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In My Community
Meeting of the Minds Conference, 2018
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Meeting of the Minds| January 12, 2018

Speaker: Mark Hensley

Can you please give examples of the types of questions people ask when they call 211?

Mark Hensley: "The most common questions are citizens asking for assistance obtaining food, rental assistance or assistance paying utilities.  Within the top 10 requests, assistance caring for an older adult loved one is one of the top 10 requests.  Call center specialists are trained to utilize their online database of resources to provide information and referral for assistance in the county or region of the state where the caller resides."

Several speakers mentions use of MMSE (Mini-Mental State Exam). Is this the screening that you typically use? Do you ever use the MOCA (Minnesota Cognitive Assessment) or SLUMS (St. Louis University Mental Status)?

Mark Hensley: "Typically, the MMSE is used.  There has not been a movement to examine the various cognitive assessment tool nor to set a standard for use with all medical professionals in NC.  Some states, like Utah, have established a standardized model."

(Q2 cont.) In other words, are the screeners (MMSE) usually done for research consistency or by the patient’s primary physician before they are referred to you?

Mark Hensley: "Because of the limited number of memory assessment centers and the waiting list that some centers have, depending on the level of training, primary physicians do utilize the MMSE.  Most commonly caregivers report they had to find community supports on their own and that physicians provide a diagnosis of ‘dementia’ and provide a prescription for a common medication like Aricept.  This is a huge concern that the Alzheimer’s State Plan is attempting to address with our current Health Care network."

Is Alzheimer’s the cause of death? I thought other thing had caused death and that Alzheimer’s was merely a condition.

Mark Hensley: "Alzheimer’s disease and related dementias is fatal.  Simply put, at the end of life, the brain cannot sustain swallowing, breathing, nor organ function.  Alzheimer’s disease is the 6th leading cause of death nationally and the 5th leading cause of death in NC."

Dr. Kavita Persaud

How do you balance memory loss with lack of sleep when using a sleep aid that may contribute to memory loss/dementia?

KV: "Insomnia needs proper diagnosis as a first step, as it could reflect many issues from undiagnosed thyroid disorders, sleep apnea or depression/anxiety. Good sleep hygiene which involve good sleep habits and regular structure can be very helpful. Avoidance of medication with anticholinergic effects should be avoided to reduce mental status changes and future dementia."

My husband’s doctor has approved to have him taken off of Donepezil (long) and Memantine (long) and to only have him on Lexapro. Will this change improve his gassiness issues?

KV: "Donepezil and other cholinesterase inhibitors are known to have potential GI side effects. These can include nausea, vomiting, diarrhea, poor appetite, weight loss. Trial periods on reduced doses or off medicatio can help clarify if the GI symptoms are related to the medication. A further re-challenge with the medication can confirm association if the GI symptoms return."

Dr. Christy Jones

Regarding the role genetics play in A.D., if your parents had A.D. should you see a geneticist?

CJ: "That is an option.  There are ongoing studies that are looking for biomarkers for AD, and you could look into being a part of a study.  Bottom line is that they will want you to engage in a heart-healthy lifestyle.  I think that Duke has an ongoing study if you are interested.  As we have likely not identified all of the genes, you may have a gene and not know it."

Can you explain “sundowning”, how common it is and ways to manage it?

CJ: "Fatigue is a stress on the body.  Stress makes our medical problems more obvious.  We can have mental fatigue as well as fatigue related to exercise, pain, etc.  Managing a person’s breaks “from mental exercise”, increasing structure and routine, and spacing out eating are examples of simple changes.  Naps during the middle of the day are fine."

What does research show about alcohol use among women in relation to A.D./dementia?

CJ: "Alcohol in women and men in excess is not good for the brain or heart.  Across time, the diet of someone who abuses alcohol changes and can lead to a vitamin B deficiency.  This increases the risk of AD.  There are also indirect ways that alcohol can lead to AD.  People may fall more and have a history of head injuries.  This increases the risk of AD."

