Transcription:

Melanie Cole (Host): Worldwide, around 50 million people are living with Alzheimer's and other dementias. Today, we're going to explain a little bit about what Alzheimer's disease is, the signs and symptoms and how you can support someone who is suffering from Alzheimer's disease.

Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and joining me today is Susan Howland. She's the Program Director of the Alzheimer's Association California, the Southland Chapter. Susan, I'm so glad to have you with us today. As we get into this and people hear Alzheimer's, they're not sure about this umbrella, that, that it's under what all these dementias are. But before we get into that, is memory loss just, is it a normal part of aging? Is it something that's inevitable or is this really something kind of special and unique?

Susan Howland (Guest): So I'd say memory loss, maybe I wouldn't use the word loss as much as changes. So, memory change is normal, as everyone grows older. It might be harder to find that word, tip of the tongue syndrome, completely normal. Something with Alzheimer's or dementia, that is not a normal part of aging and it actually spans beyond just memory changes or memory loss.

Host: Well, then tell us the difference between Alzheimer's disease and dementia. We hear these two words and I mentioned the word umbrella before. Tell us a little bit about how these all fit in together on the spectrum of memory loss conditions.

Susan: Absolutely. And it's probably one of the most commonly asked questions that I hear on pretty much a daily basis. So, when you talk about dementia, it really is that catch-all phrase that describes changes in cognition, typically changes or decline with memory, language, communication, organization. When I say dementia, it just tells you what those outward symptoms are.

It's not telling you what's causing it. So, if I were to sneeze right now, we would all recognize that I sneezed, but we wouldn't know why I sneezed. Was it that my house is dusty. I have an allergy, perhaps I have a cold. So, when we talk about Alzheimer's disease, that is a biological change in the brain that is causing decline or changes in cognition. So, some people actually have what's called a vascular dementia. So, that might be a disruption of blood flow and function to certain parts of the brain. So, that's the biology that's occurring that's causing these dementia symptoms.

Host: That was an excellent explanation. So, I think one of the bigger questions is this, is there a big genetic component to this? Is it hereditary? Is it random? Are there risk factors, behaviors, lifestyles, anything that contribute to our risk of Alzheimer's disease and Susan are women more at risk than men? And if so, why do you think that is?

Susan: Oh, my gosh. That is just a huge question that you've asked me. So, we do know that there are some genetic components that might put an individual at increased risk of developing Alzheimer's disease. There are say mutations on certain genes that tends to occur in individuals when they're younger and it tends to be fairly rare. So, most individuals develop Alzheimer's disease after age 65. And it seems to be a little bit more sporadic. There's not necessarily a mutation on a gene as with say, Huntington's Disease where somebody is automatically on that path. So, risk factors is a huge area of research right now, and it's actually really exciting.

This Alzheimer's is a disease that we don't have a cure. Medication is pretty limited at this point and we don't have really well-defined ways to reduce our risk. Currently, some of the research is looking at the role of cardiovascular health. So, that ties into exercise, a good diet, staying socially and cognitively engaged. So, the Alzheimer's Association actually funds a couple of really exciting studies that are looking at the role of lifestyle and lifestyle improvement in benefiting cognition in the brain and later life.

Host: Oh, that's so cool. I'm an exercise physiologist. So, I will be fascinated to hear those results. And will you come back on with us once you get those? Because we'd like to hear how those studies come out. That would be very exciting information. Now as we talk about symptoms, stages, diagnosis, all of those things, it's pretty scary. I'm 57 Susan. So, if I can't find my keys, I start right away and I go into that bad place. What symptoms would send up a red flag that would say, you know what, we may need to go see somebody and get this at least looked at, you know, and even TV shows like This Is Us. They started showing mild cognitive decline, you know, impairment. And we were looking at the symptoms. Tell us those symptoms so that we have an idea of things that are different from normal and that are really red flags.

Susan: So, I think one of the greatest challenges with Alzheimer's disease is it's actually the biology that's changing, you know, the structure of the brain is occurring anywhere from 10 to 20 years before somebody is exhibiting symptoms. So, a really interesting area and research is really looking at how do we identify individuals with the biology that's occurring before they are symptomatic and then how can intervention occur so that person does not progress or those plaques and tangles can be pulled from the brain. So, that's one thing. So, a lot of the signs and symptoms are really gradual and as the average person, we often make excuses for some of the signs and symptoms that we see, and we don't necessarily see them as red flags.

But you would look at what is that person's baseline and what are changes from that person's baseline. So, somebody that used to be a fabulous cook, maybe their famous chicken casserole is coming out and the chicken is still raw. Or the famous chicken casserole that, the fabulous cook could whip up and 30 minutes is now taking three hours. It could be problems with short-term memory. Remembering not necessarily what I just ate for breakfast, but even if I ate breakfast. It could be difficulty in learning new tasks or new activities. So, I have had individuals who have been fired from their position because they could no longer perform those tasks and activities. When in fact it was the presence of some of those dementia or Alzheimer's symptoms. It's going to be a little bit different for everybody. And we do have a list of the 10 warning signs on our website, but it's really changes in somebody's baseline that start to interfere with day to day life.

Host: Well, that's really good to know. Great way to describe it. So, tell us about any exciting advances that are made to treat some of the symptoms. You said there was no cure. Is there anything for slowing the progression and we're going to talk in a little while about, maybe some things that we can try at home to optimize functioning for our loved ones, but are there some exciting advancements or anything on the horizon you'd like to tell us about?

