Cleveland_Clinic_Host: Cleveland Clinic’s Neurological Institute is pleased to announce the creation of our new Lou Ruvo Center for Brain Health.
The Cleveland Clinic Lou Ruvo Center for Brain Health (CCLRCBH) brings together neuroscientists, physicians, therapists, surgeons, imaging specialists and other Cleveland Clinic staff to establish programs that will improve our diagnosis and treatment of cognitive disorders, especially those of later life.
The CCLRCBH offers state-of-the-art diagnostic service for patients with cognitive disorders and a multi-modality treatment program for diagnosed with mild cognitive impairments. The treatment program includes physical exercise, cognitive rehabilitation, and cognitive enhancing medications.
Alzheimer’s disease is a brain disorder that seriously affects a person’s ability to carry out daily activities. It is estimated that more than 5 million individuals in North America suffer from Alzheimer’s disease. Alzheimer’s disease progresses over many years from symptoms such as mild forgetfulness to more severe difficulties with memory, abstract reasoning, language, and the ability to function in general.
While increasing age is the largest risk factor for developing Alzheimer’s disease, severe memory loss is not a normal part of aging. Alzheimer’s disease is the most common form of dementia among older people.
Dementia is the loss of mental functions—such as thinking, memory, and reasoning—that is severe enough to interfere with a person’s daily functioning. Dementia is not a disease itself, but rather a group of symptoms that might accompany certain diseases or conditions. Symptoms also might include changes in personality, mood, and behavior.
Dementia develops when the parts of the brain that are involved with learning, memory, decision-making, and language are affected by any of various infections or diseases. The most common cause of dementia is Alzheimer’s disease, but there are as many as 50 other known causes.
Today, join us as we discuss a variety of questions regarding memory loss, Alzheimer’s and dementia. To make an appointment with a specialist at the Cleveland Clinic Lou Ruvo Center for Brain Health, please contact us directly at 216.636.5860 or 866.588.2264 or visit our web site clevelandclinic.org/brainhealth
Welcome to our Online Health Chat. Let’s begin with some of the numerous questions we have received.
richsec: What about people who repeat themselves much of the time? Is that normal? Is that the beginning of memory loss or just normal aging?
Cleveland Clinic Physician: Many people repeat themselves out of habit, or because they are a little bit obsessive. However, if this occurs as a change in the person's behavior it can be an early sign that he/she cannot remember what has been said. This, indeed, can be one of the earliest signs of Alzheimer's disease.
costalot: Isn’t diminished memory just part of getting older?
Cleveland Clinic Physician: This is a hard question to answer. Everybody thinks now that failing memory is an inevitable part of growing old. I myself have my doubts about this, and I wonder how slight our memory loss might be with the years if we took better care of ourselves along the way.
Some of things we can do throughout life to maintain cognition include: keeping our minds busy continuously, maintaining life-long physical fitness, and avoiding the treatable cardiovascular risk factors such as hypertension, elevated cholesterol and others.
Ogailf: Have you heard of or ever used the Animal Naming Test?
Cleveland Clinic Physician: Yes, as part of our diagnostic process, we sometimes ask that question. We ask people to name all the types of animals that they can think of in 60 seconds, and most people should be able to name 12.
marcopolo: If your thyroid is under active (very low), can it affect your memory?
Cleveland Clinic Physician: Yes. Any significant metabolic disturbance can impair attention concentration, and then "down stream" from the impaired attention concentration, memory function also gets disturbed.
marcopolo: Can short term memory be affected negatively if I am on thyroid medication and my levels are maintained?
Cleveland Clinic Physician: In general, no. If thyroid supplementation is needed, memory function is usually improved.
marcopolo: Please comment/explain the effect of hypothyroidism on memory and depression.
Cleveland Clinic Physician: For the most part, memory loss and depression both do not have much to do with thyroid status. A good medical evaluation for either syndrome (dementia, depression) almost always includes measurements of thyroid hormone levels.
maybe: Does long-term loss of sleep affect memory? Can daily use of Lunesta® for difficulty sleeping have an effect on future memory loss? What “long term” effects do sleeping pills or Melatonin have on the brain and/or early memory diseases? How about other medications?
Cleveland Clinic Physician: Sleep disturbances, for whatever reason, can make people feel inattentive and sluggish in their thinking, but they do not usually cause long term memory loss. Similarly, the medicines that are prescribed for sleep can make people feel groggy or strange the next day, but they are not known to cause long term damage.
Mild Cognitive Impairment
sasser: I have been diagnosed with mild cognitive impairment. What places me in that category?
Cleveland Clinic Physician: In mild cognitive impairment (MCI) some failure of mental function has begun, but it can still be compensated and normal function maintained. The real concern about MCI is that a large number of such people will develop Alzheimer's disease within 5 years. We need to work in medicine to develop tools to prevent that.
md1218: What is the difference between MCI and early Alzheimer's and what drugs should be used in MCI?
