What's The Difference Between Dementia And Alzheimer's?

[00:00:11] Speaker A: Welcome back to the podcast. That was our lovely mother, Joanna, once again singing her heart out. She has dementia, but she still finds joy in tapping the keys and belting out that rockstar voice, along with my brother Andrew and today, my sister Julie. Say hi, Julie. [00:00:27] Speaker B: Hello. [00:00:28] Speaker A: I'm Karen. We're here to help our community solve in your care challenges because we've learned if it's not one thing, it's Joanna, our mother. And it could be your mother or your father, your grandparent, any loved one you're taking care of. [00:00:45] Speaker C: Today's topic, diagnosing dementia. Karen just said, mom's got dementia, but does she also have Alzheimer's or one or the other? What are they exactly? What's the difference between dementia and Alzheimer's? Spoiler alert. Alzheimer's is a form of dementia, the most common form. And we will discuss all of this with this week's expert, Dr. Tony Emmer of Neuro Consultants. Dr. Emmer has spent his career studying how the brain works and helping dementia patients. We look forward to chatting with him in a bit. But first, as we like to do on each episode, we'll share our family experience with this issue. Here's our story of how we first knew something was off with mom and where we went from there. As I mentioned in our first episode, I was living in China during the initial phase of discovering Mom's condition. So I'll ask Karen and Julie to walk through some of the key moments that led to finally taking her to a geriatric doctor to see what was going on. So, Karen, you being on the ground five minutes away from mom, doing a lot of the heavy lifting, you were seeing firsthand some of the signs that mom was showing decline. Why don't you walk us through some of the first things you saw that gave you that first hint some changes were happening. And then Julie will take us through her experience when taking mom to see a doctor to check it out. [00:02:09] Speaker D: Okay. [00:02:10] Speaker A: Well, it started off small, and also I would wonder, are these just normal signs of aging? The time that seemed like that might be the case, a lot of them were things like she would put something, you know, an aluminum pan in the microwave, or she would leave burners on on the stove. And I would come in the house and I would smell that something had burned, and she would kind of seem like she had no knowledge about it. I noticed that she was putting dirty dishes away in the cupboards as if they had been cleaned. And, you know, really, her inability to cook something, follow a recipe. I think it's fair to say that mom was never the tidiest housekeeper, and she was really. What's the word I'm looking for? She was a terrible cook. So, I mean, I think. Can we. We can agree on that. That, you know, her culinary expertise wasn't great. [00:03:08] Speaker C: Agreed. [00:03:09] Speaker A: So I think that for a while, I kind of thought, well, this is sort of who she is and what she's like. But then there were other things that happened, such as, you know, when she was trying to open a Kleenex. Kleenex box, instead of just ripping off that perforated piece, she would tear the entire piece apart, the box apart, to get the Kleenex out. Or, you know, she started to lose her way. [00:03:33] Speaker C: And Can I just jump in there really quickly? I noticed that, like, on visits back, I noticed that particular one also. And it was weird because it's like she couldn't. It's a combination of the dexterity or her mind. She couldn't, like, get that it's the perforation that opens the box, and she just wasn't seeing that. [00:03:51] Speaker A: Right, right. She would start to get lost during driving, and that was a big issue because. And we're going to talk about that concept of taking away the keys and how challenging that is, but, you know, she would complain that when she would have a scratch. Well, one time she had an orange mark on the car, and she claimed that the Trader Joe's parking lot was filled with orange pylons that would come out and get her. I would go over every Sunday just to kind of check on her and make sure she had food, groceries, et cetera, et cetera, keep her company. And it got to the point where I was spending hours cleaning or looking for where she stuffed dirty briefs, because by that time, she was fairly incontinent. And it started to become an issue beyond just, all right, these are normal signs of somebody getting older. [00:04:42] Speaker C: And can you just walk us just quickly through, like, the briefs and the incontinence and, you know, what should have been happening and then what you were discovering, which wasn't happening? [00:04:52] Speaker A: Well, originally, you know, this is kind of personal for mom, but since we're sharing, it's important to note that her incontinence started early on, and originally she must have recognized it. She was still very with it at the time. And she started to wear pads, and that wasn't really doing the trick. And then eventually she started to wear briefs. And, you know, sometimes these briefs would end up in the washing machine and then find their way to the dryer. And we would find, like, shredded pieces of briefs everywhere or. [00:05:24] Speaker C: And briefs just for. For everybody listening. It's basically like an adult diaper. [00:05:28] Speaker B: Yes. Right. Yeah. Oh, and by the way, I'll just jump in for a second along these lines, because you said initially she understood what was going on, but there was a time when I was there and all of a sudden I looked down and she had peed on the floor. She's like, like, what is that on the floor? And it was her pee, and she didn't realize that she peed on the floor. So at one point when this was getting bad, we did take her. Well before the dementia. I mean, it was probably after the dementia diagnosis that. That the OB gy, The urologic urology, OB gyn, I'm sure that's not the right title, had