♪ Bob and Brad ♪
♪ the two most famous ♪
♪ Physical Therapists ♪
♪ On the internet ♪
- Hello, I'm Brad Heineck, Physical Therapist.
- Hi, I'm Chris, The Pharmacist.
- And I'm exactly one half of the Bob and Brad
Physical Therapy channel.
Today, we are extremely happy to have Chris
here to compliment and upgrade our show.
We've got some very good information
that's gonna be helpful for you
as well as for me personally,
about Alzheimer's and we're talking about...
- treatment
Treatment you can do medically
as far as medications that are offered
as well as what you can do
without medications that can help
hopefully slow the disease process down
and help out your loved one, or your friend,
whoever you may be interested in helping with.
So before we go on any farther,
we've need to go to Chris 'cause
I'm going to relax a little bit.
- Alright, well,
I guess we're going to talk about Alzheimer's today
and it's more about the treatments.
And so basically Alzheimer's
is the most common form of dementia worldwide.
So we're talking about 60 to 70% of the patients.
In the U.S., you're looking about 5 million patients.
- Wait, 60 to 70% of...
- Alzheimer's... or dementia patients have Alzheimer's.
- Oh, I see.
- Yeah, I mean, yeah, and then the next one is Lewy Body,
and then there's vascular dementia,
temporal frontal...
There's, there's several forms of dementia,
and if we think about it, like I said,
in the last year, kind of an umbrella,
but we're going to talk
about Alzheimer's 'cause I think it's the most...
- it's the most...
Most prevalent.
- Yup, so...
- So, and do you have some,
you said there's more women
typically have it than men?
- Yeah, kind of, interestingly,
just from a statistical standpoint,
it affects women more than men.
So women, the ratio is about one in six,
which is about 16% and men, it's one in 10,
which is about 10%.
- Okay.
- So of the population may experience that,
and again, with Alzheimer's, you know,
it takes six years just to get the diagnosis
because we have to rule out several different things.
It's going to be whether, you know,
your medications are causing it,
had a head injury,
mini stroke...
I mean, these are things that we have to be aware of.
- And it seems like often times early on,
especially memory is the biggest symptom of Alzheimer's,
but it can be symptomatic with other things.
- Exactly.
- So that's why it's hard to define what it is.
- I mean, you know, when you're busy
and you just, you know,
where'd I put my keys, I have no idea,
why are they in the bread box?
It doesn't make sense.
Not that I really use a bread box, but...
- Like I mentioned, I literally put my socks
in the refrigerator
and I don't think it was a symptom of Alzheimer's,
It's because I was thinking
about what I was doing...
- You were thinking about everything at once.
- At one o'clock in the afternoon on that video
and I was trying to get lunch, you know,
all that kind of thing.
So again, it's not easy to diagnose,
but, you know, something the...
- And that's what makes it so tricky for, you know,
doctors and neurologists to actually diagnose it.
- Sure.
- So there's a variety of tests
that they kind of go through.
One of the simpler things that's done,
that's inexpensive is the SAGE Test.
So the big fancy term,
Self Administered Gerocognitive Examination,
it was done by this...
- So S A G E is this something
that you could print off right off the internet?
- I printed that right off the internet.
It's from The Ohio State University so...
- So I could print this off,
I could take this home,
and do it with my mother tonight.
- Yup, you bet.
It takes about 15 minutes
and then basically, you can present that to your doctor
and then basically
as scientific as you could,
probably do it about a year apart or six months apart,
so you have an interval
to see if there's any decline going on
and you don't have to do the same test all the time,
although scientifically,
it's probably going to be the best
- Sure.
because then you'll see...
- You can compare...
- You can compare it.
- historically how things are going.
And I just want to say, if you do do this,
for example, I know with my mother,
she would have a hard time reading this
because of her vision, so I would help her.
And some of these questions on here,
I would probably have
to explain to her a little bit
about it so she understood it and that's okay.
You just, you know, you can make little notes on the back,
so that later on, six months later,
you kind of know where you're at.
- And sometimes, you can even set this up
so that it's part of your appointment.
So let's see, you're going to be seeing neurology.
- Yeah.
- You do the test right before you go in or as you go in
and then the doctor will grade your results
and then they'll get at least a baseline.
So this is something that's inexpensive.
It requires just a printer
and some pencil and some paper...
and the papers right there.
So it's, it's something that's
nice that you can definitely do
and it doesn't cost an arm and leg,
whereas a PET scan is an expensive test.
- Sure.
- So, but you know, when we come down to it,
they're going to do cerebral spinal fluid tests,
they're going to look at,
they're going to do PET scans
to see what's happening in the brain.
I mean, Alzheimer's is caused, what we think
anyways, is by, you know, these amyloid proteins
and these tangled tau proteins.
So that seems to, if you think about our brain,
it's a network of nerves
and then when we get these damaged tau proteins,
it's kind of like if I took a bunch of spaghetti
and dumped it on the table
and tried to make order out of it.
And those brain signals
don't necessarily communicate properly.
- So they get mixed up...
