January 10, 2012.
12:00 p.m. – 1:00 p.m. (EST)
- Tarannum Khan, MD - Neurologist
Alzheimer’s is the sixth-leading cause of death in the country and the only cause of death among the top 10 in the United States that cannot be prevented, cured or even slowed.
Cleveland_Clinic_Host: Today's Live Web Chat, "Alzheimer's Disease" with Tarannum Khan, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.
Cleveland_Clinic_Host: Welcome to our Online Health Chat "Alzheimer's Disease" with Tarannum Khan, MD. We are thrilled to have her here today for this chat. Let’s begin with the questions.
Ginger12: I have often heard that Alzheimer's is not hereditary but so many members in my family have had it. My mother is now in a nursing home with Alzheimer's and her mother and three older sisters all succumbed to this disease. Is there any new research that indicates this does run in families?
Dr_Khan: Definitely. There is a good amount of research to indicate that a small percent of Alzheimer's disease runs in families, but the more definitive genes are for the younger onset familial Alzheimer's. Younger onset is before the age of 65. The later onset disease, that is after the age of 65, do have some genes, but it is not very specific thus most of the time the specialists choose not to test for it, as it doesn’t mean much when positive.
But with strong family history if there are any symptoms of forgetfulness, it is worth seeing a Dementia specialist, or a neurologist who can do a detailed history exam and check some relevant blood work, do imaging if necessary, do some neurobehavioral testing, and do the monitoring.
Gatorfrog5: My mother is 81 and she appears to be showing signs of Alzheimer’s, according to what I have read online about the disease. What do we do to have her checked out? She has had a test in her primary care doctor's office but it was a very short test and about anyone could pass it. I think she needs a more thorough exam. Thanks for any help. Much appreciated!
Dr_Khan: I think it will be worth taking her for a neurological consultation, which you can take to any neurologist, or if possible a dementia trained neurologist (fellowship training). He will be able to test her in the office and also do relevant blood tests, and imaging if needed.
Tracy: I have a 92-year-old grandmother experiencing memory issues. My question to you is, what is the right way to respond to her when she repeatedly asks for her children or her parents who have died? 3 of her 4 children have already passed on, the last being over 4 years ago but she continues to ask about them, wants to call the police to say they are missing or will get upset cause her daughters have not been around. It breaks my heart to tell her over and over that these people have passed. Any good reference books out there you can recommend?
Dr_Khan: This is a very difficult question indeed. Such questions and situations are the most difficult part of day-to-day care for the caregivers. There is a very good book "36 hour day" especially for the caregivers of the Alzheimer's (Alz) disease patients. There is another book, "Coach Broyles Playbook for Alzheimer's Caregivers" Hope these help!
Cleveland_Clinic_Host: For those now joining us, we are currently chatting with Tarannum Khan, MD, who is taking your questions about Alzheimer's Disease. To ask a question, type in the box below and then click 'Ask'
Francois: How is Mild Cognitive Impairment different from memory problems due to aging? When is memory decline due to aging a precursor of MCI?
Dr_Khan: MCI is slightly worse than the memory problems due to aging. There are specific deficits of memory and sometimes other faculties like visuospatial, where one can get confused in directions. However, the activities of daily living are not affected, the person remains completely independent.
In mild cognitive impairment one domain for example, is that memory can get affected more than others.
If someone is concerned about their lack of memory or forgetfulness and not their family members its most likely age related. Once others start noticing it then it becomes more severe.
cindid: Is there any value in trying to make the Alzheimer's patient perform a task that seems to frustrate them? Should you allow them to get more and more frustrated over it, or should you step in and just do it for them?
Dr_Khan: I don't think it's fruitful to try and make the Alzheimer's patient perform the same task that frustrates them. Increasing their frustration will not help. But letting them try is important; the most important thing for these patients is to keep them socially involved. They should continue to do the chores themselves as much as they can. Also watching current events, reading if possible and again interacting with people as much as possible is beneficial.
Grannyscott: If someone has reached their mid-eighties without any apparent signs of dementia, is it safe to assume that they have escaped this terrible disease - or can it begin at any age, and if so, does it progress much more rapidly?
Dr_Khan: The prevalence is higher as the age progresses for sure. The prevalence is close to 30% after 85 years of age. So if there are no symptoms in mid-eighties, well and good. Excellent! No, nothing to support that the disease progresses more rapidly if it strikes at a later age.
nystrom: What is the difference between Alzheimer's and dementia?
