Memory Disorders: Dementia and Alzheimer's Disease
We see most
patients with memory disorders dementia
is cognitive problems they're sometimes
referred by their primary care physician
who could be internal medicine or
psychiatrist. And we evaluate them for
their memory problems we see the patient
in addition to their family who provides
history.
We do history examination blood
tests and neuroimaging studies such as a
cat scan or MRI of the brain and then
come up with a diagnosis. I think it's
important to be evaluated for memory
disorders because there are some
reversible causes such as thyroid
disorders, vitamin b deficiency, sleep
apnea, and sometimes patients are taking
medications that can interfere with
memories so these are things that we
screen for in our clinic once those
things are ruled out then we look for progressive neurodegenerative disease.
One of the more common dementia and then
once someone is stable on the
medications that we already know are
effective. We offer participation in
research studies we're very optimistic
about these studies we're also moving
into prevention and trying to prevent
Alzheimer's disease for the first time
to participate in a clinical trial has
no associated costs or insurance claims, it's all covered by the sponsor of the
trial you do get additional tests and
medical care medical attention
by participating in a trial. And this is
also the first way to get access to what
we think is going to be a new medication
and a more effective medication it's
important to sign up for a clinical
trial because this is the only way we're
going to make progress in the field that
medications that we have now are not
that effective, and so, we're looking for
medications and treatments that are more
effective.
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We're also moving more into
the prevention realm so we're looking
for individuals who are at high risk for
Alzheimer's disease and starting
preventive strategies. I get a lot of
satisfaction from seeing patients and
their families. I think there is
definitely value in providing a
diagnosis and starting treatments I
think the research is very interesting
and very exciting. And I think we will
come up with more effective treatments
in the coming years. So I think this is the
aspect of the field that is really
exciting to me.
1. . What’s the difference between dementia and Alzheimer’s?
Dementia is the more global
problem with memory and thinking and
there are many causes of dementia which
we look for in our history and
examination and diagnostic evaluation, the most common cause of dementia in the
United States today is Alzheimer's
disease.
2. What is Alzheimer’s disease?
Alzheimer's disease is a particular form
of dementia that is characterized by
plaques and tangles in the brain that we
can see on animals a PET scan for example
it's a slowly progressive disease that starts
with memory problems from diagnosis to
the end of the disease takes to
years so it's gradually progressive
you can delay Alzheimer's disease.
3. What can I do to prevent Alzheimer’s disease?
Probably about five to ten years by
lifestyle changes for example
maintaining ideal body weight throughout
your lifetime physical exercise
cognitive activities social activities
Mediterranean diet and avoiding head
injuries.
4. What are the most common causes of dementia in the United States?
Alzheimer's disease is the most common
dementia in the United States the other
major dimension that we see in our
clinic is Lewy body dementia which is
the combination of cognitive decline
with parkinsonism Parkinson's meaning
slowness and stiffness and tremors
another major cause of dementia is
frontotemporal dementia so these are
different neurodegenerative diseases
that present in different ways and these
are the major three causes of dementia
in our clinic.
5. What is the value of getting evaluated for dementia?
There's value in getting a diagnosis
because as I mentioned there are
reversible or treatable causes of
cognitive decline with aging such as
thyroid disease and vitamin b
deficiency sleep apnea medications that
can affect memory so there could be
something very easily treated or
reversed in someone's memory complaint
and we also see patients who are anxious
and we call them worried well and we
often can tell them that they're
completely normal so their anxiety may
be alleviated we also start treatments
and I think the treatments are more
effective if given early and as I
mentioned we're looking for more
effective treatments and these also will
be most effective if given early.
6. What are the major risk factors for Alzheimer’s?
The major risk factors for all time
disease are our aging and family history
having a parent or sibling who's also
affected with Alzheimer's disease other
risk factors are less important but
things like having diabetes and being
overweight in midlife having
hypertension smoking having a history of
head injury these are other minor risk
factors.
7. When should somebody be concerned that memory issues could be dementia?
We all sometimes misplace things or
can't find the car in the parking lot
but what we're looking for is a pattern
of declining things that are getting worse
over days or weeks or months so not just
a single individual event or things that
are not changing over time but a
particular pattern of memory loss and
cognitive decline that's getting worse
over time and also beginning to impact
your daily life your ability to function
in your daily life.
8. Will my child get Alzheimer’s disease if I have it?
There's a particular gene called a
polite protein II and there are three
different kinds of this gene a bogie two
three and four and if you have the apoe4 which is about a quarter of the u.s. the population has then you're a higher risk
for Alzheimer's disease so in the
sporadic form of Alzheimer's disease
there is a genetic component so if your parent is affected your child
will have twice the risk of someone who has not affected or twice the risk of
someone who has the apoe4 gene.
9. When do you recommend genetic testing for Alzheimer’s?
There is a genetic test available for
Alzheimer's disease we included in all
of our research studies we don't
recommend getting a genetic test
clinically just because there may be
some discrimination in getting insurance.
