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Melanie Cole (Host): Each year, more than 6 million Americans are diagnosed with a neurological disorder. When your loved one is diagnosed with Alzheimer’s disease, many questions come to mind. My guest today is Dr. G. Peter Gliebus. He’s a neurologist with Lourdes Health System and the Director of the Cognitive Disorders Center at Drexel Neurosciences Institute. Welcome to the show, Dr. Gliebus. Who is at risk for Alzheimer’s?

Dr. Gliebus (Guest): Thank you very much. Thank you for having me. The people who are at a high risk of developing Alzheimer's – we frequently classify the risks into the genetic risks and the environmental risks. Genetic risk factors – the true genetic Alzheimer’s disease is really very rare, meaning it runs in each and every generation, but there are some risk genes we are aware of that can increase a person’s risk of developing the Alzheimer’s disease. We usually, on a clinical basis, do not test for those gene because having a gene does not guarantee developing the disease and as well as not having those genes does not guarantee that the disease will not occur. The way we understand right now it is probably a combination of the nature-nurture with having, again the environmental factors which could increase the risk of developing Alzheimer’s would be our usual cardiovascular risk factors which need to be addressed such as high blood pressure, diabetes, high cholesterol. There is more and more data coming showing that people who are not physically active might be at increased risk, or at least the increased physical activity might decrease the risk or slow down the disease progression. Again, there is some data pointing out certain types of diets that may be protective against Alzheimer’s, such as Mediterranean-type diet with a significant amount of fruits, vegetables, fish, healthy oils. Recently it came out of one report that people living near expressways might be at slightly higher risk, but again, that’s probably, at this point no reason to panic regarding that.

Melanie: Dr. Gliebus, what are some red flags that a loved one or someone might notice in themselves that would even send them to be diagnosed.

Dr. Gliebus: The typical – the classical presentation of Alzheimer’s disease is worsening memory. Now, many people have this benign forgetfulness and especially people after the age of 50. Frequently it is difficult to differentiate, at least initially, or for people who are not professionals, whether the forgetfulness is benign forgetfulness or whether it actually could signify the development of the disease. The benign forgetfulness as we frequently refer is just intermittent forgetfulness, or the information comes back to the tip of the tongue situation when people have some difficulty recalling, but again it comes back. When it goes a little bit beyond that, the person actually needs to be evaluated.

Melanie: And what’s involved in the evaluation? How do you diagnose Alzheimer’s disease?

Dr. Gliebus: First, probably one of the very important steps in diagnosing Alzheimer's disease initially is to exclude that we’re not dealing with some mimics of the disease or conditions which can present with forgetfulness. Very frequent conditions which can sometimes present with forgetfulness sometimes would be mood disorders, such as depression and depression has to be treated and when we treat depression, then frequently the forgetfulness improves as well. We also have to exclude some nutrition abnormalities or endocrine abnormalities which also can present with some cognitive complaints. If we do exclude all of these factors then the next step would be to do a more thorough cognitive evaluation and frequently it would start with an in-office test, which sometimes can lack the sensitivity. And then we in that case would proceed with a neuropsychological evaluation, which is an objective memory and cognition evaluation. We have norms how people at a certain age, with a certain education level are supposed to perform and then we can see if actually they are slipping somewhere in the more impairment range. The other thing is very important is to make sure that overall neurological diseases, the symptoms depend not on the disease process itself, but on the localization of the process in the brain. We want to make sure that actually the forgetfulness is present and -- forgetfulness, I’m referring to forgetfulness because It is the most frequent symptom and sign of the disease, at least initially – that we exclude any other conditions that could present like that, such as stroke, such as brain tumors. Anybody we see who has a memory impairment, or a cognitive impairment, they do deserve to get their Brian scanned to exclude any other conditions. If we still have any questions or doubts we can proceed with more specific testing such as evaluating how the brain is functioning, how it is utilizing the glucose and are there any areas of the brain which have decreased usage of glucose, which would point to certain pathologies. Other specific biomarker studies – biomarkers meaning that we try to identify the very specific biochemical changes that are associated with a disease. Alzheimer's diseases we would check for – to get the special scan, looking for the amyloid which is one of the components of the disease – biochemical markers of the disease – or we can perform a lumbar puncture, also known as spinal tap and check for specific changes which would be seen with Alzheimer's disease. That would be a very, very general overview of diagnosing – evaluating someone who we may suspect be having Alzheimer's disease.

