Alzheimer's disease is the most common cause of dementia.
Expert Dr.
Maria Kataki is here to share information on both and why they're different.
Dr. Kataki Alzheimer's disease causes dementia?
Alzheimer's disease is one of the most common causes
of dementia for patients older than 65 years of age.
This is correct.
What's the difference between Alzheimer's and dementia?
Most of my patients, when we talk about their family history,
they're telling me that the mother or the father
had some type of dementia but not able to specify.
We diagnose dementia when people have cognitive or behavioral symptoms
that would interfere with the ability to function at work,
or usual daily activities would represent a decline
from previous level of functioning and there is no delirium
or any major psychiatric disorder that could explain those symptoms.
So this is the clinical syndrome, the constellation of symptoms
that represent the change from previous level of functioning.
Now, when we identify that, we need to see what's causing the dementia
and the Alzheimer's disease is the most common type of dementia,
but there are several other causes that could also cause dementia.
What causes Alzheimer's?
What we know is that there are neuropathological changes in the brain,
amyloid plaques and neurofibrillary tangles that would show up
20 to 25 years before people would have any symptoms of the disease.
There is
a complicated hypothesis, research hypothesis,
to identify the etiology of those changes in the brain.
We have several research projects to see
how we could develop
medications that could alter the course of the disease,
prevent the disease, or eventually cure the disease.
So we're in the process of learning
more about the true cause of Alzheimer's disease.
There are some medications, though, that are now being used
that appear to be working right?
So in the year 2021, the FDA approved medication
called aducanumab, which is an amyloid clearing medication.
This is the first medication that modifies the course of the disease in Alzheimer's
disease and was the second medication in the year 2021
next to a medication for amyotrophic lateral sclerosis,
as this is modifying treatment for a neurodegenerative disease.
Now, in April of 2022,
CMS decided that they will no longer cover
the cost of the drug unless patients are part
of a clinical trial, either CMS or NIH sponsored
because we need to define the true clinical efficacy of the drug.
However, it opens the door for a new era in the treatment and management
of neurodegenerative conditions and specifically Alzheimer's disease.
And there are several more medications that are awaiting evaluation.
And hopefully in January we'll hear
if reviews for lecanemab,
which is another amyloid clearing medication and many more are coming.
So we're hopeful that we'll be able
to have efficacious medications in the future
to treat the disease, prevent the disease, or one day cure the disease.
The research is ongoing.
Many people believe that dementia is just a part of aging.
But is that correct?
This is not correct.
If patients experience symptoms of memory loss
or any decline from previous level
of functioning, any behavioral changes,
should request an evaluation by the primary care doctor,
who then could initiate a referral to a cognitive
specialist to establish a diagnosis and treatment.
Sometimes there are treatable conditions that would cause dementia,
and that's always our first basic evaluation,
is there any treatable cause of memory loss of dementia
that we should address immediately so the patient would improve.
If this is not a treatable cause of the memory loss or dementia,
then we need to consider other causes and provide appropriate management.
Are there risk factors tied to this?
There are risk factors.
If we're talking for Alzheimer's disease
in particular, age is a major risk factor and accounts
for maybe for 99% of sporadic cases of Alzheimer's disease.
1% of the cases could be familial cases,
in other words, might be a genetic component.
There are some mutations that have been identified
with an earlier age of onset of the disease,
usually associated with these familial cases.
Apolipoprotein epsilon
genotype, has been identified as a genetic risk factor,
and several other genes have been identified recently
and represent the target of treatment.
Lifestyle can definitely represent
an area for modifications,
prevention and risk factors.
And of course, the better people take care of their health,
especially cardiovascular health, the higher chance
they have to prevent
dementia cognitive issues later in life.
Several risk factors have been associated.
We tried to see which one would be the most efficacious
to represent a target for treatment.
There are simple things like exercise
that might delay progression to dementia,
and this is something we all can do without a prescription,
even though it's nice when there are programs that people could participate.
Mediterranean diet has been found
to delay progression to dementia.
So little things like, it's not that little, to pay attention
to our diet and exercise with our complicated lifestyle.
But these are things that hopefully we can control and can have a great impact
in our good health of the brain, of the heart, in our whole body.
Does keeping your mind busy help?
Mental stimulation is always a good friend.
And we have this slogan use it or lose it.
This is absolutely true in the area of dementia.
And there is also the big, basically research,
related to cognitive reserve of the brain.
And this is why basically
so many studies have been done to evaluate whether education earlier in
life could prevent dementia later in life.
There is no harm from mental stimulation,
can only improve the cognitive function.
There is, though,
one thing that we always advise our caregivers.
