Hello and welcome.

I'm Laura.

I'm the outreach coordinator with the UAMs Arkansas Geriatric Education Collaborative.

And I've got some fellow experts with me here today to discuss one of the most important health and caregiving challenges facing families across America, and also right here in Arkansas.

Alzheimer's disease and related dementias.

Nearly 7 million Americans are currently living with Alzheimer's disease, and that number is only growing.

It's growing significantly as our population ages.

Here in Arkansas and throughout rural communities across the country, families and health care providers, community organizations are working every day to support individuals living with dementia, while also caring for the caregivers who walk beside them.

We're going to explore what what dementia really is, how Alzheimer's disease affects the brain and the body.

The latest developments in treatment and research, and how families can navigate the journey with knowledge, compassion and support.

Joining us is an outstanding panel of representatives from UAMs on their geriatric experts, including Doctor Denise Compton, a licensed clinical psychologist and geriatric neuropsychologist specializing in seniors and cognitive disorders at UAMs.

Doctor Robin McCarty.

She is an assistant professor and director of the Arkansas Geriatric Education Collaborative in the UAMs College of Medicine, Department of Geriatrics, and Doctor Gohar Azar is our Professor of geriatrics and the Jackson Stevens Endowed Chair in Clinical Affairs at the UAMs Donald W Reynolds Institute on Aging in the College of Medicine, and Doctor Elizabeth and Assistant professor of geriatrics at the UMS Walker Memory Center.

And she also sees patients in both Springdale and Pine Bluff.

And Debbie Brady, our licensed clinical social worker at UAMs and the Department of Geriatrics.

Thank you all for joining us for this important conversation.

I would like to mention, though, that today's conversation does not replace talking with your health care professional about you and your family's own health.

All right, well, let's just jump right in, everyone.

The first questions I have are, in general just about understanding dementia.

And, Denise, I'm going to start with you.

What exactly is dementia?

So is a very broad term that means a person is experiencing substantial decline in their memory and other thinking skills, and that decline in thinking is enough to really impair their ability to function in everyday life on important things, such as taking their medications correctly, paying their bills correctly, very importantly keeping track of their appointments.

This is one of the things that really becomes problematic early on.

So missing doctors appointments and other important appointments as a sign that a person's memory is declining to the point that they're really impaired in functioning.

Doctor Azar, can you tell the audience what is the difference between dementia and Alzheimer's disease?

Exactly, yes.

I often get asked that question in the clinic.

Do I have dementia?

Do I have disease?

But actually, else I must.

Disease is a kind of dementia.

It is the largest section in all the dementias, as disease comprises between 70 to 80% of all dementias.

So it is a degenerative and progressive disease.

Yeah.

I've heard you talk about this before, Denise, but can you tell us the difference between normal aging and then how someone would know about if it's a mild cognitive impairment?

So normal aging involves some very subtle changes in memory.

Not very troublesome at all.

Usually.

Maybe just a little slower to remember things.

Thinking in general is a little bit slower in processing, but really doesn't.

Normal aging does not cause any significant problems with functioning.

Mild cognitive impairment is significantly different.

There is more identifiable decline in cognition, and yet the person is still able to function with accommodations and maybe just a minimal amount of support.

Along those same lines, what would be some common misconceptions that people have about memory loss and then aging?

Well, I think it's pretty common assumption that everybody who ages is going to have some significant memory problems.

And that's really not accurate in normal aging.

It's so subtle.

It's really not very troublesome.

At what point would you advise families to maybe be a little more concerned with their loved one?

What I mentioned before, I think is, is an important thing to know.

One of the first differences with Alzheimer's patients is keeping track of time and keeping track of appointments.

So maybe asking a family member over and over now, what time are we supposed to go?

Or where are we supposed to go?

Not being able to keep track of the date and missing appointments, that's a very important early sign that maybe something's up and needs professional attention.

Good advice.

All right.

Doctor Azar, how actually is Alzheimer's then diagnosed today?

Yeah, we have made a lot of inroads in the diagnosis in the past at least a decade or so.

So Alzheimer's, you know, patients would come to me and they would say, well, my grandfather, my grandmother had Alzheimer's.

It was kind of guesswork before that, someone had Alzheimer's.

Like everyone who had memory loss, the the doctor would term them as having Alzheimer's, which was not correct because it is a very complex process in the brain that is going on.

And now we have diagnostic steps.

So anyone who comes into the clinic, first, they have to have a physical examination, a history, a physical examination.

After that, we do some lab tests.

And the latest that we have in lab test is a protein called tau phospho tao.

We check for that in the blood.

And if the level is high, then there's a 90% 92% probability that the person does have Alzheimer's disease.

There are few other conditions that can elevate the Tao protein, like kidney disease or just age itself.

So you can get a false positive.