- They get mixed up, so you're trying to follow one noodle
and all of a sudden you're looping it on, you know,
and it's the same thing with the way that your brain fires.
And so what, what do we do?
Well, I mean, we can certainly eat well,
we can exercise,
try and stabilize sleep,
but there's medications that we can try and use.
And there's not a lot of them out there.
So it's, it's, you know, pretty short list.
So you have Cholinesterase inhibitors
and then you got the Glutamine...
- So there's two, two medications commonly used?
- Well the two that I most commonly see in the pharmacies
that I work in are going to be Donepezil
and then, Memantine.
So, and they behave differently,
but you can, you know, there's Galantamine
and, and Rivastigmine, but...
- Keep it simple.
- Yeah, but we'll use those two
'cause those are the most widely prescribed drugs
and sometimes they're used separately
and sometimes they're used in combination with one another.
- And the physician decides...
- The physician, yeah,
and usually, when you're...
When do you do this?
Well, we've found
that the earlier you get on these medications,
the better, because, again, no cure,
like we talked about,
but it does put the brakes on.
So instead of it coming down sharply like this,
it's going to be a much more angled thing.
And so what does that do?
Well, because we know that the average caregiver spends
about five hours a day with the patient,
it may allow the patients to become a little more,
a little more freedom, a little bit more independence,
you know, and, and maybe allow, you know,
and maybe a time occurs
where something miraculous does happen.
There are a lot of things in the research pipeline right now
that they're discovering,
there's a new, very expensive drug
that at least it's out on the market,
it's, it's very expensive,
it has not been proven to work,
it's actually got the emergency authorization,
kind of like the COVID vaccines,
but we're not going to go in that direction.
(laughing)
It got out on the market a lot sooner
than it normally would.
I mean, the ultimate results of this drug
are not going to be fully processed 'til 2030.
So it's 2021 right now,
so that kind of tells you,
it's a very embryonic process
with learning whether this drug
that may inhibit...
it's called Aduhelm
- Yeah, because it's so far in the future,
can we take, can we go into,
you mentioned about food and diet.
- Yeah.
- And I'm thinking as, as the saying, well,
let's look at the diet,
'cause I was looking at some of this
and as opposed to just good food,
let's be more specific,
like you're going to eliminate
or cut down on processed foods,
- Sugars.
- Sugars, the big one, get those darn sugars out
and yogurt has as much, you know...
- Oh, yeah!
- You can buy a yogurt and it has as much sugar in it as...
- Can of soda.
- A can of soda, Pepsi, or Coke, whatever.
- But yeah...
- So you really got to read the labels
on what you're eating because sugar is in everything.
Everything is processed,
sugar and a bunch of, you know,
the fat, the bad fat, trans fat,
so boy, get after the food and do the...
it doesn't matter,
it's going to make the person's body healthier,
even if in theory, it doesn't help them, it's a good thing.
- Yeah I mean, it's going to do all over it.
I mean, really the time for this is probably now.
You don't want to wait until you get to that point
to just get started with healthy habits.
If you're young enough, start today.
I mean, really one of the simplest ones that I liked,
the Mediterranean diet,
if you guys Google the Mediterranean diet,
it's got a perfect blend of proteins and healthy fats
and, you know, nuts and things...
- Leafy greens, spinach...
- Exactly.
So it's going to give you that type of diet
and pretty flavorful food, to be honest with you.
- I know I just heard one thing it was,
and I've heard this and read about it in books is, you know,
the color of food indicates...
- Yup, eat the rainbow.
- Yeah, you know, so you got your berries,
your, your raspberries, blueberries, blackberries,
all these berries and nuts,
and you're not going to overeat them.
You're going to eat, you know, a handful or whatever,
and that's enough.
- Yeah, I mean you can have the flavonoids,
they're all antioxidant, which seems to show,
and there's actually quite a few books now
that do show that by eating well,
does help to slow the progression of the disease.
- Sure.
- So again, it's going to be healthy for you,
whether you have it...
I mean, if you're talking about one in 10 or one in six,
male or female, so not everybody's going to get it,
but eating well is still something,
that's something we should strive for every day anyways.
- If it's, it's gonna help your heart for sure.
- Yup, exactly.
And that's actually, you know,
when you look at all the lists of things,
cardiovascular disease and cancer, one and two, you know,
Alzheimer on the, on cause of death is number six
- Number six.
- for older adults.
So it's something that, you know, and so what happens is,
again, it progresses from mild to severe,
but along the way when we get to those milder stages
and probably earlier is when we want
to get on those medications.
- Sure.
- And so whether it's Donepezil or it's,
you know, Memantine, I mean,
those are the things that they work differently
to help brain transmission, processing memory.
But I will tell you with Donepezil specifically,
which is a Cholinesterase inhibitor,
so for all you pharmacy nerds out there, you know,
that raises the neurotransmitter acetylcholine
and, and as, as our brain's diminishing capacity,
it helps to keep those levels up,
to allow them to fire longer,
but eventually that reservoir does run dry.