They should encourage the patients to do as much as they can because
sometimes if they have the disease, might be things that might be hard to do.
Mental stimulation is always one of the best friends.
What do you do if you see signs of dementia in someone you love?
Initiate a visit with the primary care doctor.
Request a referral for a cognitive specialist.
Another easy thing to do while waiting for an evaluation,
or even before a discussion has been started, is you can access the website
of the Cognitive and Memory Disorder Center at the Department of Neurology
and try to download the Sage Test, the basically self-administered
geriatric cognitive evaluation that was developed by our director, Dr.
Sharre and our team and has been extremely helpful and easy to take.
There are instructions on the website
how to score the test.
If there are any difficulties there, then there is a good reason
to request the referral and further evaluation.
And if somebody can have
basically a very good score with the Sage,
there is a good chance there are no true difficulties
and there is what we call a subjective cognitive decline.
However, we are always open to evaluate our patients because
sometimes if people get concerned or somebody else gets concerned,
might be some medical condition that requires further
attention, evaluation and management.
Can you tell by looking at a brain through imaging if someone has dementia?
Imaging can be very helpful to differentiate
some types of dementias,
vascular dementias, demyelinating diseases, inflammatory conditions of the brain.
Trauma can be diagnosed by imaging.
So by looking at the brain,
I don't know if you're referring just to structural
imaging like an MRI of the brain or a CAT scan,
snd of course, normal pressure, hydrocephalus, subdural hematomas,
there are several conditions we could identify just by looking at the brain.
Another thing that we have available nowadays
is basically an amyloid brain PET
and sometimes can be
covered by Medicare on a case by case basis.
And we can see actual amyloid in the brain.
And if we see that that supports that, that
the biological diagnosis of Alzheimer's disease.
We can also image tao in the brain.
There are Tau PETs available still in development,
still in the research area, but we're able
to view the histopathological changes
associated with the biological diagnosis of Alzheimer's disease.
So imaging can be extremely helpful.
It's not the only thing that we should do to diagnose dementia or Alzheimer's
disease, but it's definitely part of the standard of care recommendations.
Structural imaging.
Functional imaging involving PET
require a much more sophisticated evaluation and approval process.
But overall, they're both very helpful in the diagnostic process.
Research plays a huge role in this.
So where are we at Ohio State?
I think we live in really very exciting times
for the treatment of these conditions
because of the approval of the aducanumab,
last year, even though it was very controversial,
opened the era for disease, for treatments
that would modify the course of the disease.
And this is really a very big thing in Alzheimer's disease.
The medications we have approved up to date,
they would all offer asymptomatic management.
It is significant, might delay progression
from one stage of the disease to another.
However, none of them would modify the course of the disease.
The new
category of drugs that basically would clean
amyloid from the brain or tau they represent the disease
modifying treatments for Alzheimer's disease.
And we're hopeful that
we'll have better treatments in the future to help our patients.
How close are we to FDA approval for some of these drugs?
We have several clinical trials at the Cognitive
and Memory Disorders Center at the Ohio State University.
We’re part of several national and international projects
and most of them offer a disease
modifying approach.
In January of 2023,
we'll find out what FDA feels about lecanemab,
which is basically a medication that also cleans amyloid from the brain.
And we recently had a press release of positive results
in a phase three clinical trial.
So we're all looking forward to the final assessment for this drug
and there are many more to follow.
We definitely
live in exciting times and we're hopeful
that we'll have better drugs in the future to help our patients.
You've said the term amyloid several times.
Is this a medication? And if so, what is it?
So amyloid is one of the proteins that aggregates
in the brain when people have Alzheimer's disease
and seems to be a leading hypothesis in explaining
the pathophysiological mechanism of the disease.
What causes the amyloid deposition in the brain is still under a lot of research.
Several clinical projects try to explain what happens in the brain.
This is the protein that's causing the plaques,
the amyloid plaques, the sticky plaques in the brain
that cause a lot of trouble with cognitive function.
The toxic amyloid that causes
the amyloid plaques is not a good protein for the brain.
It causes damage, it triggers a neuronal dysfunction,
cerebral degeneration, neuronal death
and basically loss of function.
So it's not a good thing to be there.
That's why we're so excited when we see that the medication
can clean the amyloid plaques from the brain.
What remains to be seen is
how we can improve the cognitive function.
If we have drugs available to clean the toxic amyloid from the brain.
So the amyloid that causes
the amyloid plaques is not a good protein from the brain.
There is a way that a good amyloid can be derived
and that's another target for future treatment.
The one, though, we see in Alzheimer's disease is not a good
thing for the brain.