, specializing in cognitive and geriatric neurology. He obtained his medical degree from the University of Kerala and later trained in neurology at Albert Einstein College of Medicine. He further specialized in cognitive and geriatric neurology at the University of California San Diego before joining Cleveland Clinic. His specialty interests include cognitive changes arising from medical illness, including multiple varieties of dementia, Parkinson's and Huntington's disease.

Cleveland Clinic Lou Ruvo Center for Brain Health
Transcription:

Melanie Cole (Host): Alzheimer's is primarily a disease of aging, although it can occur in younger adults. My guest today is Dr. Jagan Pillai of Cleveland Clinic's Lou Ruvo Center for Brain Health. Welcome to the show, Dr. Pillai. Tell us about Alzheimer's disease.

Dr. Jagan Pillai (Guest): Thank you for having me. I am a neurologist, and I do see patients with Alzheimer's disease. It is a progressive degeneration of the brain that happens when cells of the brain die out faster than they need to because there's an abnormal protein being accumulated in the brain.

Melanie: What are some risk factors that might predispose someone to getting Alzheimer's disease, whether early onset Alzheimer's or later in life?

Dr. Pillai: That's a very good question. We broadly define early onset when people have symptoms under the age of 65. This is just a cutoff that's randomly put in based on people's working ages. Usually, with younger onset, genetics plays a strong role. If you have strong family history, that increases the chance of having Alzheimer's at a younger age. Sometimes it can happen randomly because of mutations in the gene. As you get older, there's a higher likelihood of Alzheimer's disease with the changes coming up. So age is a huge risk factor, along with some lifestyle habits. Having uncontrolled diabetes and hypertension and cholesterol sometimes makes the changes in your brain for Alzheimer's more prominent or earlier in their symptoms.

Melanie: Dr. Pillai, people are always wondering what the difference is between just the onset of dementia, an age-related dementia, versus Alzheimer's disease symptoms. What are we looking at that people might send up a red flag and come to see you?

Dr. Pillai: That's again something that's on people's mind. One way I try to answer that is that as we get older, we're still able to take care of ourselves independently, which means maintain a social life, do your normal routine, take care of yourself, go for walks or shopping, and taking care of your finances. If you're having difficulty maintaining your normal routine, not from physical problems but because of your making mistakes, it is time to consider a possibility that there are changes in your brain. A neurologist plays a role here in trying to figure out is this part of a disease pattern or is it just something related to do other changes in your life, from medical reasons or medication-related and things like that. So often, it's very hard to make a simple rule of thumb unless you see a progressive change over a period of time that would be of concern.

Melanie: And if it's a loved one, you're noticing things in them. What would you notice? Would you notice them forgetting things? Would you notice mood swings and changes that typically were not usual for this person?

Dr. Pillai: Again, that's something that we do come across. I tend to tell people that they can distinguish between two kinds of forgetfulness. One is immediate forgetfulness in which case you misplace where you had your keys, what you just did in the other room and you walked into a room and forgot why you're here. That's difficulty keeping track of things as they're going along. That's less of a concern as a sign for Alzheimer's. What we're more concerned about is when you're having difficulty holding information inside yourself. You're given some pieces of information, and 10 minutes later, you're still asking the same questions. This becomes a pattern throughout the day. That's more of a concern than having occasional episodes of forgetfulness to come on and off.

Melanie: What tests are available to find out if this is actually what you have? And then, if it is diagnosed, Dr. Pillai, what are the treatments right now that you've got?

Dr. Pillai: There used to be a concern that we cannot diagnose the Alzheimer's until you looked at the brain after the person has passed on. But that is no longer true right now. We can have a high degree of confidence in the diagnosis that this is from Alzheimer's, that the changes in [life has had] taken place. We tend to pursue such additional treatment when the person is young and working and they need to find an answer fast for making decisions for their life. As we get older, the probability of Alzheimer-related changes is so high that additional tests are more of a burden for the patient and family to go through them. So we tend to take patients in their context to suggest additional tests that are useful for them. Some additional tests to confirm Alzheimer's and right now, we have an amyloid PET scan, which measures amyloid protein, which is an abnormal protein deposit in Alzheimer's in the brain. We also have cerebral spinal fluid testing, where we put a needle in the back of the spine and take the fluid out and test for Alzheimer protein-related changes. Or we can also have a very high confidence of testing by detailed neuropsychology evaluation along with brain MRI measuring memory areas in the brain. So a combination of tests is usually used depending on the clinical context and the age of the person and other things going on. Usually, you need to have a discussion with the neurologist trying to figure out what's the right choice for you.

Melanie: So if this diagnosis comes out positive after you've done the neuropsychological testing and MRIs and your amyloid PET scan and spinal cord fluid testing and all of the different tests that you have available to you, Dr. Pillai, then what are the treatments? Is there a way to slow the progression of Alzheimer's?

Dr. Pillai: Absolutely. I think a clear diagnosis has a different role, say, from making a diagnosis of breast cancer. Making a diagnosis of Alzheimer's does not suddenly impact your life expectancy, whether you make the diagnosis or not. But it does cut down uncertainty in somebody's life as to why they're facing changes, why things are not the way they are. It also improves the chances of applying for social security benefits if you are very young and having these changes, because financially, planning for these things becomes very important. As far as treatment measures are concerned, there are clinical trials available for slowing down or stopping progression of the disease. But right now, medications that are FDA-approved just improve function in spite of changes in the brain. So they don't stop the disease progression but improve function in spite of the protein-related changes in the brain.

Melanie: So you're using the medications to manage symptoms and different medications for different stages of Alzheimer's, correct?

Dr. Pillai: That is true. There are FDA-approved medications that are used in mild functional changes from Alzheimer's or more severe functional difficulties from Alzheimer's.

Melanie: Dr. Pillai, caring for someone with Alzheimer's, can be very challenging. Please give us your best advice for the caregivers out there.

Dr. Pillai: I get asked this question often, I have some few tips I give them. First is understanding the disease, to make an effort to understand what the course of the changes are going to be. What you can expect in the future. Second would be giving more space to the person who is being affected with the disease, manage your expectations, and set reasonable goals for the person you are dealing with. Third would be, and most important, in my mind, would be safety. So people tend to make more mistakes and place themselves in situations that are dangerous and need hospitalization when they are diagnosed with Alzheimers disease, dementia. The safety precautions are important to be in place. The forth would be that you might need to have a medical care provider involved in the care of your loved one so they can help you make some decisions when things are out of control or you feel overwhelmed. And that's pretty much what I would say to someone who is caring for a loved one with Alzheimers.

Melanie: Thank you so much, Dr. Pillai. You're listening to Talking About Your Health with Cleveland Clinic. For more information, you can go to clevelandclinic.org/brainhealth. That's clevelandclinic.org/brainhealth. This is Melanie Cole. Thanks for listening.