But that is a very good test.

Easy.

You get the result back within five days or so that there's a high probability that the person has Alzheimer's disease to confirm it.

We generally follow up with an Pet scan that actually shows the amyloid plaques in the brain, and that also is a number between 0 and 100.

So if you get, for example, a number 35, that that is the quantity of blackbird, and then the person has significant moderate plaques that require treatment.

So these are the two tests before we had the plasma biomarker of phospho tao.

We used to do CSF examination or spinal examination.

That was a little bit more troublesome for the patient and the family member.

Scary also to have a needle in your back.

So now it has become very convenient to do this blood test.

That's a lot easier, isn't it?

Yes.

So who should someone see first if they are concerned about, they should see the primary care physician.

But the primary care physician would then should refer them to either neurologists, a geriatrician, a neurosurgeon, a psychiatrist.

These are the providers who have been designated by the Alzheimer's Association to be to have expertise in diagnosing memory disorders.

But you know, more of the providers need to learn how to diagnose Alzheimer's disease, but it will be good for them to mention it to the primary care provider.

Okay.

Great information.

All right.

Shifting gears, doctor McCarthy, let's talk about why is dementia becoming such a significant public health issue.

I think one of one of the main reasons it's becoming such an issue is because we're living longer.

You know, Americans are living longer is one thing.

The baby boomers are, of course, now of age to get all summers.

And I think people are afraid of it.

You know, grandma had dementia or grandma had, you know, all summers disease.

And people are afraid of it.

So we just need to know that it.

I think it's becoming more prevalent because we're getting old.

Everybody's allowed to get older.

We live longer.

Just a good one.

One of them, one of the main reasons, I think.

Right.

And so with that trend, what would you think that some of the future challenges are going to be for?

Well, as we live as caregiving is a big issue, getting enough providers.

And one of the main things we do at the Arkansas Geriatric Education Collaborative is train providers in this.

But there aren't sufficient.

And I think Doctor Azar and Doctor Compton's will support this.

There aren't enough geriatricians and neuropsychologist to help us diagnose and to treat.

So I think that is a challenge.

So we do need to, as Doctor Azar mentioned, train more of our primary care doctors to be able to recognize this and to be able to lead the the older adults to the help that they need.

Absolutely.

And I know this is one of your areas of expertise, but how about the rural aging and how that affects our care and our services?

Rural areas are hard for health care in general.

And then it gets even worse when you're older adults.

One of the main things I think is transportation is they get out there and they have no way to to get to their appointments.

It's a long way.

They're having to all of a sudden drive in a big city.

Little Rock may not be considered a big city to some, but it is to a lot of our older adults.

You know, they're not going to drive in that.

And there's no public transportation really to, to, to any degree.

And then just getting the resources out to them, they get isolated.

And I know we you know, they talk more about isolation, but they're isolated out there.

Internet access is an issue.

It's just harder to get information.

It's harder to get help.

It's harder to get transportation and even things that city people may take for granted, such as having a meal delivered, having groceries delivered.

It's not it's not common out in the rural areas.

So absolutely, even grocery stores are, you know, they're long way away.

Right.

Absolutely.

Good points.

All right, Doctor Ove, let's talk to you about Alzheimer's disease and the brain.

And first of all, can you explain to our audience what happens to the brain during Alzheimer's disease?

Of course, during all times disease, there's proteins that are abnormally building up in the brain called amyloid and tau.

They disrupt communication and damage the neurons and affect parts of the brain that control memory and thinking.

We don't actually quite understand all of the pathophysiology, but we do understand quite a bit.

And there's still being studies done to understand it better.

And then how would someone recognize we all know it, but there are stages of Alzheimer's disease.

So could you tell our audience a little bit about that.

They're typically for mild, moderate or severe and end stage when you get to dementia or major neurocognitive disorder.

And we we stage it based on their functioning.

We use, we have a few scales called the Fast or the GDS Global Deterioration Scale that can help us stage based on the patient's functioning.

And then is each person the same?

Do they all progress?

The same difference is highly variable from patient to patient based on their overall health, genetics, their age, their other medical issues and what they're doing about the disease.

What type of interventions you know they're taking so different.

Yes.

Yeah.

Okay.

Well, Doctor Azar, this is your area.

What what are the current treatments and things that families can realistically expect to get help?

Yeah, there have been treatments for dementias in large all kinds of dementias for a very long time.

So what happens when someone's cognitive ability and memory declines?

There is a deficiency of a chemical acetylcholine that goes down in the brain.

So the previous drugs that were that have been there for the past 20 years or so, longer than 20 years, have targeted that chemical and have increased that chemical in the brain so that the brain operates better.

And the neurons talk to one another and there's better communication.

Those drugs are commonly one of them.

Very commonly used is called donepezil.

The brand name is Eric.