said that the ability for her mind to understand when she was, you know, urinating or, you know, that that was gone. That connection was severed, basically. So that was part of that was wrapped up into this. And one thing I wanted to mention, didn't mean to jump in. Another thing that we didn't realize was, we later realized was a characteristic of dementia, but we didn't know was that she would often really dominate conversations and talk endlessly without listening to people, and she would laugh incessantly and inappropriately. Both of which, we came to later learn, were symptoms of dementia. And we had absolutely no idea that they were right. [00:06:35] Speaker A: We just thought, well, Mom's always been a little bit socially off. And, you know, it kind of became a joke among us that we would get her on the phone and I would put my AirPods on and let her talk. I could literally clean my entire bathroom head to toe while she was talking. And she would never know it because I was never really part of the conversation. And we didn't know at the time that these were symptoms of dementia. We just thought, all right, well, these are things that happen to people as they get older. But over time, we started to recognize that these were pretty significant. [00:07:05] Speaker C: Yeah, I remember once on a visit when I. When I had just moved back and she visited me in la and we went to see one of her old friends who had moved to la, and we went for lunch, and she was doing that. She was really dominating the conversation, not really responding to questions directly. And then when I dropped her friend off, her friend was like, is she okay? You know, she was, like, even, like, startled at the change and how she was. And I don't know that I had noticed it as much until that point when her Friend really noticed something going on. [00:07:41] Speaker B: And by the way, her doctor had explained to us later that the reason that she does this, and dementia patients often do this, is they want to dominate the conversation because they're not prepared to be able to answer the questions others would ask of them. So if she just controls the conversation and controls the script, she can mask that. [00:08:01] Speaker A: Yeah. And I think that for us, we're so in it that we're not really noticing how massive that change is. It kind of really took other people to say, hey, this doesn't seem right, or is there an issue here? And, I mean, I think all of these issues were pieces that concerned us, but I don't know if, if they together really felt like it was something drastic until Julie, I can't remember when we decided that it was time for her to see the neurologist. [00:08:35] Speaker B: Yeah, well, honestly, there were, there was. I can get into Andrew if you want me to now that. [00:08:40] Speaker C: Yeah, just one quick question. Before. Before that is. I was just wondering, like, as these things are happening, Karen, are you like confronting her at all and saying, hey, mom, by the way, you know, you're kind of dominating the conversation. You should let people spe like, you're doing this, you're doing that. Was there any, like, trying to let her know that some things were that she was doing was a little bit off? And was there any response from her on that? [00:09:02] Speaker A: A little bit. I didn't really. I tried when I was with her in conversation and she was dominating, I would try to jump in and kind of steer it in the direction of the person she was talking to more because I was kind of a little bit embarrassed because if you didn't know better, you would just think, well, this is an incredibly selfish person. And in fact, interestingly, if we look back at mom, she really used to be kind of more shy than domineering in a conversation. So that didn't feel like her. But yes, I would constantly say, hey, mom, you can't put this metal piece in the microwave. Or mom, did you notice that there were dirty dishes that were in your cupboards? And she would kind of look at me as if I was speaking another language to her. That wasn't an issue. And I will say that one of the big pieces that, as I recall, Julie, this may have been part of our conversation to lead to the neurologist was the driving. She would get lost on the way to my house, which was, like we said, a five minute drive away. She had taken to only driving during the day, but one time she was at a choir rehearsal, and it went late, and it got dark, and she completely lost her way home. And she was able to call me, but I wasn't able to help guide her back. And it was stressful, and I couldn't figure out where she was. And so I eventually called the police in her neighborhood, thinking, well, if at least she's nearby, they can find her. And sure enough, she was around the block from her house. And that was really kind of the beginning of the end of her driving days. Also, there had been scrapes all over the car, and she said that she had been hit by a tree. [00:10:44] Speaker C: So trees can be nasty that way. [00:10:48] Speaker A: So can the Trader Joe's lot. No offense to Trader Joe's, but if we're being honest, it's a challenging lot for anyone. [00:10:54] Speaker B: Yeah. Yeah, exactly. [00:10:57] Speaker C: So, Julie, you want to talk through a little bit about this appointment? And then once we finally decided to have her see a doctor and what happened? [00:11:04] Speaker B: Yeah, so Karen and I used to joke that we thought she had social dementia, but again, we didn't really necessarily think it was Alzheimer's, which, by the way, she had a memory like a steel trap, which made us, in hindsight, realize she probably started to lose her memory much sooner. But because her memory was so good to begin with, it took some time for us to really notice. Also, her hearing started to be an issue. And I thought, you know, combined with the driving situation, it would be a good time to see a geriatric specialist. And I'm in Ann Arbor. You know, Michigan Medicine has an really outstanding