Featured Speakers:

Anna Caldwell, DNP, APRN-CNP, GS-C

Anna Caldwell is a Nurse Practitioner in the specialty of Geriatrics at Summa Health. She completed a Master of Science in Nursing degree from Vanderbilt University and a Doctor of Nursing Practice degree from the Ohio State University. With a strong interest in geriatrics, she further completed a Geriatric Medicine fellowship at Atrium Health in Charlotte, NC and is a Certified Gerontological Specialist through the Gerontology Nursing Certification Commission. She currently practices outpatient geriatric medicine at the Summa Senior Health Center and inpatient on the Geriatric inpatient consult service.     

Joe Marchiano, PharmD, BCPS, BCGP

Dr. Joe Marchiano is a Clinical Lead Pharmacist in the specialty of Geriatrics at Summa Health and an Assistant Professor of Pharmacy Practice at Northeast Ohio Medical University. He completed a two years of pharmacy residency training at the UH Geauga Medical Center. He maintains national-level advocacy in the pharmacy profession, has been invited to speak in several inter-professional events regarding medication use in older adults, and currently practices as a member of several multidisciplinary geriatrics care teams.

Scott Webb (Host): On today's podcast, we're going to discuss Alzheimer's disease and dementia, which is a form of Alzheimer's, the importance of early stage diagnosis, and the various treatment options with Anna Caldwell. She's a Nurse Practitioner who specializes in Geriatrics, and I'm also joined by Joe Marciano. He's the Clinical Lead Pharmacist for Geriatrics, and they're both with Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. 

I want to thank you both for joining me today. We're going to talk about Alzheimer's disease, dementia, treatment, we're going to cover as much as we can in a podcast anyway. So, Anna, I want to start with you just basic level sort of question, I guess, like what's the difference between Alzheimer's disease and dementia?

Anna Caldwell, DNP, APRN-CNP, GS-C: So when we say dementia, that's actually the umbrella term that we use to describe decline in memory or mental ability and function that's severe enough to impact someone's daily life. So the most common cause of dementia is Alzheimer's disease, and that's the one we most likely hear about. And the Alzheimer's Association estimates that there's nearly 7 million adults living with Alzheimer's disease.

Host: Yeah, that sounds right. And it's good to have your expertise today. Let's talk about this. Anna like the common signs and symptoms of early stage Alzheimer's, more so than just, I didn't hear what someone said and, or I've forgotten because it didn't seem important to me. What are the real significant signs and symptoms?

Anna Caldwell, DNP, APRN-CNP, GS-C: Yep, absolutely. So this isn't certainly a comprehensive list and certainly, you know, it varies person to person, but some common early signs and symptoms to look out for, would be memory changes that impact daily life. So, this may look like repeating stories or trouble remembering newly learned information.
Difficulty completing familiar tasks. So, if somebody has a family recipe they've made a hundred times, now they're suddenly having more difficulty completing that task. Maybe having difficulty paying for something at the store. Changes in judgment is something that we often see, so this would look like dressing inappropriately for the weather or falling victim to scamming. And certainly changes in mood or personality from someone's baseline.

Host: Yeah, as you say, it's not a comprehensive list and I think some expert along the way said to me that it's like, the difference between, you know, in terms of like normal aging versus signs of early stage Alzheimer's. It's like, it's one thing to sort of forget where you left your keys. It's another thing to forget what keys are for.
Does that make sense? Does that jive with your understanding and your expertise that, yeah, everybody forgets where they set something down, but when you find that something and you can't even sort of process or remember what they're for, that might be Alzheimer's, right?

Anna Caldwell, DNP, APRN-CNP, GS-C: So yeah, it's completely normal for us all to forget a name or why we walked in a room, but we should later be able to recall that information. You know, it's okay to occasionally make some errors in our checkbook, but when this is an ongoing trend that's continuing to happen and really impacting our daily life, that's when it becomes concerning.
And I think here too, I also want to stress that dementia itself is not a normal expected part of aging.

Host: Yeah, it's interesting. And there's been a lot in the news lately of professional football players announcing that they have Parkinson's and dementia and all sorts of things. And that's a separate podcast, but it's just, it's in the news a lot. It's in the headlines a lot. And I think there's so many things, Anna, that we get to a certain age and we go, well, what are you going to do? You know, I'm older, right? But as you're saying, dementia is not one of them. It's not expected that everyone's going to get dementia, right?

