Ask Us Anything About… Slowing Down Dementia

Description – The video begins inside the Penn State Health Milton S. Hershey Medical Center. Two people are standing next to each other in front a large screen showing the Penn State Health logo. Standing from left to right are Scott Gilbert and Dr. Charles Duffy.

Scott Gilbert – Thanks so much for watching Ask Us Anything About Slowing Down Dementia from Penn State Health. I’m Scott Gilbert.  When an individual is diagnosed with dementia, a lot of questions surface immediately. They may wonder, ‘How long will I live?’, ‘How will it affect my lifestyle?’, and ‘Is there a cure?’. Now, unfortunately, the answer to that last question is no, but there is some encouragement for people that to live a long life after diagnosis, and a happy one at that. We’re here today to talk about that topic with Dr. Charles Duffy. He’s a neurologist here at Penn State Health. Dr. Duffy, we appreciate you being here today. Let’s start by talking about what we know about the genetics of dementia. I feel like one of the most common questions people ask is, you know, ‘My uncle has it. My mom has it. Am I destined to get it?’.

Dr. Charles Duffy – I would say no, you’re not. It’s important to understand that there are many types of dementia, and some types have stronger genetic components than others, but if we are talking about the most common kind of dementia in America, that would be Alzheimer’s disease. There are really 2 types. A type that starts earlier in life, in your 40s or 50s, early 60s that is often called early on-set Alzheimer’s disease, and there is a strong genetic component to early on-set Alzheimer’s disease. The kind of Alzheimer’s disease that most people get is later on-set disease that begins in the mid to late 60s, 70s, and 80s, and that has some genetic components, but for the most part, it would not be appropriate to think of it purely as a genetic disease. The most important point is that no, it’s not inevitable, and it shouldn’t be looked at that way.

Scott Gilbert – This is Ask Us Anything About Slowing Down Dementia from Penn State Health. Dr. Charles Duffy, a neurologist here welcomes your questions. You can put them in the comment field below this Facebook post whether you’re watching this video live or if you’re watching it on playback, we’ll make sure we get you some answers to those questions, and we know a lot of people have questions about this topic because dementia affects individuals, it affects the entire family, and we’re going to get into some of those dynamics, as well. I want to first lay out the difference and the distinction between treatable versus reversible versus curable because there are some types of dementia caused by some particular life events that are actually reversible, correct?

Dr. Charles Duffy – Well, yes, that is correct, but it’s important to distinguish exactly what we mean by dementia. I think most practitioners in this area would reserve the term dementia for the irreversible kinds. There are other kinds of cognitive impairment, and particularly late life cognitive impairment that aren’t usually thought of as dementia, but do limit people’s abilities with the respect to memory and attention and other functions and can be caused by other factors that are reversible. So, yes, it’s important to recognize that there are reversible causes of late life cognitive decline, and a lot of what we do is make sure that people are not suffering from such a problem either as the sole cause of their cognitive decline or as a contributor to their cognitive decline as part of a broader dementia syndrome.

Scott Gilbert – So, it sounds like part of the challenge for you as a practitioner is trying to figure out what form of dementia, if it even is actually dementia that’s affecting the person– what does that diagnosis process look like?

Dr. Charles Duffy – Well, it is a multifaceted process. The first process, part of the process is to get to know the patient, and understand what’s been happening to them, both in their own words and in the words of family members or others who know them well enough to inform an understanding of what’s been happening to them. The second part of it is a detailed neurological exam, understanding if there are signs that would indicate one or another kind of cause of impairment, and that might indicate treatable causes or directions for treatment. The third step is usually a detailed analysis of behavioral capacities. These include paper and pencil tests and other modalities, electrophysiological measures, functional or volumetric imaging of the brain with CT scans, x-rays, or with MRI scans, magnetic waves, or with a special labelled ligon that will act as a marker of disease, what is often called a PET scan, a positron emission scan, and together they form a core of the evaluation of dementias. Important in that is a set of blood tests that will identify treatable causes of dementia, in particular that may provide the basis for a genetic analysis, and finally, a sampling of the cerebral spinal fluid, usually by a spinal tap that allows us to see really what’s going on in some aspects of the biology of the brain that also can inform a dementia diagnosis.