geriatric practice. So I thought, let's do two things. The driving situation. I knew, by the way, she was always a bad driver, but we were really afraid. And again, I've researched this. As a journalist, I write about aging a lot. And I know that this taking away the keys conversation is really hard. And I thought someone had told me. I think it might have even been the geriatric. I think that's what happened, that we took her to see the geriatric specialist to do an evaluation of her. And she then said, we have a whole. I think it's occupational therapy department, and they can do an assessment of her, just like, without going on the road to see if, you know, to assess her driving skills and whether training would help her. So first we met with the geriatric specialist and the geriatric doctor. We did not take her to a neurologist, but the geriatric doctor did some memory tests and then also ordered a CAT scan of her of her brain. Subsequent to that, right around the same time, we took her to. I took her to the person who did the driving assessment, because my idea was, this person's probably going to tell her she shouldn't be driving, and it would be great to hand it off to a professional as opposed to me making that decision. [00:12:52] Speaker D: Right. [00:12:53] Speaker B: So the woman said to me, unfortunately, looking back, I feel like it was all handled with not much heart, and I regret that. But she said in front of mom, you know, some people there. There's training, more classes they can take. She said, we rank people on a scale of one to one to five, and your mom, you know, one being the best, five being the worst. She said, your mom, is this the worst in terms of her abilities? There are. No, there's absolutely. She should not be driving. She should not ever be driving again. So this assessment, she was a 10. Well, yeah. What. It was a bad. It was. It was. Yeah, yeah. My mom was always physically healthy, and she would always say, like, I got an A on my physical. But she was not happy that she did not get an A on the driving desk. It was brutal. She was very teary, and I. I played it up. We'll get drivers for you. You can have all these assistants driving you places where you want to go. She still blamed me, and also Karen, who wasn't even involved in it profusely, but I just felt like it was the right thing to do. They also did a memory test, a cognitive test that was identical results to the test that the geriatric doctor had. And then the brain CAT scan showed plaque that was consistent with normal aging. But paired with the results of the memory test, the physician said he was basically 90% sure that she had Alzheimer's. That's interesting. [00:14:13] Speaker C: So the plaque. The plaque data alone does not in itself diagnose dementia. They. They combine that with some circumstantial evidence of what's going on. [00:14:24] Speaker B: Well, you know, I would, of course, run this by a physician, but I was told that, you know, everybody has plaque buildup in their brains over time. But, you know, and so it was consistent with the fact she was older. But when they looked at the memory tests, I mean, we could have. You know, we could have taken her to a neurologist for yet one more step. But I thought, first of all, what we do differently, not much. And the geriatric doctor was outstanding and very compassionate and kind to her. And. And I do remember we didn't tell my mom for a while that she had Alzheimer's because she always Used to say, if I ever have Alzheimer's, you can just shoot me. And she would always just say such disparaging things about people who had Alzheimer's as if it was somehow their. [00:15:03] Speaker A: As if it was self inflicted. [00:15:06] Speaker B: Right, right. [00:15:07] Speaker A: Well, so and so, I mean, they have Alzheimer's. She would, she was so interestingly judgmental of people who had it, as if it was their fault that they had done something right. Created that we thought, oh, is this the ultimate, you know, situation that now she herself has it. It was. [00:15:26] Speaker B: Right. [00:15:27] Speaker A: Distressing, like her buddy. [00:15:28] Speaker C: But like her buddy's wife who smoked forever, she eventually had lung cancer and she was always disparaging of that woman because she did it to herself. [00:15:36] Speaker A: Self inflicted lung cancer. She. [00:15:38] Speaker E: All day. [00:15:38] Speaker A: Well, you know, she used to stand on the porch smoking, like. [00:15:42] Speaker B: Right, right. But to be, to be fair, you know, that is more of a self inflict. I mean, if you have Alzheimer's, I don't think it's really right, but it's. [00:15:49] Speaker C: Not a fair comparison, of course. [00:15:51] Speaker B: So for many, many months, I would say we didn't tell her because we thought it would devastate her and she was cognitively well enough to know that this is bad. But over time we just, we decided we didn't use the word Alzheimer's, but we had the doctor tell her that she has dementia. And you know, I have to say, to her credit her. Andrew, you were on that call and I think she said something like, okay, I need to do. How do I survive this? And she was a survivor and she's a tough cookie and she really just was like, okay, I'm in it. Let's figure out what to do. And she was receptive at the time to some suggestions, but it was a long haul and she probably in reality had it well before we knew about it or had it diagnosed. But it really doesn't matter because I don't think we would have really done much differently except maybe gotten her more help in the house sooner. But yeah, I don't have any. I don't have any regrets about that. It's hard to. It's hard to tell it sometimes. [00:16:43] Speaker C: Sure. And then. So were there any. Before we hand it over to Dr. Tony, were there any specific steps that were taken right away once you had that diagnosis that changed things for her daily living? [00:16:54] Speaker B: Well, we got her a driver right away. We had a cut. Her