And I think many people who are listening to this might have heard about this.

So that is a has been used for a very long time, which helps increase that chemical.

And there's another drug called and the chemical name is momentum.

But brand name is that is also used with that donepezil type of drugs.

There are three drugs in that class.

So there are river stigma mean, galante mean and donepezil.

So those are drugs that have been used for very long time.

The latest development has been the development of monoclonal antibodies against amyloid.

That is very exciting because that actually targets the amyloid.

Those drugs go and bind to the amyloid plaques in the brain, and they slowly dissolve it and gets rid of the amyloid, which is in the brain.

So all that amyloid is which is forming clumps and forming kind of roadblocks in the neural transmission so that transmission cannot occur.

You have traffic jams, it can get dissolved that and it can get rid of it over time, you know, over a period of a year or 18 months.

That is very exciting.

So that is what the latest trend is now, another new development that has happened in one of these drugs called the Map.

There has been an auto injector that has been developed that the patients can give to themselves once a week.

It can be given in under the skin, just like the insulin injections subcutaneously and the abdomen and the arms and the thighs.

And that is a weekly.

So they don't have to come and get infusions.

So they wouldn't be sitting in an infusion center anymore for.

No they can do it.

Do it.

That's great.

That's great news.

All right.

Well doctor, beyond medicine and those kind of things, what other supportive.

I guess interventions could improve the quality of life for someone with.

So evidence shows us that non-pharmacological, non-pharmacological lifestyle interventions can really make a huge difference for patients with or without Alzheimer's disease.

Things like physical activity, mental activity, social activity, good sleep, a healthy diet, some type of relaxation to decrease stress as well.

All these things actually are probably more effective than our medications to date.

And so I really underscore these with patients.

Great advice.

All right so this is for you researchers out there.

Let's see what what have we learned about in terms of genetics in Alzheimer's disease?

I know that's one of the main risk factors age and genetics.

But what have we learned over the years about.

Yeah there is a gene called epilepsy protein.

So there is if you have inherited epilepsy protein which is called in brief it is called apo ApoE4.

If you inherit two copies from both parents, the risk of developing Alzheimer's disease is much higher, up between 8 to 12 times higher.

If you get that Apple E4 gene only one copy from a parent, the risk is about 2 to 3 fold.

If you don't have the four Ely gene, you have an apple E, 2 or 3, then the risk is not high.

So there are people who have the apple for even two copies of it.

But interestingly, it is not necessary that they will get Alzheimer's disease.

So they shouldn't panic.

They shouldn't.

Yeah the risk is there, but they shouldn't panic because they might not get it.

And another interesting fact is that there are protective genes.

So even if they are have there they have the two copies what is called homozygous.

There are two copies of that gene.

There are protective genes.

Some of them we know we know about those protective genes.

Some are yet to be discovered.

One of the protective genes is in the same family, for it is called a. It is a different name, but it is protective because it does not does not lead to the accumulation and sticking of the millet.

So that protects against even if you have the two genes.

Another gene is called a fibronectin gene.

There's a mutation in the gene that also prevents the stickiness of the plaques, and they are yet more to be discovered.

Wow.

Yeah, I think I kind of you kind of answer this question, but what gives you the greatest amount of hope for future development?

There are more treatments being developed.

Obviously.

There's a lot of a lot of research going on about inflammation in the brain.

Because inflammation can lead to neuronal damage.

It can kill the neurons, kill the cells.

So how do we reduce inflammation?

One of the things that doctor had mentioned was to reduce stress.

Well, you can reduce stress.

There are also diets that are pro-inflammatory.

You reduce those kind of diets and take a better diet.

So then there are drugs that are being developed to reduce inflammation, reduce immune attack on the cells.

And there are also a lot of clinical trials being done on development of vaccines that will just like the flu vaccine.

One day we might have a vaccine, which might we might take once a year, which can help prevent the accumulation of plaques.

And you're doing some of that research right here.

Some of the research we are doing, we have a lot of research on lemurs going on in our own center.

And in we have we have we have very promising research.

Another research that we are looking at is the microbiome.

And the microbiome is our own bacteria that are present everywhere in the body, on the skin, everywhere.

So the gut microbiome can alter the toxins that are in the body.

It can utilize the toxins.

Or if you don't have a good microbiome, if you have more of the bad bacteria, then you have the kind of toxins that will enter the circulation that can go through the blood brain barrier.

They can reduce the good chemicals that the brain needs, and it can affect memory and thinking.

So it is important to have a good microbiome.

So that is being studied.

We are studying also the oral microbiome.

And there are if you have for example gingivitis you can produce a toxin which can go to the brain through the nerves and it can harm the cells.

These are some of the things that we are studying.

Yeah.

That's so exciting.

Yes it is.

Keep it up.

Keep it up.