Should someone diagnosed with M.C.L. pursue periodic testing or go see a neurologist for an MRI?

CJ: "Certainly getting baseline neuropsychological testing baseline is a good idea."

What is good sleep hygiene?

CJ: "Try to get at least eight hours of sleep per night.  If you have sleep apnea, get it treated.  Cut off your TV.  Preferably, keep the TV out of the bedroom."

Can you recommend vitamin supplements for vegetarians?

CJ: "If someone is vegan, they are apt to become vitamin B12 deficiency.  Talk to your primary care provider about your diet.  If you start to have memory problems, they may choose to draw B12 levels."

How do you balance memory loss with lack of sleep when using a sleep aid that may contribute to memory loss/dementia?

CJ: "There are many choices for pharmacological intervention for sleep.  Talk to your primary care provider about these options.  Also, exercise, diet, yoga, etc. are activities in which a person can engage to promote good sleep hygiene."

Dr. Ben Bahr

Regarding the role genetics play in A.D., if your parents had A.D. should you see a geneticist?

BB: AD specialists will look at many members of the family to detect signs of the rare hereditary form of the disorder. Also, hereditary AD usually shows up early: "early-onset AD" starts often between 40-50. Thus, if family members have AD before 60 that information should be given to the AD specialist."

Can you explain “sundowning”, how common it is and ways to manage it?

This question is better for Drs. Jones, Hensley and Persaud

BB: Should someone diagnosed with M.C.L. pursue periodic testing or go see a neurologist for an MRI? I found this online that points to getting more information if warranted by specialists: Treatable Conditions That Can Be Mistaken for Alzheimer’s Disease Normal Pressure Hydrocephalus (NPH) :gradual buildup of spinal fluid in the brain. Your medication: AGS publishes  a list that should be used with caution by older people.Depression: can sometimes cause a syndrome of cognitive impairment Vascular dementia: stroke or mini strokes, reduce risk by physically active, not smoking…Brain tumor or head injury:  dementia may be from a benign tumor or hematoma. We often hear that a true diagnosis of Alzheimer’s disease cannot be made until autopsy- is this still the case? I am told many AD clinics and Centers have 95% accuracy of diagnosing AD, but it requires specialists and many months to follow the progressive nature of AD, and to rule out other possibilities as noted above. Just like early detection = early cure with a cancer screening, can there be early tests done before symptoms appear? Great strides have been made and early tests are now being used in some clinical trials before symptoms; e.g.

In one study, "Participants at risk but not showing symptoms will undergo brain PET scans to measure the accumulation of amyloid plaques and tau tangles, as well as declines in brain size and energy utilization that are associated with Alzheimer’s." Dr. Ochs of California developed the LENS (low energy neurofeedback) system. Would this help prevent Alzheimer’s disease? I am not aware of all the pros and cons regarding this procedure, nor have I seen clear evidence of prevention."

Hello Dr. Bahr - I attended the lecture here in Wilmington Friday.  I really enjoyed it and learned a lot from all of you.  My father had Alzheimer's and died at 87. I think he started showing signs around late 70’s.  Are there any supplements you recommend? I just watched  PBS Every  Minute Counts video.  What  test can I get for finding out if I have the gene that causes Alzheimer's? As I learned from the lecture I will make sure I have purchased Long term Care Insurance before getting tested!  My mother's brother had Lewy Body disease. My family history has high cholesterol and heart disease. I have read statins may cause memory loss?  My dad who had Alzheimer's was on a statin.  Do you think statins may lead to Alzheimer's?  My doctor wants me to go on a statin for my high cholesterol. Worried due to side effects.