cousin who took around my Karen and took her to appointments and took her to the gym and I. That was, that was a start. Right. And then we got her more help in the house. And she agreed to that. [00:17:08] Speaker D: We did. [00:17:09] Speaker A: And also we started driving her around ourselves when we were with her. You know, for instance, on the days that I would spend chunks of time with her, I would save all of the appointments that we needed to do so that we could kind of do as much as possible in one shot. And we did hire various people here and there to drive around. It took a while to find the right companion for her. And a lot of battles, she did not want that. And she fought that driving piece right up until the end. I will say that the piece that kind of saved us, interestingly, was the Pandy, the Pandemic, because she lives in this small square mile town, and all of a sudden, nobody is really going anywhere, but they're walking everywhere. And so the streets would be filled with people walking in socially distanced groups. And so I was able to say to her, this is unsafe for you to be driving through your town because there are so many people walking. And the thought of you accidentally hitting someone and injuring them or worse is something that none of us can live with. And so for this time, I'm going to drive you and I'm going to. Or we'll have other people doing that for you. And that actually ended up being almost, interestingly, a helpful piece. [00:18:27] Speaker C: Yeah, I remember when we had some people come in, like the student who was kind of just going to help her with general administration and files and mail and stuff like that. She was very resistant to anybody coming in. And then later we'll talk. Obviously, we're going to cover this in a different episode. But talking about the cameras coming in, she was always very resistant. But I remember that was the beginning of this negotiation where we said, hey, you want to stay in your house? We want to honor that. And so these are the compromises. You have to let some people come in every once in a while. You have to allow us to have some cameras. Obviously, you can't have the keys to the car. And she. That was always kind of like, acquiescer. She was like, okay, I get that. That's fine. Even though she wasn't psyched about it. [00:19:11] Speaker B: Right? Sure. [00:19:13] Speaker C: All right, well, thank you, sisters, for walking us through that. Next we will bring on Dr. Tony and get some expert advice on what this is all about. So stick around. We'll be right back. [00:19:29] Speaker E: This is a musical parade called Wicked. And when you see it going all around, that's a wonderful thing you need to say. [00:19:45] Speaker C: We are back. Our guest today is Dr. Tony Emmer. Dr. Emer is a doctor of osteopathic medicine. He's co owner at Neuro Consultants in West Bloomfield, Michigan. Dealing with so many important neurological areas. He's an expert on how our brains work and what happens to those brains when we develop diseases like Alzheimer's and dementia generally. He's here to help us understand what this condition is and how best to live with it. Doctor, welcome and thanks for being here. I know you have many specialties within this realm but probably best for us to let you tell us all about it. Feel free to introduce yourself first and what it is that you focus on. [00:20:25] Speaker D: Thank you for the opportunity to be on your podcast. I appreciate it. My name is Dr. Anthony or Tony Emmer. I'm a board certified neurologist, board certified general neurologist, but do have a sub interest in what we call neurodegenerative disorders which includes dementias. So I'm pretty active in the diagnosis and treatment of such disorders in addition to practicing general neurology. [00:20:54] Speaker C: That's great, thank you. And what we're going to do is ask a few series of questions and talk a little bit about our mom's experience. And we noticed some things about her that of course my sister noticed more than me because I hadn't been living here while these things progressed. And I'd like to introduce our sister Julie who is with us and is going to be talking about her experience and the things that her and Karen noticed and the run up to actually getting her to see a neurologist and then some questions Julie has for, for Dr. Tony. [00:21:28] Speaker B: Yeah, well thank you. I want to second Andrew's thanks for, for being on here. I should mention that in addition to living this through my mother, I'm a journalist and I write, I cover aging issues very extensively for the New York Times AARP and we've always been very attuned to my mother's situation. The first question I wanted to ask you is. So Andrew had mentioned that the difference between dementia and Alzheimer's. I know that Alzheimer's is actually a form of dementia, the most common form of dementia. But could you just really walk people through? I think there's a lot of people don't quite understand what dementia is and what are the different kinds of dementia. If you could speak to that. [00:22:11] Speaker D: Sure. I agree. A lot of people will just assume that dementia and Alzheimer's are the same thing. And like you just pointed out, Alzheimer's is the most common cause of dementia. And what dementia is is it's a broad term to describe A neurodegenerative or a group of neuro. It's a neurodegenerative condition to where certain areas of the brain stop functioning appropriately due to various different causes. And like you said, there's, there's not only Alzheimer's, which is the most common form of dementia, but there's other types of dementias. Before I get into that, getting back to dementia, I threw out a bunch of terms like neurodegenerative, etc. What that means is like I had alluded to before, certain areas of the brain start to. The, the neurons or the cells in the brain start to degenerate or no longer begin to function. And that, that becomes progressive in nature or worsens or