All right, I'm gonna throw this out to the panel.

But maybe in particular this first question.

Debbie, what questions would you think families should ask when they first get that diagnosis?

I know you, you deal with that every day.

I think there's often fear, worry, concern.

What will happen to me in the future?

What will my family think?

What will my friends think?

Will I be the same person that I am right now?

And so I think that really planning ahead, developing a team, trying to ask your provider what is your role in helping me deal with this as I continue on this journey?

And then obviously this is for everybody.

How can early diagnosis help families plan for the future?

Anybody?

And I think we all want to be independent.

We all want to decide our own futures.

We want to be autonomous.

And and I think that what we realize is that we all are getting older and we have to have a plan.

What will happen to us if we're not able to be as independent as we've always been?

So if we can get diagnosed early, if we can deal with any medical issue or just general aging early, we can help decide what do we want, what can we afford?

How can we put lands into place that allow us to live the life that we want to live?

I want to chip into that.

Sure.

That diagnosis is very important nowadays because these monoclonal antibodies are approved for early dementia.

So if you let it go on to long, you will not be eligible for the monoclonal antibodies.

So the monoclonal antibodies are for mild cognitive impairment and for early stage dementia.

Because if you have too much buildup of black and moderate stages, they might not work okay.

Isn't that part of an annual physical for your I know, for your annual medical for Medicare?

At your annual visit, you can ask talk to your physician.

You know.

Yes.

Definitely mentioned you can ask any time.

Okay.

It doesn't have to be just your annual physical.

You can ask, all right.

You bet.

Please.

I think it's also important, as Debbie was mentioning to, especially if it's a loved one or if it's yourself that has this diagnosis to tell your loved ones, those decision makers.

For one thing, you need to decide who those decision makers are when you no longer can, but to tell them what's important to you, how you want to be treated.

And I think that's different for almost everybody.

You know, it's what's important for that individual.

And so we don't force our paternalistic maternal instincts on them, that we treat them the way they want to be treated.

But we need to find that out pretty early on.

And I know a lot of people don't want to talk about it.

It really does relieve a lot of hard decisions that have to be made at the end.

And they can say, no, mom or dad wanted it this way.

That's right.

And get that stuff in writing and and talk through it.

Good point, doctor McCarty.

Right.

All right.

Let's talk about some of those fun things, doctor Compton, such as behaviors that often occur with this disease, such as wandering and agitation.

Sun downing, can you explain why those things happen or do we know?

Well, so I the way I think about that is in the in the earliest stages of Alzheimer's dementia in particular, we talk a lot about short term memory, the persons having trouble learning and storing new information about the things that have happened recently, recent conversations, recent life events, family events, etc.

but as the disease progresses, and particularly if it progresses into a moderate stage, the long term memories, the things that have been stored in memory for years begin to fade.

And they fade sort of in backwards order over time.

And as that occurs, you know, things that have happened in more recent years are forgotten first.

And then, you know, as it proceeds backwards, it eventually comes to a point where what the person can really remember all the things that happened early in their life, those nerves have died that store the memories of recent years.

And so what's prominent in their memory that they can access or where I grew up, the home where I grew up, my family of origin.

And so one of the things that happens frequently is that in the late afternoon or evening, we're here in this place and it's a nice place, but this is not my home, you know, I want to go home now.

And that's a really hard challenge.

But I think it's it's important to be able to enter that person's brain mind and understand that the memories of this place where we live now, they're gone.

And the only home they can recall is the one they grew up in.

And so people want to say, well, this is your home now, don't you remember?

We've lived here for ten years.

No, they don't remember that.

And it comes and goes, but eventually they just don't.

And so we have to find ways to communicate in loving, supportive ways, appreciating that if you were in a place and you have no idea where you are or how to get home from here, you would be agitated, right?

So being sympathetic, you know, understanding, you know that this is distressing.

But we need to stay here tonight.

We're going to stay here.

Everything here is ready for us.

You know, there are reasons why we can't leave.

We just need to stay here and be comfortable tonight.

That's the kind of an example of how those memories are fading and causing agitation or wandering.

You know, I'm leaving here.

I'm going out looking for my to go home.

Yeah, literally.

Very good.

Well, Debbie, what should someone know about when their loved one does become confused or more, more angry?

Agitated?

You have some tips.

One of the most important things is that feelings are really important.

That they may not remember what you say, but they're going to remember how you treat them.

So taking a breath and being kind because I think we want to to help somebody come back to reality.

But their reality may have changed.

And so what we want to do is be kind, sometimes redirection, sometimes just asking them.

Tell me a little bit more about this.

This sounds very important to you.

Those are some questions.

I like the idea of having a three by five index card in my back pocket, with some questions on it, and some of those questions I just pull out to be able to ask, to help somebody, to be able to come back, to say that, you know what?

