This article is a transcribed edited summary of a video Bob and Brad recorded in October of 2021. For the original video go to https://www.youtube.com/watch?v=ILW0JKUGfBc
Brad: Today, we are extremely happy to have Chris here to compliment and upgrade our show. We've got some very good information that's going to be helpful for you as well as for me personally, about Alzheimer's and we're talking about treatment.
Chris: Treatment.
Brad: Treatment you can do medically as far as medications that are offered as well as what you can do without medications that can help hopefully slow the disease process down and help out your loved one, or your friend, whoever you may be interested in helping with. So before we go on any further, we need to go to Chris because I'm going to relax a little bit.
Chris: Alright, well, I guess we're going to talk about Alzheimer's today and it's more about the treatments. Basically, Alzheimer's is the most common form of dementia worldwide. So we're talking about 60 to 70% of the patients. In the U.S., you're looking at about 5 million patients.
Brad: Wait, 60 to 70%?
Chris: 60 to 70% of dementia patients have Alzheimer's.
Brad: Oh, I see.
Chris: Then the next one is Lewy Body, and then there's vascular dementia, temporal frontal, there are several forms of dementia. If we think about it kind of like an umbrella term, but we're going to talk about Alzheimer's because I think it's the most prevalent.
Brad: You said there are more women typically have it than men?
Chris: Yeah, kind of interesting just from a statistical standpoint, it affects women more than men. So, for women, the ratio is about one in six, which is about 16%, and for men, it's one in 10, which is about 10% of the population may experience that. Again, with Alzheimer's, it takes six years just to get the diagnosis because we have to rule out several different things. It's going to be whether, your medications are causing it, had a head injury, or a mini-stroke. I mean, these are things that we have to be aware of.
Brad: And it seems like oftentimes early on, especially memory is the biggest symptom of Alzheimer's, but it can be symptomatic with other things.
Chris: Exactly.
Brad: So that's why it's hard to define what it is.
Chris: When you're busy and you just, you know, where'd I put my keys, I have no idea, why are they in the bread box? It doesn't make sense.
Brad: As I mentioned, I literally put my socks in the refrigerator and I don't think it was a symptom of Alzheimer's, it’s because I was thinking about what I was doing at one o'clock in the afternoon and I was trying to get lunch, you know, all that kind of thing. So again, it's not easy to diagnose.
Chris: And that's what makes it so tricky for doctors and neurologists to actually diagnose it.
Brad: Sure.
Chris: So there's a variety of tests that they kind of go through. One of the simpler things that are done, that's inexpensive is the SAGE Test. So the big fancy term, Self Administered Gerocognitive Examination.
Brad: So S.A.G.E. Is this something that you could print off right off the internet?
Chris: I printed that right off the internet. It's from The Ohio State University.
Brad: So I could print this off, I could take this home, and do it with my mother tonight.
Chris: Yup, you bet. It takes about 15 minutes and then basically, you can present that to your doctor. Then basically as scientific as you could, probably do it about a year apart or six months apart, so you have an interval to see if there's any decline going on. You don't have to do the same test all the time, although scientifically, it's probably going to be the best.
Brad: Sure, because then you can compare historically how things are going. And I just want to say, if you do this, for example, I know my mother, she would have a hard time reading this because of her vision, so I would help her. And some of these questions on here, I would probably have to explain to her a little bit about it so she understood it and that's okay. You can make little notes on the back, so that later on, six months later, you kind of know where you're at.
Chris: And sometimes, you can even set this up so that it's part of your appointment. So let's see, you're going to be seeing neurology. You do the test right before you go in or as you go in and then the doctor will grade your results and then they'll get at least a baseline. So, this is something that's inexpensive. It requires just a printer and a pencil and some paper. So it's something that's nice that you can definitely do and it doesn't cost an arm and leg, whereas a PET scan is an expensive test.
Brad: Sure.
Chris: So, when we come down to it, they're going to do cerebral spinal fluid tests, they're going to do PET scans to see what's happening in the brain. I mean, Alzheimer's is caused, what we think anyway, is by these amyloid proteins and these tangled tau proteins. If you think about our brain, it's a network of nerves and then when we get these damaged tau proteins, it's kind of like if I took a bunch of spaghetti and tried to make order out of it. And those brain signals don't necessarily communicate properly.
Brad: So, they get mixed up.