BB: "Regarding genetic tests, unless you have other members of your family that had early-onset AD (usually before 60, or even 50) I am told it is very unlikely hereditary AD is involved. Your father had the typical age of onset for non-hereditary AD. I hope this is helpful. If not clear, please try calling my office, afternoons are best when I am not in the lab. For supplements, many researchers and companies are studying and suggesting several. My best response is that everyone eats lots of fresh fruits and vegetables. Indian spices like curcumin has been linked to benefits, and onions and apples have components that appear to be helpful. One study shows 1-2 cups of coffee each morning is very helpful.

My family also has a history of high cholesterol and heart issues, and I am on statins (for many years now). Much research shows that statins reduce the risk of heart disease and AD. One company actually did a clinical trial for AD using a statin. My doctor says if you can take the lowest dose of statin, to help the cholesterol number without muscle side effects, it is good to take. My big advice for everyone is to not sit and worry about every issue that might cause a disease (there is a song that says everything causes cancer - not true;  and I have had many many questions about things that "might" cause AD). Eat healthy, see a physician that stays up on the news regarding AD and healthy aging, and enjoy life by staying physically (walks, dancing, chair-yoga), mentally (reading, knitting, painting, answering Jeopardy questions), and socially active (have visitors, call family members, attend community events)."

Todd Cohen, Ph.D.

Regarding the role genetics play in A.D., if your parents had A.D. should you see a geneticist?

TC:" It might be helpful to have a genetic panel of markers tested to see if you’re “at risk” but it may also be an ethical dilemma to know this information."

What does research show about alcohol use among women in relation to A.D./dementia? ?

TC:"I’m not aware of any really strong studies showing a link here, but I think it depends on the severity of alcohol use (mild, moderate, high)."

Should someone diagnosed with M.C.I. pursue periodic testing or go see a neurologist for an MRI?

TC:"I assume you mean MCI (mild cognitive impairment). I would see a neurologist and take steps to avoid progression of disease (keep mentally active, nutrient rich diet, exercise)."

If you are a woman and your mother had Wernicke-Korsakoff Syndrome, should you get tested for dementia? Is this a genetic issue or just related to alcohol abuse?

TC:"I’m not familiar enough with this syndrome, but if you are showing any cognitive issues I would see a neurologist."

How do you measure brain inflammation and can you “eat” forms of HDAC inhibitors in dietary supplements?

TC:"Brain inflammation is normally measured after someone dies using their brain tissue. But you can measure circulating levels of “inflammatory markers” like TNF-a and IL-6 in standard blood tests. You can inquire about these from your primary doctor. Some naturally occurring foods are thought to have HDAC inhibitor activity (turmeric, garlic, green tea, cruciferous vegetables, Brazil nuts) but their impact in Alzheimer’s disease is not known."

Will there be, or is there an MRI or genetic test that indicates early A.D. that will be as common as receiving a mammogram or colonoscopy?

TC:"There is now a PET scan that detects AD, but not early AD. For this, we would need an early biomarker that detects a blood marker or a brain scan that senses some early event that kick-starts the disease process."

Since there are individuals who do not have access to preventative care, how will gene deletion be feasible for everyone?

TC:"I’m not sure, but this probably would need access to some preventative care to administer the drug. Remember, IONIS pharmaceutical is making “antisense drugs” that could reduce your tau levels, no gene deletion needed."

Will the Chemours water damage here in Wilmington be a cause or create inflammation for A.D.? 

TC:"I’m not sure. But avoid contaminated water if its deemed contaminated!"

In layman's terms, how did you eliminate Tau from the mouse in the pool?

TC:"We used a genetic strategy to excise the tau gene in germ cells that we grow in the lab, then introduced those cells into a pregnant female mouse to make a tau deletion."

Since the mini mental exam was not designed to detect dementia, is there a better test?

TC:"This is most commonly used. However there are now apps, that I’ve heard can detect changes in cognition (e.g. Sea Hero Quest), but this is pure hearsay."

Do humans have the HDAC6 gene?

TC:"Yes, we all have the HDAC6 gene."


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