I really feel safe and comfortable here.

Well, those are great communication tips and strategies.

And to use a term diversion or distraction to see if we can, in a kind, gentle way, kind of change the subject away from the things that are disturbing by understanding what are some things that are important to you, or what are some things you like to talk about or do that maybe divert that distress in agitation?

Music and picture music's wonderful, very important stories.

Reminiscing.

Those are great ones.

Denise, this is a tough one.

Driving.

What should we do?

And we're worried.

Okay, so I guess the first most obvious thing is if a person is driving and getting lost, getting disoriented, forgetting how to get from one place to another, neighbors are calling and saying they saw somebody in the wrong place.

Or, you know, that's an obvious one.

I think the less obvious, but more important one actually, is that an important skill for driving is the ability to shift attention back and forth from one thing to another quickly.

If you imagine a complex driving environment where lots of things are happening at once and we have to keep track of it all in a timely, prioritizing manner, and that is an ability that declines over time.

And so and then the person is really more at risk for an accident making left turns and busy traffic, fast traffic merging and fast traffic.

And one of the things people do to compensate for that slowing of processing speed is they slow down their driving.

So if a person is driving below the speed limit and people are complaining or honking, that's a sign that they're not able to assimilate the driving environment.

Well, you have to drive with a person often to know that those things are happening, but those are the kinds of circumstances where trouble can happen.

Yeah, great.

I want to add to that we often order a driving evaluation, which is done by an occupational therapist.

Great point.

Yeah.

There is so and then they give a very long report.

They tell where the person was not able to comprehend or make those fast turns or make good decisions, and they give a recommendation that they should not drive.

Sometimes, though, people do pass the driving evaluation.

So then it is up to the provider or the doctor to tell the patient.

And in our clinic we generally give them a certificate.

Do not try.

We recommend do not drive.

So if they don't listen to the to the family member, the family member can always take that certificate and show it to them and remind them that this is the doctor's recommendation.

That's a great idea.

Yeah, I'd like to add to that.

This is probably one of the most difficult subjects I discussed with families day after day.

And if we take something away, we really want to try to figure out how to add something like who can drive the person around?

Sometimes just seeing the car in the driveway is just an impetus to drive, so we really want to be able to help them problem solve.

What are we going to do about this?

Or what are you going to do about this?

And how can we support you in that regard?

Absolutely.

Good point.

Well, along those same lines for anybody, but I'll start with you, Denise, about when when do you know if they're safe to live alone?

Well, so I mentioned earlier some of the things that we pay a lot of attention to.

How are they doing with their meal preparation?

Or are they forgetting to turn the stove off or burning things?

It's the food in the refrigerator, you know, safe to eat.

Is it in date?

Is it moldy?

You know, where they taking their medications correctly?

That means somebody's got to monitor.

Somebody's got to look and see.

And the best way is to use one of those pillboxes, because that makes it easy to look and see.

Are they taking it?

Is that box prepared correctly in the first place?

Issues about paying bills, keeping appointments?

All of those are the kinds of things that when we know we've got a diagnosis of mild cognitive impairment that might be moving towards dementia, or definitely if there's a dementia diagnosis, somebody needs to be paying very close attention to those things and seeing what kind of help and support is needed.

And there are many shades of gray in terms of ways that families can can be supportive.

Professional caregivers can be supportive.

It's different for every family.

When is the time for the person to leave the home?

But the bottom line, I think, is maintaining their safety and security for them.

For them.

Yeah, yeah.

And others might have thoughts about that too, that modern technology can really be useful.

And, you know, we're we can learn new things that people having cameras in the home and in not, you know, places that cameras shouldn't be, but to be able to monitor somebody, somebody coming in and looking at food in the refrigerator, for example, and just just being available if the person you just is having trouble.

Absolutely.

Some technology that we've talked about across the country where the son or daughter, they can't be there, but they they will talk to them through an Alexis or some device and say, good morning.

They'll open the blinds, they'll tell them it's time to get up, good morning and things like that.

So yeah, I think technology has come a long way and can be very, very helpful for this.

Or it's time to go to bed, whatever they time to eat time, take your medicines.

So some great ideas for good use of technology.

All right.

And it's just for anybody chime in.

But what are some common mistakes that caregivers make.

And and just knowing you know what to expect.

What are some of the things you see that caregivers maybe were surprised by or mistakes they make?

I think one of the main things I've seen is trying to reorient, you know, that it's a constant barrage of, you know, that, mom, you know, they may get kind of angry at the one with with dementia because they don't remember something.

They try to reorient them.

They just it makes it difficult.

Yeah.

Yeah.

I try to tell the caregivers not to keep saying, I told you so.

Don't you remember?

I've told you that many times.

And it you know, it it is very disheartening for the person to hear this, and it becomes almost like a nagging thing.