becomes more prominent over time. And, and that's, that's the way to describe it, dementia. And that involves memory, mainly short term memory. And then as time goes on it can affect different, what we call spheres of memory. So immediate, remote, long term, in between memory. It can also affect certain dimensions, can also affect behavior and mood and also affect mobility. So that in a nutshell is kind of what dementias are. And like you said, and as I keep saying again, the most common form is Alzheimer's. [00:23:59] Speaker B: So what are some signs that you're, you're, you know, you should take your loved one to see their provider and do you start with a primary care physician or do you go right to a neurologist? [00:24:11] Speaker D: The first to answer the first part of your question, anytime that there's a change in cognition, whether that's difficulty with short term memory, a person's repeating themselves, not remembering conversations, they're starting to have some word finding difficulty. I mean we all, as, as we mature in life develop that. But more than a person saying, you know, help me, and then they continue on, help me meaning fill in the word for me. And they continue on with their conversation, I. E. They get lost in conversation, they start to not keep up the home, they start to maybe get a little turned around with driving or managing finances, writing checks becomes an issue. Those, those would be some of the earlier things that would, that you'd want to have your, if your loved one was showing that you'd want to have them evaluated. Now who to have them evaluated by initially? Well, Medicare now is part of a wellness visit. Will for primary care providers should have a built in cognitive test that would raise red flags or would confirm that there is an issue with cognition. And depending on the primary care provider's comfort level, they may start the workup or more likely neurology referral would be next. [00:25:48] Speaker B: And how do you determine, how do you diagnose it? Like, I thought that for Alzheimer's, for example, you really can't diagnose it until you do an autopsy. So how do you determine which of these dementias it is? You know, how is the diagnosis made? What do you look for? [00:26:03] Speaker D: Great, great. Correct, great question. Because sometimes it's tough to tease through the symptoms and hit the diagnosis. And like you said, you know, up until I would say recently, we were 100% sure because we're basing it on history and clinical exam and ruling out other causes, like doing an MRI of the brain to make sure there aren't strokes, tumors, bleeding in the brain, doing an EEG to make sure there are any seizures, doing blood work to look for any systemic medical problem. Now, what we can do is we can get a little bit more accurate in some with. With being able to get a whole lot more accurate coming down the pipeline soon. Now, with the advent of some newer medications being available and what's required to get them approved, we've gotten better access to PET scans, both what we call amyloid PET scans, where we look for beta amyloid plaques and Alzheimer's or metabolic PET scans that look at how the brain metabolizes or takes up or doesn't take up glucose, which is the main source of energy for the brain. So that's a way to help us narrow things down. Not always, but better. And then there's. There's spinal fluid testing that you can do specifically for Alzheimer's. [00:27:36] Speaker C: I've got a quick follow up to that one and then we'll turn it over to Karen for some more questions. Once you diagnose it, how do you, or is it important to continue to measure the progression of the disease? We noticed when we took our mom to kind of an adult daycare facility that we were going to maybe take her to a couple days a week, and they did an entry exam to see how she was doing and they asked her a bunch of questions and we were there. And it was quite striking to hear things like she couldn't recall her husband's name, she couldn't recall what day it was. It wasn't shocking, but we hadn't done done a test like that in probably a year. And we were like, oh, yeah, I guess this is where it is. Because it's difficult to know where it is outside of your casual daily observations. How do you address that with continuing monitoring of the disease from a diagnosis perspective? [00:28:33] Speaker D: So that is multifaceted. Number one, it's clinical exam, meaning me examining the patient, asking the patient questions, looking at the differences over time. And that would also include not only checking reflexes, their mobility movement for other non cognitive components of a dementia, but also doing a quick five minute in office cognitive test like a mini mental status exam or a Montreal cognitive assessment or a slums exam in tracking them over time. [00:29:12] Speaker A: And so this is Karen, how often should we be doing that? Because it did occur to me that we really haven't had mom back at the neurologist probably since our original diagnosis. Is it necessary for us to be taking her to regular visits? And really is there anything to be gleaned from those experiences? [00:29:34] Speaker D: That's a great question. I think, you know, I'm biased because I'm a neurologist. I think, you know, my dementia patients should be seen every three to four months as things progress and you know, care changes and it goes more into a supportive role. That could be every six months initially and up until the later stages of a dementia. I'll do cognitive testing three times, three times a year, maybe four times a year if it's a little bit earlier in the course of the disease, certainly, you know, questions to patient. But again, it'll be limited as to what they can tell me, family caregivers, what this person is able to do that, that helps me also track and see where they're at because functionally, I mean it's, it's hard in the office to do a full functional assessment. And is it realistic to send, you know, a