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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.

Memory Disorders: Dementia and Alzheimer's Disease
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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.