Scott Gilbert – Now, as you mentioned earlier, Dr. Duffy, and by the way, we welcome your questions for Dr. Duffy. Just put them in the comment field below this Facebook post, and we’ll pose them to him right here on Ask Us Anything About Slowing Down Dementia, and speaking of the kind of the name of this interview, Slowing Down Dementia, a lot of people are wondering because Alzheimer’s, the most common form of dementia, is not curable. Can it be slowed down? Are there steps that can be taken medically or otherwise to do so, and the answer is, according to a lot of sources, yes.

Dr. Charles Duffy – Well, I think that you’re right. According to a lot of sources, the answer is yes. I would agree that there are things you can do to improve the course of a dementing illness. There are also things you can do that would worsen the course of dementing illness, and I think you want to keep both of those in mind.

Scott Gilbert – So, what are some examples of things that could actually make it worse?

Dr. Charles Duffy – Well, so, probably the one that we recognize the most directly is injury to the brain, and that injury can be mechanical injury– getting hit in the head either by accidental injury or most commonly by falls, which is why we really want to prevent falls in people with dementia because it does make the dementia worse in a couple of ways, both by direct injury and by the whole process of treating people for the consequences of falls. Partly it’s hitting your head, but also, it’s breaking your hip and being in bed for a period of time, undergoing surgery, all of that. That’s not good, and we’d rather avoid it.

Scott Gilbert – So, then what are some of the ways in which perhaps, like you say, if dementia may be able to be slowed down or at least to be able to maximize your life when living with this illness, what are some of those steps people can take?

Dr. Charles Duffy – Well, the first thing is to recognize that you can do things that are better for you than worse, and there is no time to waste in starting down that path. In particular, you’d like to be starting down that path before a dementia diagnosis to slow when you might start having symptoms of dementia. Things that you can do include eating right, and getting appropriate rest, but also being physically active, and mentally active, and doing things that stimulate your brain. Your brain is a very dynamic organ. It is always changing, not just day by day, but hour by hour, and minute by minute, and what you want to do is promote brain health by keeping it active, and keeping it active doing things that you want to continue to be able to do. So, if there’s a general rule, it would be: stay active, and the direction of that should be active doing the things that you want to be able to continue to do.

Scott Gilbert – So, take literally, a lot of people would say, ‘Sure, that makes sense’, staying active and stimulating the brain, but why do things like diet and exercise, how do they affect brain health because clearly they do.

Dr. Charles Duffy – Well, the most important thing to contextualize any discussion of this topic is to recognize that we don’t have all the answers. We don’t know exactly what’s going on, but we can see some things that are good and bad as I mentioned before, but there are general principles that we know seem to make a difference. So, for example, we want to be able to control how much your inflammatory mechanisms are activated. So, we want to avoid things that are stimulating the immune system, and that are stimulating inflammatory mechanisms because we believe those mechanisms contribute to the brain diseases that we call dementias, and to whatever degree that we can keep a lid on that, we’re helping slow the course of dementia.

Scott Gilbert – Thanks so much for tuning in today for Ask Us Anything About Slowing Down Dementia. We’re talking with Dr. Charles Duffy. He’s a neurologist here at Penn State Health, and we welcome your questions and comments. Just add them to the comment field below this Facebook post. We have received a question, and that is: Is suffering from depression a predisposition to dementia?

Dr. Charles Duffy – That’s a complicated question. I think, in general, we should say the answer is no, but let me just talk briefly about a couple of the things that complicate that. First of all, true life late on-set depression can be an early sign of dementia, so that having it might, in fact, be revealing the beginnings of dementia– not so much that it’s causing it, but it is actually part of it. Now, the other part of that is that depression can, in fact, prevent people from doing the things that are good for your brain, and avoiding the things that are bad for your brain, and as a result, contribute to the development of dementia. So, although there isn’t a single, straightforward, direct answer, it is appropriate to say, well, they’re not unrelated, and one can be an indication of risk of, or presence of a dementing illness.