nurse or a provider out three, four times a year to do a functional assessment in the home? No. So history plus the intermittent cognitive testing I think is, is, is important. [00:30:53] Speaker B: Interesting. [00:30:53] Speaker D: But like you said, I'm sorry to. [00:30:55] Speaker A: No, no, no, no, go ahead, pause. [00:30:57] Speaker D: And then start up again. But once it gets to a point where they're in the latter stages or more moderately severe to severe component of a dementia where care is supportive, what you want to do is you want to promote quality of life. And so sometimes it can be a burden, you know, bringing the patient in. [00:31:14] Speaker A: I agree. I think the process of, I can't even imagine right now the process of putting my mom through that when you know, it's very clear to us that she in a pretty extreme, I mean, I guess maybe not an extreme progression based on what I'm hearing you say, but also just the idea that is there really information that we're going to gather that would make a difference in terms of her level of care? Our goal right now obviously is to keep her happy, to keep her comfortable. And I do often feel like I don't really want to drag my mom to appointments because it's so overwhelming for her, but I also don't want to miss something that could be vital to her care. [00:31:55] Speaker D: Sure. And you know, again, not hearing your mom's story or examining her, etc. I'm assuming she's along the more moderate to severe or further along in the course of the disease, is that correct? [00:32:09] Speaker A: Yeah, I mean, she knows who she is, who we are, where she is. I kind of would say that sort of seems to be the extent of, of, you know, her knowledge base right now. She's comfortable, she's happy, but, you know, she certainly can't remember really much about her own history, our history, like Andrew said, you know, when we did the diagnosis at the daycare center, I was. It wasn't that I didn't see it coming, it's just that I think it was a little shocking for me to see how seriously she had progressed in what felt like a relatively short period of time. [00:32:49] Speaker D: Yeah, that's not uncommon. [00:32:51] Speaker C: And physically she's in decent shape. She's incontinent, but she's getting up and moving around with a walker pretty well. It's. And she's very pleasant. [00:33:00] Speaker B: She doesn't have to, by the way. [00:33:02] Speaker C: Walking naked in the street type dimension. [00:33:04] Speaker A: None of that. Also, she's become a very nice lady, which was not the norm for us before. [00:33:13] Speaker D: So that's, that's, yeah, that's. That's a good thing. Because what I was going to say is someone like that, you. You what? The medicine, the tools we have available to help slow progression of the disease. She's not a candidate for. [00:33:29] Speaker B: Right. [00:33:29] Speaker D: Or someone who's more progressed. Not a candidate for. [00:33:32] Speaker A: Yeah, like you said, you want to remember. Sorry. With her initial diagnosis that we did try, I want to say a generic version of Aricept, that it just wasn't successful for her. I felt like there were some side effects. That was a while ago, but it does kind of lead to. And it's kind of leading into our next question about, you know, are there developments, Are there things that people should be jumping into, which is why an earlier diagnosis could be helpful. [00:33:58] Speaker D: Well, across the board, the medications that we have, we know they're going to have what they're nothing in terms of effectiveness that any of us want. They help all of them out, are going to help slow progression of the, of. Of the disease. The pills that are out are going to give us the biggest bang for the buck for the first two years. The newer medications that are out, which are new IV infusion medications, which actually help. Well, not help, but actually remove the amyloid plaques from the brains of patients with Alzheimer's. All of this you want to do early because the effectiveness of these medications are better earlier overall. And in fact, the IV medications, the newer medications that I mentioned, they've only shown effectiveness in patients that have. That are early in the course of the disease. [00:34:56] Speaker C: And Dr. Emmer, is these drugs that you're mentioning and where we're at with how much value they have. Is Leqembi one of these drugs? I know there was some news about them being FDA approved for the first time in this category. And is that something that's real or effective or something people should keep an eye out for? [00:35:17] Speaker D: It is. Leqembia is definitely real. There's also another medicine in that family called Kisunla. Both of those medications have been kind of had accelerated FDA approval. They're certainly not without controversy. Those are the medications that I was talking about that remove the plaques in patients with Alzheimer's brains. And these, the two medications work fairly equally, although some people think Leqembi might have the edge. But if you look at the studies and the numbers, they haven't been done head to head, but they both will show a slowing of progression of. Of disease by about 27, 30% in patients with mild cognitive impairment or an early dementia due to Alzheimer's. [00:36:08] Speaker C: Okay, got it. Thank you. Just a couple more final questions. And one, it relates to how to deal with the disease in front of the patient. I know one of the things that was difficult for us to get used to, me personally, is to, like, not get frustrated with mom when she would make a mistake or do something that I had instructed her not to do or not walk with her walker. And I realized over time that it's not her fault. This is. This is the disease. You know, as difficult as it is to kind of like control your emotions in that way is, you know, is how. And then I remember also one time we were going back to her assisted living facility that she was in, and I was trying to remind