Cleveland Clinic Physician: MCI or "mild cognitive impairment" refers to a milder syndrome than Alzheimer's disease - one in which the memory loss or other cognitive function loss can still be compensated for by the individual, so he or she doesn't lose functional ability. No drugs are yet approved by the FDA for MCI, but we do still sometimes give such people the Alzheimer's drugs, like Aricept®.
jenny: How do you determine type of dementia? Does treatment vary according to the type of dementia?
Cleveland Clinic Physician: Dementia just means the syndrome of significant cognitive failure. It does not tell the cause of that failure. Indeed, our present treatments do vary according to the underlying cause of dementia.
To clarify, dementia refers to the syndrome of serious cognitive loss. The term dementia does not name the specific cause. The disease causes of dementia include many, from Alzheimer's disease to depression.
Ogailf: What is the typical age that you start to see signs of dementia?
Cleveland Clinic Physician: The average for diagnosis of Alzheimer's type dementia is in the early 70's. But, people experience the first signs of the disease several years before diagnosis.
We believe that medical evaluations and treatments for memory loss should be undertaken at the first signs of memory failure.
mewmew: Would you discuss Creutzfeldt-Jakob disease (CJD) relative to dementia?
Cleveland Clinic Physician: There is a small group of rare disorders which cause rapidly progressing dementias. These people get worse week by week instead of over a period of years. The prion diseases, such as CKD are the most common cause of rapidly progressive dementias. Prions themselves are recently discovered very small particles, smaller than viruses, which can gain entry into the nuclei of brain cells and destroy them period.
The mad cow disease is a prion disease.
vets: What is alcohol dementia and does drinking continue to worsen memory?
Cleveland Clinic Physician: Alcohol dementia refers to the type of dementia which really heavy and long-term drinkers can get. This is not the headache and confused thinking that many have had on Monday mornings. In alcohol dementia usually memory is affected far worse than other cognitive functions. Sometimes we call this Korsakoff's disease. For most of us however, drinking a moderate amount of alcohol probably helps to prevent dementia.
turnedin: What test can I take to see if I might develop dementia or Alzheimer’s disease in the future?
Cleveland Clinic Physician: As I said above, dementia refers to many different diseases which can cause cognitive loss and so no specific answer can be given for dementia.
For Alzheimer's disease, however, the most robust risk factors for developing the disease are genetic. The presence of a strong family history, or the presence of the genetic marker APOE mean that your chances are much greater to develop Alzheimer's disease than for people without those risks.
dfortier: You mentioned earlier that the first signs of disease often precede a diagnosis of AD by several years. Why the long delay in diagnosis?
Cleveland Clinic Physician: I believe the delay is shortening as people become more aware that memory loss in the later years of life is abnormal, and not something that we should all expect or accept.
michie: What are the warning signs or symptoms that someone has dementia, Alzheimer’s disease or other mild cognitive impairments?
Cleveland Clinic Physician: For Alzheimer's disease and most MCI people memory loss leads the way.
mygoal: Do you differentiate Alzheimer’s disease from other forms of dementia with a brain scan?
Cleveland Clinic Physician: Current standard brain scans are much less helpful than many people think in diagnosing dementia, or is in diagnosing the disease subtype. Still, scans can show stroke based syndromes sometimes, and PET scans can help with frontal temporal dementias.
sally: Is there a correlation between stroke & dementia?
Cleveland Clinic Physician: There is a correlation between stroke and dementia, in that people with cardiovascular disease affecting the brain are more likely to develop various dementia syndromes than those who do not have cardiovascular disease. Often the dementia which such people develop has a mix of stroke like and Alzheimer's disease like features.
LittleLyn: I recently read that Alzheimer’s may be related to the virus that causes cold sores (Herpes). I only take my cold sore med now when I feel a cold sore coming on. If I took it on a more regular basis, would it prevent the onset of Alzheimer’s? I'm already having a few memory problems at age 56.
Cleveland Clinic Physician: Although many possible explanations for Alzheimer's disease have been sought, explanations related to infections, including herpes virus, have not held up across various types of medical studies, and are not generally accepted as real connections by most cognitive specialists. I would not think any cold sore medicine would have any effect on your risk for Alzheimer's disease, one way or the other.
JohnB: I am an Alzheimer's caregiver, and I hate being told that there's nothing anyone can do. Please tell me that you have suggestions for folk medicines, diet and exercise, clinical trials, ANYTHING that I can do to help.
Cleveland Clinic Physician: There is always something that can be done. For later stage Alzheimer's disease the caregiver burdens are severe - yet drugs can be given to help some behaviors that such patients have, respite arrangements can be made, exercise and music programs can be designed. Research interventions have not given us much for this stage of the disease, nor have non traditional medicines.
billoviatt: I know of a lady who was able to control her Alzheimer's for 12 years with Phosphatidylserine (PS). Another did remarkably well with a combination pf PS and Ginkgo Biloba extract whereby there probably was some synergy as you get when hundreds of antioxidants are combined and balanced - the real secret why nutritional medicine is advancing so rapidly. I have medical references to 12 double-blind, placebo-controlled clinical studies on PS if you would be interested. Have you either witnessed any of your patients on such regimens or heard about these studies before?