Chris: They get mixed up, so you're trying to follow one noodle, and all of a sudden, you're looping all over. It's the same thing with the way that your brain fires. And so what do we do? Well, we can certainly eat well, we can exercise, and try to stabilize sleep, but there are medications that we can try and use. There are not a lot of them out there. So it's a pretty short list. So you have Cholinesterase inhibitors and then you've got the Glutamate
Brad: So there are two medications commonly used?
Chris: Well the two that I most commonly see in the pharmacies that I work in are going to be donepezil and Memantine. So, they behave differently, but there is also Galantamine and Rivastigmine but well keep it simple. We'll use those two, donepezil and Memantine, because those are the most widely prescribed drugs and sometimes, they're used separately, and sometimes they're used in combination with one another.
Brad: And the physician decides?
Chris: The physician, yeah. When do you do this? Well, we've found that the earlier you get on these medications, the better, because, again, no cure, like we talked about, but it does put the brakes on. So instead of it coming down sharply, it's going to be a much more gradual thing. And so what does that do? Well, because we know that the average caregiver spends about five hours a day with the patient, it may allow the patient a little more freedom, a little bit more independence. And maybe a time occurs when something miraculous does happen. There are a lot of things in the research pipeline right now that they're discovering, there's a new, very expensive drug that at least it's out on the market, it's very expensive, it has not been proven to work, it's actually got the emergency authorization, kind of like the COVID vaccines, but we're not going to go in that direction. It got out on the market a lot sooner than it normally would. I mean, the ultimate results of this drug are not going to be fully processed until 2030. So it's 2021 right now, so that kind of tells you, that it's a very embryonic process with learning, it's called Aduhelm.
Brad: Yeah, because it's so far in the future, can we go into what you mentioned about food and diet? I'm thinking let's look at the diet because I was looking at some of this and as opposed to just good food, let's be more specific like you're going to eliminate or cut down on processed foods.
Chris: Sugars.
Brad: Sugar is, the big one, get those darn sugars out and yogurt has as much.
Chris: Oh, yeah!
Brad: You can buy yogurt and it has as much sugar in it as a can of soda, Pepsi, or Coke, whatever. So you really have to read the labels on what you're eating because sugar is in everything. Everything is processed, sugar and a bunch of the fat, the bad fat, trans fat, so boy, get after the food. It doesn't matter, it's going to make the person's body healthier, even if in theory, it doesn't help the mind, it's a good thing.
Chris: Yeah, I mean, it's going to do all over it. I mean, really the time for this is probably now. You don't want to wait until you get to that point to just get started with healthy habits. If you're young enough, start today. I mean, really one of the simplest ones that I liked, is the Mediterranean diet, if you Google the Mediterranean diet, it's got a perfect blend of proteins and healthy fats and, nuts and things.
Brad: Leafy greens like spinach.
Chris: Exactly. So, it's going to give you that type of diet and pretty flavorful food, to be honest with you.
Brad: I know I just heard one thing, and I've heard this and read about it in books is, the color of food is important. So you have your berries, your raspberries, blueberries, blackberries, all these berries, and nuts, and you're not going to overeat them. You're going to eat a handful or whatever, and that's enough.
Chris: Yup, eat the rainbow. I mean you can have the flavonoids, they're all antioxidants which seem to show, and there are actually quite a few books now that do show that by eating well, does help to slow the progression of the disease. So again, it's going to be healthy for you, whether you have it or not. I mean, if you're talking about one in 10 or one in six, male or female, so not everybody's going to get it, but eating well is still something that we should strive for every day anyways.
Brad: It's going to help your heart for sure.
Chris: Yup, exactly. And that's actually, when you look at the list of things, cardiovascular disease, and cancer are one and two, Alzheimer’s, on the cause of death, is number six for older adults. So what happens is, again, it progresses from mild to severe, but along the way when we get to those milder stages and probably earlier is when we want to get on those medications. And so whether it's Donepezil or it's Memantine, those are the things that work differently to help brain transmission and the processing of memory. But I will tell you with Donepezil specifically, which is a Cholinesterase inhibitor, so for all you pharmacy nerds out there. It raises the neurotransmitter acetylcholine and as our brain's diminishing capacity, it helps to keep those levels up, to allow them to fire longer, but eventually that reservoir does run dry. So sometimes then they will go to, the Memantine, which works on glutamate, which is a different neurotransmitter, and actually, the brain seems to kick out too much, so what the Memantine does, is it kind of blocks that, so it leaves just the appropriate amount of glutamine in there.