her that she needed care when she was asking to go home after we had dinner at my sister's, and I was saying, oh, you need care, we got to go back. You know, you have medicine stick. And she started crying and she was really upset. And then later, our Kelly, who ran our assistive living facility, gave us the advice, you know, sometimes just deflect and you don't have to hit this stuff head on. It doesn't add any value to actually, like, tell her she has dementia. And so I raised in a couple my own anecdotes. But however you want to address that, like, what are some tips you have for dealing with the disease with or without talking to the patient about it? [00:37:27] Speaker D: Sure. I think each individual patient is different. Some patients might want insight early on as to what's happening, others don't. To try and convince a patient you have dementia, you have memory loss, this is why these are happening. These things are happening to you. This is why you're. This is why. And fill in the blank. Yeah, that can be counterproductive. I agree with that. And that doesn't necessarily need to. To happen. And unless the patient inquires and they might. They might forget after you tell them. But still, I agree with the deflecting. I think that's super helpful. Like, for example, the evening, you know, you said to your mom, look, you got to go back. You know, you have dementia, you got to take medicines. You. You gotta go. Maybe, right. Deflecting it, saying, okay, we're done with dinner, time to go home. I'm gonna take you home now. And it doesn't matter whether she knows or not that she's going to get meds and she's going to get ready for bed. They're going to do that. So let that, let that just happen. Something like that is a good example. Also, support groups, good and bad for families. Good in that it's an outlet to see you're not alone, to bounce ideas off people. And also just support in general, making sure that for family, that there's a. Let me back up and say there's a lot of guilt involved because of the frustration or because what. The limitations of what all, me included, if I were a family member of someone with dementia or a caregiver can do. So there's that guilt. And you just got to remember to take care of yourself. That's huge. Right. Because if nothing good comes from being a martyr. Right. The disease has one individual already. It doesn't need any others. So that's for the family members in terms of dealing it with themselves, in terms of the family members dealing with the patient. I go back to saying, deflect, don't confront. I mean, obviously, if the person's doing something, you know, totally inappropriate, you. You take care of that behavior. But the deflecting and trying to, you know, engaging somebody about, for example, if they think something is happening, that Isn't you? You can, you can try and tell them it's not to kind of soothe them and calm them, but to engage them and say, look, it's not happening. There's no dogs in the room. You're the only one. Not good, right? [00:40:15] Speaker B: Yes. [00:40:15] Speaker D: Not good. So I could go on and on with different examples, but I think the point's been made. [00:40:21] Speaker C: Thank you. Yeah. And so one final question. Is there a genetic component to dementia? You know, like doctors always ask you, do you have history of cancer in the family? And is there anything that children of parents with dementia should be concerned about or something that they should be doing to protect themselves that, that we should be thinking about? [00:40:42] Speaker D: So genetic testing for risk of dementia or dementia in general, I think in asymptomatic individuals is a Pandora's box, because if you do that genetic testing, then one, some of them are not accurate enough to, to confirm that you're going to have it. Two, the ones that have the higher accuracy, they might let you know what's going to come, but there's nothing to do about it. Or those two might not be accurate. So I say stay away from genetic testing. If you have a family history, a parent or two that has a dementia or you see a lineage that is other family members on that side, then you know, you're. I mean, that, that gives you an increased risk of dementia. What is that? Is it 50%, 80% lower than that? So things that you can do to prevent, to delay onset is eat healthy. And people say, well, what is that? What, what diet is that? If you look up in general healthcare, whether it's dementia, stroke, heart disease, it's the Mediterranean diet, right? So eat healthy, be physically active. Physical activity equal in importance to cognitive activity. Right? You got to do them both. And then you got to reduce what's what, what we call vascular risk factors, like patients who have hypertension, diabetes, high cholesterol. Got to make sure those are under control. And if you don't have them, do your best not to get them. But, you know, sometimes that's out of our hands. Stress reduction. Right. The world is what it is now. That's easier said than done. And getting adequate sleep, those are the things that I would say, someone who would, who felt that they would be at risk should. [00:42:43] Speaker C: Dr. Tony Emmer of Neuro Consultants, thank you so much. This has been so helpful. We really appreciate your time. We learned a lot ourselves, obviously of stuff that we haven't known before, and we're going to take that info and it'll Help us on our journey, and I'm sure it's going to help a bunch of people. Thanks so much for joining us today. [00:43:04] Speaker D: Thank you for the opportunity. Much appreciated. [00:43:08] Speaker A: And we'll be right back. [00:43:19] Speaker E: When you're learning me now and when it seems to me that's the conversation. [00:43:31] Speaker C: And we are back. [00:43:33] Speaker F: Fascinating discussion with Dr. Emmer. [00:43:35] Speaker C: Karen, what were some of your takeaways? [00:43:37] Speaker A: It was really interesting to hear Dr. Emer talk about each of these