Cleveland Clinic Physician: The medical science for Phosphatidylserine (PS) and gingko has not been considered strong enough for those treatments to become generally accepted by scientific medicine - but much of medicine remains outside science and I never object to families trying such treatments.
dfortier: Is treatment for Alzheimer's disease more effective if started at an early stage of the disease or patients out of luck either way?
Cleveland Clinic Physician: We definitely believe that Alzheimer's disease is now treatable even if our treatments are not as powerful as we would like. We also believe that intervening early is better than waiting.
skipper: If one is having frequent bouts of short term memory loss, is it advisable to be tested by a doctor for the Alzheimer’s marker?
Cleveland Clinic Physician: We do not yet have a truly reliable biological marker for Alzheimer's disease. We can determine APOE (apolipoprotein e4) for genetic status, and we can measure certain proteins in the spinal fluid, and all of these things confer greater likelihood for Alzheimer's disease. But still, the most reliable diagnostic test by far remains a clinical assessment by a knowledgeable physician.
verymari: Is dementia or Alzheimer’s as common in other countries as in the US?
Cleveland Clinic Physician: The Alzheimer's disease type of dementia is about as common in other countries as here, but other disease types of dementia, such as vascular, seem to be more common in certain countries like Japan. There also may be ethnic group variations in risks for dementia, but we don't have very good information yet about that.
Thalia_2: If the Dr's notes say the PET SCAN results show "decreased uptake with the temporal and parietal lobes" what does that mean in simple terms?
Cleveland Clinic Physician: That means that the lateral cortex areas of the brain showed less metabolic activity, or brain cell firing, than the frontal areas and the posterior areas. That is a common pattern for Alzheimer's disease on these tests.
Remember, however, my earlier comments, that these brain scans are not terribly useful in making a diagnosis by themselves. A thorough diagnostic evaluation by an experienced physician is the essential tool for diagnosis.
Thalia_2: My mom has been diagnosed with early onset. She's 56. She has a slight memory problem but nothing she can't live with. Do you recommend she have a heavy metals test?
Cleveland Clinic Physician: No. Unless there is something quite unusual about a person, such as known occupational exposure or other things, we no longer routinely screen for metals.
teehee: If you are diagnosed with one of these diseases, what can you do to maintain or improve your cognitive abilities
Cleveland Clinic Physician: We believe at the Cleveland Clinic Lou Ruvo Center for Brain Health that treatments must be multi-modal including not only drugs but also cognitive exercise, physical exercise, and vascular risk factor adjustment.
carolelangley: My 88 year old mother suffers from depression and her dementia is advancing. She has been on Aricept® for 15 years and now takes Namenda® for the dementia, plus Prozac® and Amitriptyline for her depression. She cannot sleep at night. Any suggestions?
Cleveland Clinic Physician: Sleep disturbance can be a terrible complication both of Alzheimer's disease and of depression. I don't want to be prescribing directly to your mother, but there are a number of other drug classes that could be tried to improve her sleep.
usedup: I believe my wife has Alzheimer's disease. How can I get her to see her doctor?
Cleveland Clinic Physician: In my experience, almost all patients with memory loss will come to the doctor, especially if a family member or friend accompanies them. Usually the reason can be most successfully framed if people use words related to the patients own view of their condition.
ross: Can people get Alzheimer's disease in their 40s?
Cleveland Clinic Physician: Yes. Early onset Alzheimer's disease can rarely begin even in the 30's. These versions of Alzheimer's disease are usually heavily genetic, and rapidly progressive.
Thalia_2: What type of doctor would need to do the diagnostic evaluation? What does it consist of? My mom is so healthy and this is devastation news for us! My mom is on her way to be with me in NYC and I just want to make sure this doctor is giving her the correct diagnosis as you said.
Cleveland Clinic Physician: In truth, most health care delivery systems do not yet have actual cognitive disorders clinics. More of them will have Alzheimer's disorders clinic. That might be your best bet.
Thalia_2: I just want to say thank you so much for giving us all your time!
Cleveland_Clinic_Host: I'm sorry to say that our time for this online health chat is now over. Thank you again for taking the time to answer our questions about memory loss, Alzheimer’s and dementia.
Cleveland Clinic Physician: The cognitive disorders may be the most important disorders of the 21st century for functional success in our society. These disorders are becoming treatable and we want to intervene with them whatever their type at an early stage. Thank you for having me chat today.
- For more information about the Cleveland Clinic Lou Ruvo Center for Brain Health and our specialists at Cleveland Clinic you may visit clevelandclinic.org/brainhealth
- To make an appointment with a brain health specialists from the Cleveland Clinic, please contact us directly at 216.636.5860 or 866.588.2264 or visit our web site clevelandclinic.org/brainhealth
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This chat occurred on June 19, 2009.
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