Anna Caldwell, DNP, APRN-CNP, GS-C: Mm hmm. Correct.

Host: Yeah. Let's talk about the risk factors just sort of along those lines about how one develops Alzheimer's and then possibly dementia from that. Are there specific risk factors? Is it genetics, family history, behavior, lifestyle, that, you know, puts us in a, or at a greater likelihood of developing Alzheimer's?

Anna Caldwell, DNP, APRN-CNP, GS-C: Yeah, absolutely. So, I mean, we know that the greatest risk factor is age itself, you know, certainly we can't change that, but there are modifiable risk factors that do increase our risk for developing dementia. So those are things like high blood pressure, diabetes, high cholesterol, sedentary lifestyle, smoking, and even social isolation can increase our risk.

We kind of have a saying here in our office that everything that's going to be good for your heart, is going to be good for your brain. So really focusing on those things and getting those things under control to help reduce our risk of developing dementia is important.

Host: Yeah, I love that. And darn you, medical professionals, you're always encouraging us to take care of ourselves. No, I mean, to live a healthy lifestyle, to get exercise, to stop smoking. You know, I just keep hearing it over and over, so it must be true. Let's talk about diagnosis, as you were saying, sort of comparing and contrasting maybe the normal aging forgetfulness versus early stage Alzheimer's. How does then one, a medical professional, how do you diagnose early stage dementia? 

Anna Caldwell, DNP, APRN-CNP, GS-C: So when you see your healthcare provider for a dementia workup, they're likely going to conduct some blood tests, get some imaging of your brain if you haven't had that done before, have you perform some cognitive testing in the office. So this is typically going to be like a paper and pen type test and obtain a functional history from you and your family or loved ones.

Host: Obviously there's patient history and speaking with them and perhaps speaking with family members, possibly friends, but so you bring all that information together. And I guess I'm wondering, and I hear this a lot too for medical professionals, just about everything that early diagnosis or early detection and diagnosis of dementia is really important for folks. Can you explain why?

Anna Caldwell, DNP, APRN-CNP, GS-C: Yeah, and I think, you know, with all healthcare related things, certainly knowledge is power. You know, by having that early diagnosis, you have the opportunity to work early with your provider on any potential lifestyle modifications that may support your brain health moving forward. This also presents an opportunity for families to work together to help plan for future needs.

And additionally, having that early diagnosis presents an opportunity for you and your healthcare provider to determine if there's any medications that might be appropriate for you to be started on.

Host: Yeah, Joe, I want to bring you in and talk about, I know you're a Pharmacist, so you're the right person to talk about this, about medications. And so we're talking here about early detection and diagnosis of dementia and why that's important. And obviously people may be able to get on meds and slow the progression. I don't think there's a cure per se, not yet anyway. So what type of treatment options are available to slow the progression of Alzheimer's?

Joe Marchiano, PharmD, BCPS, BCGP: So I think that question and interplay between early detection and slowing the progression of Alzheimer's disease dementia is a wonderful one. And it's one that reflects a lot of what's being discussed in the news lately, but I think an important thing to first discuss is to sort of just spotlight what the status quo has been in terms of how Alzheimer's disease dementia has been treated with medications, in a more longstanding way, in a way that has been the status quo, I suppose, up until the past few years. And so traditionally speaking, the only medications we had available to treat Alzheimer's disease dementia, are things like donepezil or memantine, other medications called galantamine, rivastigmine, and these medications can, in a way, be thought of as cognitive band aids, because what they all try to do, even though they work somewhat different from one another, is try to temporarily shield the person who were using the medicines or who we're treating with the medications from being fully impacted by their dementia without actually affecting how the dementia itself from a pathophysiologic or brain standpoint develops or worsens.

