“Where Are My Keys?” Understanding and Treating Alzheimer’s Disease in the 21st Century
The San Diego Psychiatric Society, in partnership with the San Diego County Medical Society and the UC San Diego School of Medicine, presented a panel on Feb. 25, 2010, titled: Understanding and Treating Alzheimer’s Disease in the 21st Century. The distinguished panel included Douglas R. Galasko, MD, Lisa Snyder, LCSW, John Daly, MD, and Dan Sewell, MD. Steven A. Ornish, MD, served as panel moderator.
Each of the speakers was allotted 10 minutes for their presentations, followed by a question-and-answer session from a diverse audience of physicians, students, and the public. Dr. Galasko, the first speaker, stressed the importance of proper and early diagnosis of dementia. Risk factors for Alzheimer’s disease include aging, genetics, head injury or loss of consciousness, and atherosclerosis. Dr. Galasko made the point that memory loss is not always due to Alzheimer’s disease, since delirium, depression, anxiety, and prescription medications can all cause cognitive impairment that can mimic Alzheimer’s disease. Although diagnosis of Alzheimer’s disease is primarily a diagnosis of exclusion, a PET scan can be diagnostic of Alzheimer’s. Although there are tests and imaging studies that can provide a definitive diagnosis of Alzheimer’s disease, these are for research purposes and currently unavailable to the general public. Dr. Galasko also pointed out that the common “tip of the tongue” phenomenon is due to a problem with retrieval and not necessarily indicative of early Alzheimer’s disease.
Dr. Daly discussed how we are living longer as a population and that the fastest demographic are individuals 85 years old and older. Since age is a risk factor of Alzheimer’s disease, the prevalence of Alzheimer’s disease is increasing. Dr. Daly stressed the importance of a comprehensive history and thorough medical evaluation in patients presenting with cognitive impairment, since underlying medical problems are not uncommonly overlooked in patients presenting with dementia that can mimic or exacerbate Alzhemier’s. A work-up for Alzheimer’s disease includes a brain MRI, vitamin B12 level, a TSH, CBC, a chemistry panel, and an ESR. HIV and RPR tests should also be ordered when clinically indicated. Dr. Daly indicated that a healthy lifestyle of diet and exercise might be protective.
Dr. Sewell, an expert psychopharmacologist in treating patients with Alzheimer’s, stated that San Diego is on the cutting edge of research in Alzheimer’s and stressed the importance of making an accurate diagnosis when evaluating patients presenting with complaints of cognitive impairment. Dr. Sewell teaches family members to use “redirection” as a tool when dealing with a distraught, agitated loved one with Alzheimer’s. For example, should a female patient with Alzheimer’s become fearful and paranoid that her purse has been stolen (when, in fact, she cannot remember where she put it), he suggests simply distracting the patient from their fear and changing the subject (e.g., “That dress looks great on you!”).
Dr. Sewell believes that medications prescribed for Alzheimer’s, such as Aricept and Namenda, are overrated but became widely prescribed since, for the first time, physicians had a treatment. Although the benefits of these medications are modest at best, they also serve to “treat” the prescribing physician’s feeling of helplessness in the face of a chronic, deteriorating illness. Dr. Sewell emphasized that when considering acetylcholine esterase inhibitors and Namenda, one should be mindful of the Hippocratic Oath — Primum non nocere or “First, do no harm” — since the side-effects of these medications, such as insomnia, loss of appetite, diarrhea, and agitation, often outweigh their modest benefits. The goal is to optimize quality of life, and this can often be achieved through simple interventions such as insuring that the patient’s hearing and vision are optimized.
Ms. Snyder addressed the daily challenges of living with Alzheimer’s disease for the patient and family members. She spoke about the many “hues” of the illness and the challenge of “the long goodbye” for the patient and their family as the patient declines. When working with families and patients whose propensity is to focus on the losses, Ms. Snyder reframes the condition by emphasizing the many “hellos” that concurrently exist by highlighting the remaining possibilities. Although we may see the Alzheimer’s patient as “different” than we are, in her years of working with this population, she has come to appreciate how we are far more alike than different. Ms. Snyder’s book, Speaking Our Minds: What It’s Like to Have Alzheimer’s, describes the experience of Alzheimer’s from the patient’s perspective. Ms. Snyder’s book in press, Living your Best with Early Alzheimer’s: An Essential Guide, is a practical guide for people with early Alzheimer’s and their families.
Many questions and answers followed this esteemed panel’s presentation. Although risk factors for Alzheimer’s include aging and genetics, and while there are no proven deterrents, Dr. Daly pointed out that following a healthy lifestyle of diet and exercise is always a good bet!