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Alzheimer's Disease: Symptoms&Treatment Options

Alzheimer’s Disease: Symptoms and Treatment Options

Tuesday, January 22, 2013
Noon – 1 p.m. (EST)

Po-Heng Tsai, MD 
Neurologist

Cleveland_Clinic_Florida_Host: Today's Live Web Chat, "Alzheimer’s Disease: Symptoms and Treatment Options" with Po-Heng Tsai, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.

Cleveland_Clinic_Florida_Host: Welcome to our Online Health Chat "Alzheimer’s Disease: Symptoms and Treatment Options" with Po-Heng Tsai, MD. We are thrilled to have him here today for this chat. Let’s begin with the questions.

Ecsucre: Good morning Dr. Po Heng Tsai...I am really glad that I am part of this chat!

Ecsucre: My name is Elena Sucre and this is my question: My mother-in-law was recently diagnosed with Alzheimer's disease stage one. I would like to know, what is the best treatment available at this stage to prevent the progress of it from this stage to stage two. Is there any treatment that can stop or delay as much as possible the progress of stage one to stage two? I have heard a lot of non optimistic answers and this is why I would like to hear your opinion. I worked at Cleveland Clinic Florida as a CVICU nurse during three years and I have a high respect for all the Doctors at this Hospital...Thank you in advance for your response.

Dr_Tsai: Currently the FDA has approved three medications to be used as treatment for early Alzheimer’s disease. They are Donepezil, Galantamine, and Rivastigmine. They work by increasing a chemical in the brain that is important for memory and cognition.

Jshealth: My question is about environmental factors and if they can contribute to the onset of the disease for people with the genetic form of Alzheimer’s in terms of how early it appears and how quickly is progresses? My grandfather was diagnosed at 62 and died by 67, his daughter (my mother) was diagnosed at 68 and is now 73 and still quite healthy although she has little or no short-term memory. Could exposure to toxins and stress have escalated the disease for my grandfather? Or, is it more probable that they had two different forms of the disease?

Dr_Tsai: Environmental factors could definitely contribute to the onset of the disease. If two people have the same genetic risk, a person who has history of head trauma, poorly controlled hypertension and is a smoker, will most likely have earlier onset of memory loss symptoms.

Php96ap: Is there a test for the Alzheimer’s gene?

Dr_Tsai: There is no one single genetic test for Alzheimer’s disease.

Cleveland_Clinic_Florida_Host: I apologize, we were experiencing some technical difficulties. The entire chat (questions and answers) will be on the transcript. If you would like to view the entire transcript of this chat after the event, it will be available on the Cleveland Clinic Florida website.

ConcernedKid: My loved one is taking Namenda as well as Aricept. What can I expect as a result? Will this slow down the dementia?

Dr_Tsai: Both Aricept and Namenda are considered symptomatic treatments. The expectation is that patient will feel better and possibly has some improvement in memory and thinking. Unfortunately, because these medications don't address the underlying disease process, patients will continue to decline.

nutzy: I know that are very different kinds of dementia. Could you mention some specific criteria only for Alzheimer’s blood tests or scans? One of my friends doesn’t remember people’s names. Could this be related?

Dr_Tsai: There is no one single test or scan for Alzheimer’s disease. The diagnosis is made based on clinical history, physical examination, and cognitive testing. Laboratory tests are done to evaluate for potentially treatable causes of dementia such as low thyroid function. Brain scan is used to support the diagnosis and also to evaluate for other causes of dementia such as stroke.

ecsucre: My second question is that we were told that Reminyl or Aricept are effective only in patients that have Parkinson like complaints, which she doesn’t have. I wonder what an expert like your self thinks about this Dr. Tsai? We know it is incurable, just want to do our best.

Dr_Tsai: Reminyl and Aricept are approved by FDA for Alzheimer’s disease. A related medication, Rivastigmine, is approved for Parkinson's disease dementia. Because all three medications are in the same class, sometimes Reminyl and Aricept are used in Parkinson's dementia, but by no means are they only indicated for Parkinson like complaints.