Dr_Khan: Dementia is more like an umbrella term. It encompasses a variety of different kinds of cognitive diseases with memory loss as one of the symptoms. Alzheimer disease is the most common form of dementia in aging adults. Others can be vascular dementia, other Parkinsonian neurodegenerative disorders, Lewy body dementia, Frontal lobe dementia etc. So Dementia is more of a general term and Alzheimer's disease is more specific.
zelda22: What exercises/activities are currently recommended to maintain healthy brains/memory functions?
Dr_Khan: Very important to maintain regular physical well being by routine exercises along with the continuing to be socially active and also taking care of their general medical health conditions including high blood pressure, diabetes and cholesterol if there is any.
DonnaR: My father has advanced stage dementia and none of the meds work at this point. Since we know that Alzheimer’s Disease is caused by a build up of plak on the brain, why aren’t researchers focusing on meds that gets rid of the plak rather than meds that suppress the symptoms? Is their any research being done in this direction?
Dr_Khan: There are few agents in pipeline targeting towards reducing the "tau aggregation" for example and some others for "microtubule stabilization" which can interrupt the process.
KitCat: How does Lewy Bodies affect a person diagnosed with Vascular Dementia?
Dr_Khan: Lewy body dementia and vascular dementia are two very different entities. Lewy body dementia patients have major fluctuations in their cognitive behavior, have hallucinations, and have Parkinsonian features in addition to dementia.
herbant66: If the geriatric physician has already made a diagnoses of dementia based on observation, and prescribed medication, is there still a benefit to testing?
Dr_Khan: Only if the medications fail to help and if any new symptoms appear, or if there is rapid progression of symptoms.
Cleveland_Clinic_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.
Nina055: My mom is 85 and was diagnosed last year. She is on Aricept & Namenda. I understand that this combination therapy will help slow down the progress. We deal with forgetfulness both long & short term. She is no longer able to cook or control her medications. No problems dressing, telephone, visiting, no roaming, always cheerful. What can we expect next?
Dr_Khan: It’s great that she is able to dress, talk on phone and other things. Also good that she is 85 and just got diagnosed. She is also getting dual therapy in the form of Aricept and Namenda. She needs to continue to be as much independent in her daily activities as possible like dressing, restroom, visiting etc. The thing she cannot presently do is not that unusual for Alzheimer's patients. Keep her socially very active and also physical activity and regular exercises definitely help. She may remain like this for many years.
Sniff: If one was always forgetful, how does one measure increased forgetfulness?
Dr_Khan: I think one may be inattentive not necessarily forgetful. A series of detailed neuropsychological testing by trained PhD psychologist can help differentiate these.
Sniff: Does memory go up and down? Can one have a forgetful few days and then return to baseline?
Dr_Khan: It can. But if it is significant one should be checked for any other underlying conditions. Blood tests should be done to check for common conditions like thyroid issues, B12 deficiency, Kidney functions tests etc. In addition to a general medical exam, one should check blood pressure and sugar levels (low blood sugar etc). Although rare but sometimes this can be a manifestation of occult seizure, and an EEG can help, but all this can be sorted out by a detailed history and exam by his/ her physician.
DonnaR: Are these treatments currently available and how can one find a doctor facility that does?
Dr_Khan: No, these are not available yet. It’s under research. You can find dementia-trained doctors in your area that might be participating in it. You can find more information on research here:
Cleveland_Clinic_Host: We are getting ready to close for today. A large number of questions were received and we apologize if we did not get to your question. We will try to answer as many questions as possible in these last few minutes. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.
MaryLou: What has been your experience with the 23mg dosage of Aricept?
Dr_Khan: If the patient tolerates, it is definitely worth trying and fruitful.
opereta: Is there any new drug for Alzheimer’s Disease rather than Namenda. My father is 76 and was diagnosed with Alzheimer’s disease about 5 years ago. He is still able to do most of the tasks including sports, his memory varies a lot, depends on the day and he can sometimes be very aggressive in a way we have never seen before. Is there new drug or treatment coming soon or on the market?
Dr_Khan: There are many medications being researched in the pipeline. Other cholinesterase inhibitors should be tried if they haven't been tried already. Aggression is not uncommon when the individual is trying to keep his / her independence. If there is co-morbidity like anxiety, depression etc, taking care of that helps.
Cleveland_Clinic_Host: I'm sorry to say that our time with Tarannum Khan, MD is now over. Thank you again, Dr. Khan, for taking the time to answer our questions today about Alzheimer's Disease. To make an appointment with any of our neurologists, or any other specialists at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at clevelandclinicflorida.org.
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