So sometimes then they will go to the, the Memantine,
which works on glutamate,
which is a different neurotransmitter,
and actually the brain seems to kick out too much,
so what the Memantine does, is it kind of blocks that,
so it leaves just the appropriate
amount of glutamine in there.
- So you're trying to get things balanced in the brain?
- You can get..
so you can connect your thoughts
and you can stay in the moment a lot more easily.
And so these drugs do have an avenue
and they seem to work best right now with current science,
in the milder stages.
We might find that with more advanced testing,
which they're working on,
- Sure.
- that we might see that maybe being prescribed younger
and younger, if they're, you know,
we might just take some blood from you Brad,
and just say, yeah, we're going to look at this,
and we've got these three genes here
that suggest that maybe there's a possibility.
Preventatively, maybe they'd do it.
So hard to say there's a, there's a lot,
there are just burgeoning amounts of, of research
going on day to day, right now.
- Sure.
- So it's not that there's a lot
of different treatment things.
It's, you know, so it's going to be staying well,
and you know, in your arena, physical therapy, I mean,
what can we do to keep those muscles strong,
to keep us walking safely.
- And really, I mean, you don't have to go out and do a 5K,
these people are typically older.
They're not, that's not appropriate anyways,
but just some walking,
whether you need a walker or a cane to stay safe
because falls, obviously we want to eliminate that risk.
- Absolutely.
- Um, memory things.
I just want to say, there's some things,
if you do have a loved one, they're walking fine,
but they, they may forget how, like where my mother lives,
she has issues, she's, it's possible she has Alzheimer's,
um, if you forget how to get to the dining room.
- Yup.
- So you're gonna walk with them multiple times
so that hopefully the repetition is gonna kick in.
The brakes on a walker, the four wheeled walker,
we've done a lot of things in skilled nursing facilities
like this, in big letters, we'd make a bigger than this,
but remember to lock your brakes
and we would tape this right to the walker,
so the person can always see it.
That repetition, repetition is one of the things
that can help so that people can remember
and make them safer.
Hang up the phone, you know, talk on the phone, you know,
some people don't, they don't, you know,
these older people don't have cell phones.
- Correct.
- My mother would be, yeah, she's got to have something
she can hang up, but she forgets to hang it up
and it just beeps and then there's a problem.
These are just examples.
Again, all these little things
that you can do to help slow the process down,
keep, keep your loved one safe.
- Yeah, it's gonna be, you know,
keeping getting rid of clutter, you know,
keeping things organized,
white boards and big checkout lists
or calendars are an excellent non-drug tool
that honestly have probably almost more utility
than even some of the medications at some points.
- Sure.
- So, I mean, it's...
- How about throw rugs, man, that's a therapist...
That's a big thing, get the throw rugs out
because they're one of the biggest fall, trip hazards
there is, in a house.
- Absolutely.
Head injury, hip injury, you name it,
whatever can happen in a fall.
There's a coffee table
and you probably want to lose those too.
I mean, that's just so that we keep things out of the way.
- And that can be a tough one because some of the,
like my mother, there's some things I, we asked her to do,
and she says, nope.
- Nope.
- Been doing it for all my life this way
and I'm not gonna change
and that's just the way it is
so that you have to kind of dance around the best you can.
- That is true and then you do, you have to find, you know,
pick your battles, I think is probably the answer,
but whatever we can do to de-stress, declutter,
help around the house, pay bills,
I mean, auto-pay, financial affairs in order,
these are all things
that are part of the treatment mechanisms.
And so those are things that you can certainly do, you know,
and, and, and with the last video,
and I think we should attach to this one,
we'll put some of the websites for support groups
that you can go to if, if you're a newly diagnosed patient
or a loved one that has a newly diagnosed patient
in your family.
- Right.
- I think those are excellent support avenues
for you to explore and to learn.
And I think knowledge above anything is, is power.
- For sure.
- And it's certainly, it's going to help us
to kind of go forward and go through this journey
as safely and effectively as possible.
- Exactly.
And just to finish a video out, you know,
when, because it is a progressive disease,
if they definitely have it,
there's going to be a point
where you are unable to care for your loved one or friend.
It's gonna be a time that
they're going to have to go to a facility
where there's professional care,
24/7 assistance to make it safe for them.
And that can be a real battle as well
because the person, individual,
often times does not want to leave their house.
You're... don't want to make that decision for them.
It's a very challenging, difficult...
- It's knowing when to punt
is a hard question to ask yourself.
- Tough thing to work with
and hopefully you won't have to deal with that,
but sometimes it goes smooth.
I know with my mother, it went smooth,
she was happy, actually, to go to this place,
she's social.
This is another big thing, you have to be social.
Get that interaction.
Isolation can be one of the big problems.
- I think it is, yeah, so anything you can do,
stimulating games, talking, walking,
anything you can do to stimulate the brain, all good stuff.
- That's right.
Alright, so these are some ideas, again,
look below the video,
there'll be some options,
books you can read, other sites,
websites that you can go to for further information.
So very good,
good luck with your friends and family
who may have these problems.
Thank you.
- Thanks everybody.
(bouncy music)