And now for people with Alzheimer's disease specifically, as the cause of their dementia, when we're trying to zoom in on what's going on in the brain to cause that particular type of dementia, we know that these people have certain specific proteins in their brain, which researchers believe might contribute to how dementia progresses in these patients.
And so recently, injectable medicines have been developed for to try to target these proteins specifically, and the thought is, well, if we can help that protein get processed out of the brain, theoretically then we might be able to slow down the progression of the actual disease, of Alzheimer's disease, particularly for people in early stages.
And so these are the medications which have gotten a lot of attention in the media recently. However, despite this goal, it is important, and to your point, Scott, to note that these medications are not a cure. There is no cure for Alzheimer's disease dementia. And going on top of that, in spite of, you know, what might be our hopes, how well these medications even seem to work, is somewhat of a controversy in and of itself.

So number one, we know that they definitely help get rid of that protein. They seem to definitely get rid of it. Whether or not that action even does amount to any meaningful change in the patient's thinking, may or may not even occur. And so I think it's important to know that even though these medications are trying to address what we think might be the main cause or one of the main causes of Alzheimer's disease dementia, and we know that things like those injectable medications that have recently gotten a lot of attention, while we know that they definitely get rid of that protein, we're not so sure yet that doing so ultimately is going to consistently lead to a detectable difference in that individual.

So I think that's a really important thing to emphasize. And also there's this other flip side of things, which is the risk that these injectable medications have. They do carry a number of risks with the way that they work, with clearing out that protein, they also have risks for making the brain swell and causing potentially micro bleeding in the brain.
And for this reason, people who decide to take these medications require regular MRI scans to make sure that these side effects are not happening. And so, because of this, you know, hopefully it's clear that the appropriateness of these newer medications is definitely not a one size fits all kind of thing.
And so that means that every individual affected by Alzheimer's disease dementia should, absolutely have an individualized discussion about the risks and benefits of these medications as well as the medications that we traditionally use for the disease state, which still very well might be appropriate to see what medications, if any, are right for them.
And so, you know, with that, you know, I am hopeful, though, as time goes on, we might be able to create a medication that is more profoundly effective for Alzheimer's disease dementia.

Host: Yeah. And as you say, maybe not so individualized, one of the closer anyway to a one size fits all, again, no cure in sight per se, but treating, living with, making life as, you know, as good as possible for folks with Alzheimer's dementia. That's the goal. That's the dream. Of course, I spend really good stuff today.
Really educational, a lot of food for thought for me. I have older parents and some things that they do concern me and You know, trying to understand, is that normal? Is that just mom being mom? Or is this these early signs of something? So, I'll just finish up with you here, Anna, and this is a sensitive one, and I, that's why I reference my parents there.
What steps that individuals can take if they suspect that a loved one may be exhibiting signs of early dementia? You know, it's a really sensitive thing. thing, dealing with, elder parents, maybe even grandparents, and sort of even broaching this subject. So, what's your best recommendations?

Anna Caldwell, DNP, APRN-CNP, GS-C: you know, If it's you yourself who feels that you are having some signs of dementia, It's important to start that conversation with your primary care provider. So if they feel it's appropriate, they can refer you to see a geriatric provider like myself or a neurology provider to get you that further evaluation or workup.
But like you said, when it's a loved one that we're noticing these changes, I can certainly appreciate how challenging that can become because your loved one may not be having the same concerns as you. So, so if you are able to attend an appointment. If you have an appointment with them or even call ahead to notify their primary care provider of some of your concerns, this can be a helpful strategy. Our office at the SUMA Senior Health Center, we are lucky enough to have dedicated time to privately talk to patients loved ones, and that can be really helpful. so much for joining us today, and we hope that you found it helpful to kind of get to the bottom of what's going on.
Um, there are other great resources in the community for people who may not be able to get their loved ones to appointments, so I would encourage people to look into things like the Alzheimer's Association and the Ohio Council for Cognitive Health for a little bit of guidance.

Host: Yeah, that's perfect. You know, this is one of these sort of ongoing conversations and we've learned so much about Alzheimer's and Alzheimer's dementia. And as Joe pointed out, some of the newer medications, newer options, but not a one size fits all, certainly not a cure. So, ongoing conversations. Glad we had this one today.

Thank you so much.

Anna Caldwell, DNP, APRN-CNP, GS-C: Absolutely. Thank you for having us.

Joe Marchiano, PharmD, BCPS, BCGP: Yes, thank you so much.

Host: And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.