10. How is Alzheimer’s disease diagnosed?
Alzheimer's disease is diagnosed by
taking a history from the patient as
well as someone who knows the patient
well, for example, a caregiver or family
member we also do a medical examination
or logic examination cognitive
evaluation do blood tests to rule out
blood abnormalities and do an imaging
study of the brain such as a cat scan or
MRI to rule out other causes of dementia
so we put together the history
examination and diagnostic evaluation to
come up with the diagnosis of
Alzheimer's.
11. What is mild cognitive impairment?
Mild cognitive impairment is often a
precursor to Alzheimer's disease we have
three categories of individuals who come
to our clinic those who are normal or
perhaps worried well those who have mild
cognitive impairment and these are
people who have memory problems but not
severe enough to impact their daily life
or daily function this often advances
into dementia meaning that
the cognitive problems are now
interfering with the ability to function in
their daily life.
12. What is prodromal Alzheimer’s disease?
We're now doing prevention trials and in
these studies, we're looking for the
individuals who are at the highest risk for
Alzheimer's disease for example we may
do an amyloid PET scan of the brain and
if this PET scan is positive that
suggests that Alzheimer's may be coming
in the near future and we can offer a
treatment an anti-amyloid treatment to
prevent the onset of Alzheimer's disease.
13. Is the anti-amyloid treatment FDA approved?
The treatment is an experimental
part of our clinical trials
there are four drugs that are already.
14. Are there treatments available now for Alzheimer’s disease?
Approved for Alzheimer's disease they do
have modest temporary palliative
benefits but they are better than no
treatment at all so we do offer these
drugs to our patients.
15. What are the promising new treatments in the pipeline?
We have many different strategies that
look very promising and exciting and
treating and perhaps preventing
Alzheimer's disease many of these are
based on anti-amyloid strategies either
promoting the removal of amyloid from
the brain such as anti-amyloid
antibodies and some of these treatments
are drugs designed to block the
production of amyloid we're also testing
a new experimental treatment here at
Georgetown repositioning a cancer
treatment drug which is already approved
for cancer and we're looking at the
effect of this drug in patients with
early Alzheimer's disease.
16. How does the already approved cancer drug help with Alzheimer’s?
We're testing a new drug
Georgetown it's a cancer drug that's
already approved and used for
individuals with cancer we think this
drug promotes sort of taking out the
trash or that these proteins that build
up in the neurons including the amyloid
protein this drug helps the cells and
the nerve cells in the brain get rid of
this amyloid by taking out with quote
taking out the trash.
17. Has this drug been tested in Alzheimer’s patients yet?
The strikes have been tested and a small
group of individuals with Parkinson's
disease which is a similar needed
neurodegenerative disease that also has
another protein that aggregates in the
nerve cells is called alpha-synuclein
and the drugs seem to have promising
benefits for patients with Parkinson's
disease so we think it will also have
benefits for people with Alzheimer's
disease.
18. How are Parkinson’s and Alzheimer’s similar?
Parkinson's and Alzheimer's are similar
in that they both have abnormal deposits
of protein in the brain that are toxic
to the nerve cells so we think that this
drug by getting rid of these aggregates
that are toxic will have benefits not
just for Parkinson's disease but also
for Alzheimer's disease.
19. Why should someone come to the Memory Disorders program at MedStar Georgetown for the diagnosis and treatment of dementia?
So an individual may be diagnosed and
treated with Alzheimer's disease and
then look for other opportunities for
example to participate in research and
we offer the largest most comprehensive
research program in dementia and
Alzheimer's disease in the Washington DC
and Baltimore area so we offer patients
and their families a menu of research
opportunities some of these may be one
visit testing a new diagnostic for
Alzheimer's disease and some of these
are clinical trials which may involve
another visit once a month for about a
year.
20. What can I expect as a clinical trial participant?
We try to make research
enjoyable and as easy as possible we
offer valet parking to our patients and
families we offer free lunch we cover the cost of transportation and we try to
make the visits as enjoyable as possible
the patients and their families become
very familiar with our staff and the
staff of the clinical research unit on
the main hospital building.
21. What is the age range of the people you serve?
Most of our clinical trials
look for older individuals who are
either completely normal for the
prevention trials or may have mild
cognitive impairment or diagnosed with
early stages of Alzheimer's disease most
of our trials are looking for
individuals in the range of years old.
22. What are you looking for in a clinical trial participant?
So many of our clinical trials are
for individuals with early or mild
Alzheimer's disease they're still very
functional very aware can make their own
decisions but they're just been
diagnosed with Alzheimer's disease so
they do have some mild dementia problems
with memory that's impacting their daily
function so these are the type of
individuals that we're looking for to
join our clinical trials
I think in five or ten years it'll be a
very different picture than we have now we diagnose someone once they have
Alzheimer's and we start medications.
23. How do you envision the future of Alzheimer’s treatment and care?
That are only modestly effective in five
or ten years we'll be doing a lot more
screening and finding individuals at
very high risk for Alzheimer's disease
and starting preventive treatments that
will be much more effective than we have
now
so I think it'll be a very different
picture in five to ten years compared to
now.