Brad: So you're trying to get things balanced in the brain?
Chris: You can get so you can connect your thoughts and you can stay in the moment a lot more easily. And so these drugs do have an avenue and they seem to work best right now with current science, in the milder stages. We might find that with more advanced testing, which they're working on that we might see that they may be being prescribed to younger and younger people. We might just take some blood from you Brad, and just say, "yeah, we're going to look at this, and we've got these three genes here that suggest that maybe there's a possibility." Preventatively, maybe they'd do it. So hard to say there's a, there are just burgeoning amounts of research going on day to day, right now. So, it's not that there are a lot of different treatment things. So it's going to be staying well, and in your arena, physical therapy, and what can we do to keep those muscles strong, to keep us walking safely.
Brad: And really you don't have to go out and do a 5K, these people are typically older. That's not appropriate anyways, but just some walking, whether you need a walker or a cane to stay safe because of falls, obviously we want to eliminate that risk.
Chris: Absolutely.
Brad: Memory things. I just want to say, there are some things, if you do have a loved one, they're walking fine, but they may forget how, like where my mother lives, she has issues, it's possible she has Alzheimer's, um, if you forget how to get to the dining room. So, you're going to walk with them multiple times so that hopefully the repetition is going to kick in. The brakes on a walker, the four-wheeled walker, we've done a lot of things in skilled nursing facilities like this, in big letters have a note "REMEMBER TO LOCK YOUR BRAKES" and we would tape this right to the walker, so the person can always see it. That repetition, repetition is one of the things that can help people remember and make them safer. A note that says, "Hang up the phone," you know some of these older people don't have cell phones, like my mother, she's got to have something she can hang up, but she forgets to hang it up and it just beeps and then there's a problem. These are just examples. Again, all these little things that you can do to help slow the process down and keep your loved one safe.
Chris: Yeah, it's going to be, getting rid of clutter, keeping things organized, whiteboards and big checkout lists or calendars are an excellent non-drug tool that honestly probably almost more utility than even some of the medications at some points.
Brad: How about throw rugs, man, that's a therapist's worst enemy. That's a big thing, get the throw rugs out because they're one of the biggest tripping hazards there is in a house.
Chris: Absolutely. Head injury, hip injury, you name it, whatever can happen in a fall. There's a coffee table and you probably want to lose those too. I mean, that's just so that we keep things out of the way.
Brad: And that can be a tough one because, like my mother, there are some things we asked her to do, and she says, "nope." Been doing it for all my life this way and I'm not going to change and that's just the way it is so that you have to kind of dance around the best you can.
Chris: That is true and then you have to pick your battles, I think is probably the answer, but whatever we can do to de-stress, declutter, help around the house, pay bills, I mean, auto-pay, financial affairs in order, these are all things that are part of the treatment mechanisms. And so those are things that you can certainly do.
Brad: Exactly. And just to finish this out, because it is a progressive disease, if they definitely have it, there's going to be a point where you are unable to care for your loved one or friend. There is going to be a time that they're going to have to go to a facility where there's professional care, 24/7 assistance to make it safe for them. And that can be a real battle as well because the person, often times does not want to leave their house. You don't want to make that decision for them. It's a very challenging situation.
Chris: It's knowing when to punt is a hard question to ask yourself.
Brad: It's a tough thing to work with and hopefully, you won't have to deal with that, but sometimes it goes smooth. I know with my mother, it went smooth, she was happy to go to this place, she's social. This is another big thing, you have to be social. Get that interaction. Isolation can be one of the big problems.
Chris: I think it is, yeah, so anything you can do, stimulating: games, talking, walking, anything you can do to stimulate the brain, all good stuff.
Brad: That's right. Alright, so these are some ideas, again, look below the video, there'll be some options, books you can read, other sites, and websites that you can go to for further information. So very good, good luck with your friends and family who may have these problems. Thank you.
Chris: Thanks, everybody.
Additional Resources
Alzheimer's Association: https://www.alz.org/https://www.lbda.org/
Family Caregiver Alliance: https://www.caregiver.org/
Dementia Mentors: https://www.dementiamentors.org/
Memory People Facebook Page: https://www.facebook.com/Memory-People-126017237474382/
Alzheimer's & Dementia Alliance of Wisconsin: https://www.alzwisc.org/
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