Susan: So, the good news is, that the pipeline is filled with research around how we can treat, reduce one's risk and you know, ultimately cure Alzheimer's disease. So, that's the good news. Kind of the less good news is there's not a lot currently on the market. So, historically there's been, you know, a collection of medications that really just treat the symptoms.

They're almost cognitive enhancers, so they don't change or slow or modify that biology of the disease in the brain. But somebody might be able to engage in life a little bit more, you know, kind of function a little bit better. Recently over this past summer, the FDA did approve in an accelerated approval process, a medication called Aduhelm. And this is the first medication that has been approved by the FDA that is reasonably likely to have clinical benefit in a person with Alzheimer's by addressing some of those plaques that are present in the brain.

Melanie Cole (Host): How exciting. So, as I said, I was going to ask you about this. Cause we hear about antioxidants and it's been shown that pills with more antioxidants do not really help with that neurocognitive decline. So, what foods, are there any foods, are there supplements that can help fish oil, resveratrol, caffeine, Gingko biloba? You know, we've heard about a lot of these things. Vitamins supplements, B12 and folic acid. Do any of these help at all? Do they help to slow the progression or to even help with some alertness during episodes? Tell us if any of these things have any merit to them.

Susan: So, it's really a bit, again, you've, you're asking really big questions and we always encourage individuals to speak directly with their physician, because anything also has a good, but a bad side to it, a pro and a con. So, always work with your physician when individuals are considering adding supplements or vitamins or changes to what they're consuming. In terms of slowing or modifying that biology of the brain, nothing really has shown to do that in terms of supplements or vitamins or food.

If you want to talk more about risk reduction, food seems to have a significant role. So, individuals who are more likely to consume what might be called, you know, a Mediterranean diet seem to do better on memory and thinking tests. And I guess the other piece is we just don't know yet. All the research is no in.

Host: That makes sense. And that's a perfectly legitimate way to answer this. And it is so important that we discuss this with our providers. Now, I'd like you to speak about the caregivers, if you would. And even to give us some behavioral strategies that caregivers, that their loved ones can help to work with their loved ones at home to optimize some functioning, but also about self-care for the caregivers, because this not only takes a toll on the patient themselves, but all of their loved ones, because it's difficult to deal with sometimes.

Susan: And I think most of us do not plan or train or prepare to be a family caregiver. So, oftentimes when we are in this role, we're caught off guard, feel unprepared and frequently overwhelmed. And we do know that family members, friends, neighbors, that kind of informal network we all have, that really is the backbone of the longterm care system.

So, most people do receive their care from individuals that they know. And it's a real challenge because when somebody experiences say at acute condition, say a broken hip, appendicitis, family members can come in and rally for two weeks, four weeks, six weeks. And that's it. They're done. But when we talk about something like Alzheimer's disease, we're talking about years, four years, six years, 12 years, again, it's going to vary and it's a very physically, emotionally and financially draining role for a family caregiver.

So, we oftentimes really want to focus on maintaining that caregiver so they don't burn out. Things such as self care, taking care of themselves mentally, making sure that they go to the doctor, making sure that they take time out for themselves, is really very important. But oftentimes your average family member will put their loved ones needs as a priority over their own.

So, it really is important for all of us to remind family caregivers, to take a break. Do some deep breathing, whatever it is that they enjoy. In terms of like a caregiver managing that day to day life, it really is also very challenging. Family caregivers will say every day is different. Some days he's great. Some days he's different. I didn't think he'd be reacting that way. So, it's almost as if they're on a constantly changing playing field. So, some things that really help, routine, making sure that individual living with Alzheimer's disease has some type of routine. It doesn't have to be military precision, but loosely the same activities and the same flow every day seems to help.

We also know that caregivers need education. So, family members, like I said, we're not really trained to be caregivers. So, how do I manage when my spouse doesn't want to change his clothes for the fourth day in a row. So, being able to support, kind of that emotional support, but also those practical tips, really facilitates that day to day living and also their ease and kind of comfort in that caregiving role.

Host: This has been such an informative episode. Susan, wrap it up your best advice, what you would like people to know about Alzheimer's disease and really even the Alzheimer's Association. Tell us a little bit about that and your best advice.

Susan: So, I mean, the Alzheimer's Association is the leading voluntary health organization for Alzheimer's as well as all dementia and anybody who has a concern, what are these changes I'm experiencing? How do I manage this behavior? What is going on in the area of research? I just strongly encourage anyone to reach out to the Alzheimer's Association. We have an incredibly complex website. We are what we call full mission. So, we work in areas of advocacy, research, increasing awareness, providing care and support, and we have a 24/7 helpline. And that is for I'm overwhelmed, I can't take one more day to something as simple as could you send me the 10 warning signs?

So I encourage everyone to reach out to the Alzheimer's Association sooner than later, and get linked in to programs and services.

Host: Great information. Susan thank you so much for joining us today and sharing your incredible expertise and passion with us for this devastating disease. Thank you again. And to learn more about Alzheimer's disease, you can always visit alz.org, that's alz.org. And of course you can visit Henrymayo.com for more information, and get connected with one of our providers and listen to podcasts. We have so many great ones in our library. And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for listening.