Melanie: So if you do suspect that and you do diagnose someone with Alzheimer's, what do you tell their loved ones, and this patient every day, Dr. Gliebus about what to do next and what they can expect and how to give them hope that things will progress the way that they will, but there are things that they can still look forward to?

Dr. Gliebus: Sure. One of the things we try to address first is the safety issues. I talk with the person who is diagnosed with Alzheimer's disease and their family and dangerous situation where they -- because of their deficit – might appear to be in. For example, one of the things we always try to address is finances. Is the person still responsible for managing for their own, or the family finances and that as the disease progresses, the ability to manage the finances will also decrease and the other family members, or caregivers have to come in and start helping or at least initially supervising to make sure there are no mistakes. Another thing we address is the medication management because people if they forget they already took their medications they might and overdose and they might put themselves into a dangerous situation. At the same time they miss taking the medications, so somebody has to at least initially peripherally, but then to become more proactive in their medication management. The next step we talk about is driving because driving requires very significant cognitive work in order to drive well and if the person has some trouble might put themselves or anybody else on the road at some risk. So when we address the safety issues, because these are very important, then we talk what can a person do in order trying to prolong their independence, or prolong their functionality and that is to make sure that they’re physically active. Physical activity is very important and there is more and more scientific data showing that older people who are exercising or physically active actually maintain their cognition for a longer period of time. Another thing is that overall, the staying cognitively active, and it’s very personal, you have to know the person personally in order to come up with a plan, whether it would be joining some book club or any activity which might make people active. The social activity, social interactions are very important because when we are socially active our brain is on fire because we have to understand what’s happening around, we have to inhibit inappropriate responses, we have to formulate our thoughts. We want to make sure that there are no underlying mood issues, or at least initially after the diagnosis, we follow people to make sure that they would not going into the depression or anxiety, which would worsen the quality of life, address that. Another thing, obviously this is not a disease, which we have a disease with defined treatment meaning we cannot stop it from progression or we cannot reverse it, but there are available clinical research which is a hope -- and could give hope to the patients or to their families – to talk about whether they would like to be involved in any clinical research, trying to find that treatment – meaningful treatment for their disease.

Melanie: And what do you tell the caregivers about taking care of themselves? In just the last few minutes, please give your best advice for caregiver stress and what you tell these people who love someone who’s just been diagnosed with Alzheimer's, what you want them to know about managing life with this new person.

Dr. Gliebus: One other very important thing is for the caregiver to actually understand that if they don’t take care of themselves and they fall ill because of that, whether it would be mental or physical illness, they would not be able to help for their loved one as well. Helping yourself, taking care of yourself is very important. Making sure that if there’s a main caregiver that they get some help from somewhere, that they have time off from the caregiving, they have time off for their own personal – whatever hobbies or they would have their free time. Another thing they should take care of themselves as well because this disease is not only a disease of the patient, it’s a disease of the whole family, or the whole social network. They have to take care of themselves the same, staying physically active, taking care of their health, that is very important. So when the caregiver understand, internalizes that, they actually become proactive trying to create that plan how to help themselves and how to keep themselves healthy.

Melanie: Well, it is so important to have a plan and thank you so much, Dr. Gliebus for being with us today. It’s really great information. You’re listening to Lourdes Health Talk and for more information you can go to Lourdesnet.org, that’s Lourdesnet.org. This is Melanie Cole, thanks so much for listening.