And then they start getting angry and they can even get agitated.

But it is, you know, memory loss can be can come with mood disturbances, depression early on.

And and when someone's already feeling bad, you don't have to make them feel worse by telling them again and again.

That forgotten.

Yeah, yeah.

Great tips.

We said earlier about what matters to somebody having those conversations.

So we know that this person is the same person, they look the same.

But what can they do versus what can they no longer do.

So I like to talk about this whole idea about the difference between cant and won't, because I think it helps people understand that maybe she's not able to do this anymore, even though she looks the same and is able to to do so many of the things that she was able to do.

That's a great, great concept to think.

And I make those mistakes out of a genuine desire to be healthy, you know, and to want the person to be okay or be better.

So it's hard, you know, very sympathetic with caregivers.

I think there are no perfect caregivers.

And they're all all we are all going to make mistakes.

But but there are certain habits that we maybe, if we can redirect ourselves, might make for a less stressful situation.

Right.

Doctor, if I want to switch gears a little bit and talk about just prevention in general, can Alzheimer's disease be prevented?

Absolutely.

This is my favorite topic I know.

So the Lancet Commission published their list of modifiable risk factors for dementia prevention in 2024.

They meet every few years a panel of experts to update us on what we can do.

It's a comprehensive list of.

I think currently it has 14 things things like a hearing loss, getting that corrected if you have high blood pressure, diabetes, making sure that those are controlled or medically managed, weight management, healthy weight management, physical activity, cholesterol, high cholesterol.

Getting that addressed.

There's a lot of things up to 45% of dementias can be prevented if these risk factors are addressed.

So it's exciting.

I know you hit on a couple of them, but let's focus on lifestyle and maybe physical activity.

Those two, they affect cognitive health.

Yes of course.

So there is a group of researchers that actually tried to implement some of these lifestyle modifications with what was called the pointer study.

The original study was in Finland called the finger study.

So I love that this one they renamed this one the pointer study.

And so but there was a substantial evidence that lifestyle modification actually there was evidence that it can slow down memory loss and improve brain function.

So that includes physical activity including a little bit of aerobic, a little bit of resistance and also some mindful movement and then diet modifications.

The mind diet is what they used in the study.

It's a combination of the Mediterranean and the Dash diet.

And people are very familiar with the the Mediterranean diet is similar.

It's for high blood pressure and then cognitive stimulation.

They actually use the cognitive stimulating app called brain HQ for these patients.

But you know, individuals can read and do puzzles and do other things to do cognitive stimulation.

And then they also worked to improve social connections and social activities.

That's really integral to not just brain health but longevity as well.

All the studies have shown us.

And emotional health.

Yes.

Yeah.

And and learned that during Covid too.

Yeah.

And then of course good sleep is one thing as well that we know our brain does like a dishwasher at night as they explain to patients.

And it cleans out proteins like amyloid.

So you really if you're having issues with sleep, you really need to talk to your doctor and address that.

Same thing with depression.

Depression can actually mimic dementia.

And so recognizing and getting that treated as well can really help.

Can I just throw hearing into that list.

Yes.

Yeah.

Hearing vision hearing and vision.

And just when people don't hear well which can happen as we get older too, we're just distanced from from being able to be involved.

Absolutely.

Good.

Can I just so there are a couple of medical illnesses and sleep you touched on.

But they sleep apnea, which sometimes remains undiagnosed.

So I always ask the patients if the spouse spouses if they snow because they don't know.

But sleep apnea contributes to, you know, less oxygen going to the brain, less oxygen going to the brain, you're not going to be alert and good in the morning.

And over time, it will really damage the neurons and there will be cognitive decline.

So sleep apnea needs to be treated.

Things like thyroid disease where there's hypo or hyper hypothyroidism is very common.

So we look for that vitamin deficiencies like B12 deficiency and nutrition.

Doctor awful mentioned good nutrition.

But sometimes people have these deficiencies because they because of aging or they just don't absorb.

So all these things need to be checked.

A good medical examination with all the vitamins, all the things that are important for brain health, including the blood pressure, diabetes control.

But thyroid is one endocrine disorder that's very common.

And we see it.

Cardiac issues, atrial fibrillation, which can lead to strokes, which is sometimes not diagnosed or people are not on blood thinners or other methods to control it because there are other things other than blood thinners that can be used like a watchman's procedure.

So all these things, the heart rate is too slow.

And a lot of medications also can make the heart rates low.

Hyperthyroidism can make the heart rate slow.

A slow heart rate again, if it's too slow, will not deliver enough blood to the brain.

A low blood pressure.

We talk about high blood pressure all the time.

We don't talk about low blood pressure, and the blood pressure is too low.

The heart rate is too low.

It won't deliver enough blood and oxygen to the brain.

