June marks Alzheimer's & Brain Awareness Month. Did you know dementia is a looming but unrecognized public health crisis in Latino communities in the U.S.? The Alzheimer's Association Special Report on Race, Ethnicity and Alzheimer’s cited research indicating that elderly Latinos in the U.S. are 1.5 times more likely than older non-Hispanic whites to develop Alzheimer’s and other forms of dementia. Currently, the number of Latinos living in the U.S. with Alzheimer's is 200,00 and this number is expected to increase to 1.3 million by 2050.
We spoke to Dr. Romina Rosen of Kaiser Permanente to get expert information on Alzheimer's, and how it affects not only the patient, but caregivers as well.
What are some of the early signs of this disease?
Early signs might be getting lost while driving, misplacing objects at home, doing things that you were able to do before that now take a bit longer. And Alzheimer’s is a type of dementia; Alzheimer’s being the most common one. It’s a slow, progressive disease that initially might not be recognized by others. But eventually it interferes with the instrumental activities of daily living and eventually the basic activities of daily living. So instrumental activities of daily living would be talking on the phone, paying your bills, getting around town, going to the market, grocery shopping and so forth. Whereas the basic activities of daily living would be dressing, bathing, going to the bathroom — those basic things that we take for granted. So eventually a person with Alzheimer’s dementia will need complete care.
And how early on does this start to take place before a physician can detect it?
At this point, we don’t have commercial blood tests that can detect Alzheimer’s disease, so there are ongoing studies, but they’re not available to the consumer yet. Usually, a person presents to the doctor or the assessing clinic because the family has noticed that there’s some issues whether it’s memory, or functional or declining social activities — something’s going on. So the doctor will do a screening test, usually a mini COG, which is a three step memory assessment [and] screening tool. If that is positive, then they can go ahead and do a mini mental status exam or a MOCA test — these are all different kinds of tests to do a deeper assessment as to whether this person is suffering from a memory impairment illness, whether it is Alzheimer’s, dementia or something else. And this takes time.
It takes time because it takes time to assess the patient to see what’s going on functionally at home. And many times the evidence is such that we don’t know. You know, we know that there is maybe mild cognitive impairment where it doesn’t interfere with your daily function, but we don’t know if that’s going to progress. A mild cognitive impairment is someone that has definite memory problems on testing but is still able to function daily. And out of those, there is a large proportion that may progress to full on dementia. Often times we need to see the patient sequentially to see what’s going on, so it may not be diagnosed on the initial presentation. The patient may have the full assessment, be diagnosed with mild cognitive impairment – memory loss -- and then [the patient is] brought back six months later and tested again. And then you see a decline in function. Then, the diagnoses of dementia may be obtained. Sometimes you need imaging, so you need a CAT scan. Some people use PET scans, and if you go to some tertiary centers, they’re doing further testing – even lumbar punctures with testing. But we don’t do that on every patient that comes in.
Is there a timeline or something one can reference to know how quickly it progresses? Because, for some people, it seems to get worse faster than for others.
Right. So, we’re talking about Alzheimer’s disease, which again, is a type of dementia that is slow progressive. But there are other types of dementia that may be more evident. For instance, there’s vascular dementia associated with strokes. So instead of being a slow progressive illness, every time someone has a stroke, they drop a notch. So that is associated with a vascular decline. Sometimes people that have Alzheimer’s dementia, they’ll seem to decline faster when there’s an associated recent infection or hospitalization because they’re more prone to getting delirious. So delirium is not necessarily a progression of dementia, but it is more likely to occur in dementia patients. And that’s seen when the alertness may change from one minute to the next. That’s due to infections, medications, lack of sleep and so forth. But that seems to subside with time and supportive therapy; whereas, dementia does not improve.
Is there any way to stop Alzheimer’s from progressing?
I mean, at this point we do have medicines that seem to slow it down. The average lifespan of a patient with Alzheimer’s dementia is about nine years from diagnosis. And the medications are split into some categories. You have something like Aero Step that is used for mild, moderate dementia, and we are using Namenda for moderate to severe dementia. But it does not reverse the effects of the illness, it prevents further decline. So these medications are only used for a bit of time, and then at some point when the decline is evident, people choose to stop these medicines because of the side effects.
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