specific pieces as they relate to dementia, different types of dementia. I think one of the pieces that he highlighted that I recognize in myself is trying to avoid the frustration of her lack of memory. Right. That, you know, it's hard when you find yourself repeating something or she repeats something over and over again and your immediate inclination is to say, but don't you remember? I find myself, or used to anyway, saying that all the time. Well, don't you remember that we talked about. Blah, blah, blah. Of course she doesn't remember. [00:44:19] Speaker F: Yeah. I think that's important to recognize that it's a disease and it's not their fault. And it's a very hard thing to do in the moment. I have many instances where I told her not to do something and she ended up doing it anyway. And I found myself getting a little bit frustrated. But then ultimately I came to realize that you just have to try to insert some compassion during those times. And it's just not easy. I mean, this is, this stuff isn't black and white. Because also I find that. Because I know that it's difficult to have conversations and that she is probably not going to be able to remember. She's not able to express thoughts and words like she used to. That means that there's not much of a conversation going on between the two of us whenever I attempt it, which means that I end up having less conversations with her. I end up trying less. And that's just a balance that you have to be conscious of and try to figure out. And in our case, I think try not to worry about it too much because that's also just part of the disease. [00:45:22] Speaker A: Yeah. And, you know, it's interesting that I, I noticed that, you know, sometimes we'll be looking at photo albums or I'll be looking at pictures in the hallway with her and I'll say, oh, do you know who this is? Do you know who this is? And then, you know, she doesn't seem particularly frustrated, but it does feel like I'm buying trouble. Of course, she doesn't remember who people are, but she certainly enjoys Looking at the photos, the other thing that I think is interesting is when we get in the car, I immediately turn on Broadway show tunes and she sings along and she couldn't be happier. So I'm sort of trying to figure out ways to spend time with her that engage her in a joyful way, because otherwise, truly, when I say I'm at a loss for words, I really am, which is not really typical. [00:46:04] Speaker C: Well. [00:46:04] Speaker F: And that everybody has to find their own balance with the condition of their own senior. Like, I know with Mom, I've also found a balance where she's still very able to sharply reply in quick sentences like, it's a beautiful day out there, and just say, oh, it certainly is, you know, and isn't this a great lunch? She's like, yeah, it tastes great. Like, those things are still very sharp. If it goes beyond that, she has a tough time. So just manage the conversation in that way and just present some things that allow her to say something back, that allows some type of conversation to go on, and that's just fine. [00:46:37] Speaker A: Yeah. And I also think that it's a learning curve because we're learning where she is in the dementia process, and it changes over time, and you have to kind of remind yourself and allow yourself opportunities to make mistakes and then correct them so that your time with her becomes more meaningful and more thoughtful. I guess, if that's, you know, kind of the way that we're looking at it. [00:47:02] Speaker F: Yeah. And I think also one of the takeaways from talking to Dr. Emmer is that there's only so much you can do once you have this diagnosis. And a lot of the work you have to do involves understanding the conditions around the disease. There's not a cure for this at the moment, and there are some promising drugs out there that we discussed and that hopefully will continue to make progress. But one of the most important things is understanding the environmental conditions around it and how to deal with it in your daily life and just be very knowledgeable about what the disease is doing and how you can mitigate some of its effects during your daily life. [00:47:45] Speaker A: I will say that I love that he ended with his comments about what we can do to stave off dementia to the best of our ability in terms of leading healthy lives, getting enough exercise, eating a reasonable diet. I love that he brought up the Mediterranean diet. There's no fad involved in this. It's not complicated. I mean, really, what he's suggesting seems pretty simple, but it does remind us that we have to be thinking about where we're going to end up in this process and do everything we can for ourselves, which includes keeping your mind and body healthy and creating a community of people who are, you know, gonna surround you with love and support, which feels like a nice little segue to the idea that we want to create a community here with all of you. So we hope that we will hear from you. If you have suggestions, questions, comments, advice that you need answered by an expert, please email [email protected] and hopefully we'll be able to share stories with each other, advice from one another, and create something that will be meaningful for all of us as we navigate our way through these challenging times. Because we all know that if it's not one thing, it's our mother. [00:49:05] Speaker F: It's our mother. [00:49:06] Speaker A: But it could also be your mother or your dad or your grandma. [00:49:10] Speaker F: It could be anyone. All right, I think that's a wrap for today. Thanks so much for joining us. [00:49:15] Speaker A: And let's lead out once again with Joanna singing one of her beautiful tunes and playing piano. Thanks for joining us. [00:49:22] Speaker F: All right, we'll talk to you next time. [00:49:28] Speaker E: My dream, a dream gone by when hope was wonderful for living I hope that my own always would be here for Michael and his buddies would always be here.