So a good medical oversight, medical examination is very important.

Very good.

I think we've covered that whole topic.

Anybody else chime in.

All right.

So these are caregiver questions.

You know we've talked about caregiving a lot today.

But Debbie I want to ask you why is that caregivers health also just as important as caregivers or heroes.

I think every one of us will either know a caregiver or be a caregiver, or need a caregiver at some point in our lives.

And when we're a caregiver, we often neglect our own needs and our own health issues.

So that's really, really important to be able to say that we matter to.

And we do need to take time.

The best way that we can help somebody else is to help ourselves.

And all of that is related.

So studies have shown that caregivers often suffer just as much as a person for whom they're providing care.

So we really want to emphasize this to caregivers.

People become caregivers all of a sudden.

Most people don't plan to do that.

And so it's really hard to plan ahead.

What would you do if this would happen to you?

You don't apply for this job.

I mean, you're kind of sometimes it just happens, right?

So tell us what the audience might want to learn about signs and symptoms of showing caregiver burnout.

Yeah, that's an important topic for sure.

And I think burnout affects caregivers just like it.

It can affect anybody else.

If we're feeling particularly stressed or very, very tired or we lose interest in things, we're not taking care of ourselves.

We just can't figure out what is our goal, what is our motivation, how do we get up and do this day after day?

But we really want to intervene before somebody has those types of feelings.

We want to be able to help people figure out, how can I be the best caregiver care provider care partner possible while also taking care of myself?

Good tips.

Doctor McCarty.

You want to speak on some kind of resources, multiple resources that might be available for caregivers, respite, those kind of things.

I think respite is extremely important for these caregivers.

They need a break.

You know, we all need a break from our jobs.

And this becomes a 24 over seven seven job.

So and there are some organizations out there that provide respite.

We don't always like to take advantage of them, but there are some day programs, especially for people tend to take advantage of the day programs when they have to go to work.

So that's not always a respite.

So sometimes I just need to go and take a week vacation or to just go and take care of themselves for a week.

So that's extremely important.

And we also have family caregiving workshops.

We have them through our geriatric collaboration.

And there are a few across the state where they you're taught more, you're giving more tools to put in your toolbox to take care of someone with Alzheimer's, such as when they have the agitated behaviors, when they have Sen Downing, and more just skills of how to deal with some of those behaviors and what to expect.

And then along with that, in the family caregiver workshops, we also teach how to get care of yourself and some particular, maybe resources in your area.

Resources vary from community to community across the state, so you really need someone who knows what's available in your community.

So there are resources for kickers, but in support groups, try to find them.

Oh yes, support groups.

You know, we have them online, in person, on the telephone, but it's someone who's been in your position or been in that position to talk with you through it.

You're not the first person that has been hit, you know, by your loved one or don't know what to do when they're depressed or what or what's going on.

So there are people who have walked the road before you and that you can learn from.

So support groups are very important, and a lot of these support groups will provide a respite for the one with Alzheimer's disease while that individual is attending the so they can go the carrier support group.

So those are available across the state and they are very critical.

This is for anybody that wants to answer.

But what about the caregiver that's really struggling with the feelings of guilt and had any advice?

I mean, I think that's understanding how normal that is.

And I think once again, as Robin said, the importance of a support group to be able to share those types of experiences, you no guilt is something I can't tell somebody will, don't be guilty because we do feel that way and those are real feelings.

So we want to figure out what is it that we're feeling guilty about, what can we do to make things better?

Even if this is a situation that we didn't ask for or didn't plan to be in this as long term as we are, don't have the resources that we have.

Asking for help is really a sign of strength.

And we've talked about this, but you want to talk just to touch again about planning early for legal and financial planning, right?

I'm amazed at how many people do not have a will, or have not talked with their families about what would happen to their worldly possessions, as well as what matters to them as they get older.

So we try to encourage people to do that.

And talking with a lawyer who has experience in elder law is often very, very important.

And people have documents, we make plans and we have to realize that those plans may need to change too.

So we want to have some alternates in mind.

But everybody should have a health care power of attorney living.

Will, you know, some type of financial power of attorney.

Some people think that they're the same.

It could be the same person, but oftentimes it's not.

And it doesn't have to be.

But being able to talk with someone about that is really key.

Yeah.

Very important.

I think a critical aspect to that also is to get the entire family involved.

If if it's a child that has siblings that aren't aren't the primary caregivers and that maybe in other states because that can lead to issues later on.

So make sure they understand what's going on and have kind of signed off.

And so they aren't they know what mom wants.

Yeah.

You know when the time comes.

Absolutely.

Everybody's on the same page.

Everybody's on the same page.

All right.

We're going to do some quick facts or myths.

All right.

Doctor Compton memory loss is a normal part of aging.

Yes or no?

Minimal.