Cleveland_Clinic_Florida_Host: We are receiving many great questions so far! Please remember that this chat is for general questions about Alzheimer’s disease. If you have a medical question not related to this condition, or that is diagnostic in nature, please follow-up with your personal health care provider or use our contact link clevelandclinic.org/webcontact to submit your questions.

Jshealth: What do you think about using turmeric or curcumin supplements to prevent the build up of plaque in the brain? Is there any evidence that this is effective? Do you know of any substances that contribute to the build-up?

Dr_Tsai: Curcumin has been shown in animal studies to be effective in preventing the build up of plaques in the brain. However, small scale clinical trials have not demonstrated efficacy in humans. So I would say that the jury is still out there on curcumin.

ConcernedKid: Will increased social interactions be helpful for someone suffering with dementia?

Dr_Tsai: Yes. Anything to keep the brain active (physically, mentally, and socially) is beneficial for someone suffering from dementia.

Kerristein: I’ve heard that women are more likely to develop Alzheimer’s than men... Is this true? Why is it higher for women?

Dr_Tsai: Studies have shown that women are more likely to develop Alzheimer’s disease. This could partly be explained that women tend to live longer than men, and age is a risk factor for Alzheimer’s disease. Another possibility is hormonal related.

php96ap: My grandfather had Alzheimer’s, his younger brother did not; my father had Alzheimer’s, his sister had early onset Alzheimer’s, the other two brothers did not have Alzheimer’s. Any recommendations?

Dr_Tsai: Having first degree relatives with Alzheimer’s disease increases the risk of developing Alzheimer’s disease. Currently there are no medications available to slow down the disease process. However, there are non-medication ways to improve brain health such as maintaining an active lifestyle physically, mentally, and socially. Also if a person has other risk factors for Alzheimer’s disease such as high blood pressure or diabetes, he or she should control the risk factors as much as possible.

ecsucre: Does Reminyl and Aricept have undesirable side effects? Or is it better then to take them knowing now that they will help but not prevent the decline?

Dr_Tsai: All medications have side effects. Common side effects for medications such as Reminyl and Aricept are lightheadedness and related to gastrointestinal system such as nausea and loose stool.

LLee4: Can people get dementia following a stroke?

Dr_Tsai: Yes, people can get dementia following a stroke, especially if it is a large stroke. In this case, it will be referred to as vascular dementia.

Ladylucky24: Is there a link between severe head trauma and Alzheimer’s?

Dr_Tsai: Any process that damages the brain including head trauma could increase the risk of Alzheimer’s disease. Severe head trauma has been linked to increase a protein called tau in the brain, which is also seen in Alzheimer’s disease.

ItalianStaliann: What is the difference between early onset Alzheimer’s disease and Alzheimer’s disease? Isn’t it the same?

Dr_Tsai: Alzheimer’s disease is referred to as early-onset when the symptoms start before the age of 65. It is the same underlying disease process.

Staceyken: My aunt was diagnosed with Alzheimer’s disease and is currently taking several meds for her symptoms but we haven’t seen much change, are there any clinical trials at Cleveland Clinic we can explore for her?

Dr_Tsai: It depends on the stage of the disease. Currently we have an active trial for a medication to treat agitation in moderate to severe Alzheimer’s disease. We are hoping to begin a trial soon for people with early or Prodromal stage of Alzheimer’s disease. For more details, please feel free to contact the Cleveland Clinic for more information.

Cleveland_Clinic_Florida_Host: I'm sorry to say that our time with Po-Heng Tsai, MD is now over. Thank you again, Dr. Tsai for taking the time to answer our questions today about Alzheimer’s Disease. To make an appointment with Dr. Tsai, or any other specialist at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.

Cleveland_Clinic_Florida_Host: If you would like to view the entire transcript of this chat after the event, it will be available on the Cleveland Clinic Florida website.