Dr. Laurel Coleman, a geriatric physician at Maine Medical Center and eight-year member of the Board of Directors of the Alzheimer’s Association, was in San Rafael at the AlmaVia of San Rafael, an Elder Care Alliance community, recently to present Alzheimer’s Disease: Explored & Explained. The presentation was free and open to the public, and for the members of the community and health professionals in attendance it was a rare opportunity to hear Dr. Coleman speak and have her answer their questions related to the topic of dementia and memory care.
Here is a Q & A with Dr. Laurel Coleman, in which she shares her advice, based on the recent presentation she delivered.
What is dementia, and how does it differ from Alzheimer’s diseases?
Dr. Laurel Coleman: Dementia is a broad term. There are several aspects to our cognitive function (as such as abstract thinking, memory, perception, reasoning), and dementia is deterioration in memory as well as a noted decline in at least two other of those areas. So, dementia is different from normal cognitive decline we may experience as we age. Patients who experience dementia may have acquired it for different reasons - such as a brain injury, stroke or Alzheimers Disease which is the most most significant cause. Dementia means that cognitive function is impaired to the level that the person cannot function independently.
You called Alzheimer’s disease an epidemic, why is that?
LC: In the U.S. 5.5 million people are estimated to be affected with Alzheimer’s or other forms of dementia, although as many as half may not yet be formally diagnosed. With the rapidly aging population, that is projected to be 10 million in 10 years, and 16 million by 2050. Around the world, the estimate is that 35 million people are affected with dementia. In terms of the understanding of Alzheimer’s, there is a similarity to the way that cancer was understood 40 years ago. In the 1960’s it was thought that all cancers more similar than not. The hope was that research would find the one “cure” for all cancer. Today, the public has a better understanding of how different the kinds of cancers can be, and that research has provided many different treatments for the different forms of cancer. In time I think we will come to understand how different cases of Alzheimer’s can be, in how it progresses and is differently exhibited in patients. This lack of understanding of Alzheimer’s is in part because we have not invested in research in Alzheimer’s Disease significantly. Cancer, AIDS or heart disease all have significantly more money invested and this has paid dividends as far as treatment development. Currently our country spends one penny on research for every dollar we spend on care for people with dementia. Remember, Alzheimer’s robs you of being able to function independently, and when you need the help of others, like a caregiver, the condition is always much more costly – to patients, families and communities.
How is Alzheimer’s disease diagnosed?
LC: There is no definitive test, but physicians use a combination of the clinical history, family or caregiver report, and various cognitive tests that can be done in the office setting. It is not necessary to have a CT scan, but it is important to rule out reversible causes of dementia, such as medication side effects, endocrine or infectious causes. In the future we hope to have a test to detect the risk of Alzheimer’s before a person experiences symptoms, because once they do it indicates brain cells have already died and that deterioration has begun. However, we would also need a medication to offer at that point which would slow or prevent the onset of Alzheimer’s. Dr. Coleman, can you add a brief statement here about one of the first actions a family member can take if they suspect that a family member might have a form of dementia?
What can a person do to stave off the onset of Alzheimer’s?
LC: It is good to know and remember that whatever is considered ‘heart healthy’ can help keep the brain healthy, because of the role that our cardiovascular condition plays. This means not smoking, regular exercise, and medical therapies to reduce hypertension, high cholesterol, and diabetes. This specifically doesn’t prevent all cases of Alzheimer’s, but it helps the brain function better overall, and possibly fight off brain diseases more effectively.
What other advice do you have related to the issue of Alzheimer’s?
LC: The role of the family is so important- they are the first line of defense, so to speak, in early detection - more so than your doctor. If a doctor only asks a patient how they are doing, and the patient says they are fine, the dialogue can end there. That's not dementia-capable, or dementia-aware, primary care. Dementia can sneak up on families. Its sufferers are pretty adept at covering lapses early on, and spouses are sometimes there to compensate. Doctors too frequently are fooled as well. Family input should be mandatory. It's the only way to know if the person really is eating and taking her medicines as she claims, and not forgetting to turn off the stove. I am on a federal advisory council tackling the issue of dementia care and advocating for more research for treatments. The Alzheimer’s Advisory Council is trying to improve early detection of dementia and better care through the stages of the disease by promoting dementia-capable medical care. The rapidly growing epidemic of dementia requires us to change the health care system to better serve the patients and caregivers dealing with this devastating disease. I also deliver educational community talks, such as these done through the Elder Care Alliance, where memory care programs are offered at their communities in California.
Advance care planning is also important. California is a state that is very good about this, as there are many people here who are using advance directives (e.g. living wills). Alzheimer’s robs you of your judgment and insight, and when one has the opportunity to participate in the plan for their care early on in the disease process, they can have a say in how they want to be cared for while they're still capable of making those decisions. It can bring peace of mind for patients and families.###