Minimal.

No.

Doctor Azar Alzheimer's only affects older adults.

Not at all.

Someone in the 30s can have Alzheimer's.

Absolutely.

All right.

People with dementia cannot learn new things.

Denise.

Harder and harder all the time.

There is nothing families can do after diagnosis.

Doctor Azar know they can do a lot of things.

Yes.

They can.

Yeah.

Good point.

All right.

Caregivers should be able to handle everything themselves.

Doctor McCarty.

Absolutely not.

Doctor.

Exercise for the brain weight.

Exercise benefits brain health.

Yes.

Yeah, definitely.

Yes, absolutely.

And, Debbie.

Social isolation affects cognitive health.

It sure does.

Sure does.

All right, doctor, can you in closing out our discussion today, what gives you the most hope about the future of Alzheimer's care?

I think there's a lot of things that give me hope right now.

For the first time in history, we can do a comprehensive evaluation with early diagnosis, with the new diagnostics.

And then we now have disease modifying medicines for the first time in history as well.

And also we know more about, you know, other other non-pharmacological measures that can improve things.

And we can implement those earlier in the disease process.

And also allowing patients to plan to discuss things, giving them time.

That's really a gift to to help make decisions while they're able to as well.

So it's really, you know, an exciting time right now for memory care.

Yeah.

Robin, have you seen people actually living a meaningful life despite having that diagnosis?

They really do.

And I think the more so with the new drugs, there's hope and there's more educated family members.

And I think these new drugs and and we do see people getting out and exercising and going to classes and being socially involved.

So yes, sometimes you don't you can't recognize it.

And you're kind of surprised they have a diagnosis of dementia.

So absolutely definitely.

Well, Doctor Azar, how would you say that?

Just over the past decade, Alzheimer's and dementia care has improved?

I know we talked about it briefly, but yeah, it doesn't prove tremendously.

You know, I'm just so excited about all the new things that have happened, including the monoclonal.

But there are more drugs being developed, more drugs in the pipeline.

They're oral drugs that don't have to be infusions that might help in, improve and increase the energy of the brain and the neuronal cells.

So and then we I've talked about the microbiome.

We will be targeting that and trying to improve it through different diets through different medications.

So there's a lot a lot of new drugs on the horizon.

So I'm really excited because we are going to beat this disease.

Yes.

All right.

And this is for everyone.

What is the one message that you hope viewers today remember after watching our program?

Anybody I'd like for people to learn that we can live well as we age, and that love and care and hope and joy really do matter.

And when it comes right down to it, really what we want to do is to be able to look back and realize that we did the best we could.

Absolutely not.

Great.

I would like people to know that research is really important, because that's how we arrived at these new drugs and therapies that can cure diseases like we beat in most of the cancers.

We can do this to.

The brain is the last frontier.

I want people to be involved in research, be involved in clinical trials.

They can go online and look for clinical trials.

They should not be frightened of research because that's the way we are going to advance and we are going to do it together.

Absolutely.

Denise, if you're not sure whether to be concerned or not, you see some changes.

You don't know if it's a normal aging or maybe something more serious.

Don't wait to get it checked out.

Because, as we've already heard today, our new interventions are the most effective when we catch this disease early.

Yeah.

Hey, doctor.

My team.

You know, I love what Debbie was saying about hope.

And I think we all need to have hope.

And we we try to educate health care providers, and we educate caregivers and family members, and we want them to know that there may be ways to, as doctor was saying, to prevent this, to treat this and to get the early intervention.

So get online and learn.

There are so many resources.

Now, if you don't know something, you think something might be going on.

Talk to your primary care doctor, get online and learn some things.

Learn some good questions, and then go back to your primary care provider and try to get those answers.

Absolutely.

There are a lot of information.

No silly question, nothing doctor.

I think my colleagues have said it all, but of course, with or without memory problems, I emphasize to my patients, you got to keep moving and shaking.

You got to stay active in life, not just for your brain health, but for longevity.

Yeah, well, they say motion is lotion.

And keep on, keep on.

All right, well, that's a wrap for our program.

We hope you have found this information very helpful.

Early recognition, informed medical care, healthy lifestyle choices, supportive communities and strong caregiver networks.

They all make a meaningful difference in the lives of those living with dementia.

If you or someone you love is experiencing memory concerns, don't ignore the signs.

Please speak with your health care provider and reach out to the many organizations and professionals that are dedicated to helping the families in Arkansas navigate this journey.

I want to thank our panelists for sharing their expertise and their experiences, and thank you for joining us for this important conversation.

For more information on resources, support services, caregiver programs, and educational materials, please visit.

Our website is AGC to the Department of Geriatrics and the Walker Memory Center have all kinds of resources as well on their website.

Again, I am Morris Riley.

I was proud to be here today and thank you for watching us.