Scott Gilbert – No proven causation there, but there is a possible link, basically. You know, I’m sure in clinic, you obviously work with patients, but then caregivers are an important part of the equation, too. Family members, friends, people who’ll be basically living with somebody as they go on this journey. What is your message to caregivers as they embark on a journey, again, helping a person live with an illness such as dementia?

Dr. Charles Duffy – Scott, I don’t think you could have made a more important point. Dementia is an illness that is affecting the entire family, and all of the friends of the patients, and all of the people who interact with the patients, and it’s important to recognize that that interaction can be a real positive in the life of patients with dementing illnesses. The most important thing is to be engaged, stay engaged, not to shrink away, to interact with people, both because they will appreciate it directly and also because it’s good for their brains. Now, it’s not to be overlooked that it’s also very good for the people who are working with dementia patients. When you do things that are good for others, they do good for you, and that is a 2 way street, so it’s important to encourage family members to be engaged, to step it up a bit, to be active, and to share that activity with dementia patients so that you are helping them, and it’s also helping you. So, please, it’s critical for family members to be involved. It’s great to have family members in the clinic visits, so there’s someone to talk to who can share the experience of that clinic visit after the clinic visit and go over what you and the doctor may have talked about, but also to be there to be supportive, to say that you’re not alone, you’re not going through this alone, and when you do that, you greatly help the patient, and as I said before, I think you also get benefit yourself.

Scott Gilbert – Let’s talk a bit about progression. Even a singular illness such as Alzheimer’s may progress differently, very differently in 2 different people. One person may live just a few years after diagnosis, another may live more than a decade. Do we know why that’s the case?

Dr. Charles Duffy – Scott, that’s a very complicated question.

Scott Gilbert – You have 30 seconds!

Dr. Charles Duffy – Haha. Well, then, the short answer would be no, we don’t know exactly why that’s the case, but we do know that it is the case. And first of all, what we call Alzheimer’s disease is not one syndrome. It’s a whole group of different syndromes, and some people will have one kind, and some people who have another kind and people will change the kind of symptoms they have during the course of disease, so that we know that that’s highly diverse. [Inaudible] Alzheimer when he described the disease over 100 years ago recognized that diversity in the patients, and recognized the impact that that had on their lives. What we know now is that there are many factors that contribute to the development of Alzheimer’s disease and that as we learn more, we learn more about the relationships between the type of Alzheimer’s and the kind of symptoms, and the kind of course that an individual might follow in the disease.

Scott Gilbert – So, it’s encouraging to hear about the ways in which people can live many years, even happily, if they’re properly supported and with those mechanisms in place with dementia. Let’s shift a bit towards what the future may hold in terms of the prospects for better treatments because obviously, there is no cure for many forms of dementia, including Alzheimer’s. What’s research looking like out there? Is there anything promising on the horizon?

Dr. Charles Duffy – I think this is a very exciting time in Alzheimer’s care and research. Part of that, in Alzheimer’s care is the judicious use of the medicines that are available, and other treatment modalities that really help patients and improve the quality of life of patients, and of the families that are involved in the care of a dementia patient, and then there’s also the basic research side which is at a very exciting point where the long term theories that you could say directly derived from the work of Aloysius Alzheimer have been fleshed out significantly and are opening up new directions, we’re seeing new things that are clearly contributing to disease, and other things that we think may be the foot in the door for effective treatments of the disease. So, for me, right now, this is a great time to be involved in dementia care, understanding that being involved in dementia care is a tough job.

Scott Gilbert – There’s no doubt, but thank you very much for taking the time away from your job to talk with us today. Dr. Charles Duffy is a neurologist here at Penn State Health. We appreciate his time. We appreciate you watching, and even if after this interview you think of additional questions that you didn’t get a chance to ask, feel free to add those to the comment field and we will post an answer in the comments after we track one down from Dr. Duffy. Again, thanks for watching Ask Us Anything About Slowing Down Dementia from Penn State Health.