Q&A on the most lethal form of dementia

Q&A on the most lethal form of dementia

Dr. Gordon J. Rafool shares the symptoms and treatment options of Alzheimer’s disease

Alzheimer’s disease is the sixth leading cause of death in America. In Polk, 11.8 percent of Medicare beneficiaries were treated for Alzheimer’s or another form of dementia in 2013, according to Healthy Tampa Bay. We interviewed Dr. Gordon J. Rafool, a geriatrician at Winter Haven’s Gessler Clinic and a Polk County Medical Association member, to find out more about warning signs, when to act, and more.

Central Florida Health News (CFHN): Who is most susceptible to Alzheimer’s?

Dr. Gordon J. Rafool: Anybody in the age range of 65 to 100, but it’s less prevalent in the younger. Maybe five percent or less of people under age 65 are diagnosed. Eleven percent of people age 65 and older has the disease. Heredity can play some role. That’s the minimum number of people, however. We know the risk is higher in those with abnormal lipids, high blood pressure, and diabetes, or who are obese, sedentary, or that abuse drugs and/or alcohol.

CFHN: What are the first signs?

Dr. Rafool: Recent memory loss. Forgetting appointments. Not balancing their finances. It’s not the patient that recognizes it. It’s the family. The family will recognize the person asks the same questions over again. They can’t remember they asked them. Patients as a general rule don’t know they don’t know… because their memory is the problem.

CFHN: What can be done to arrest symptoms?

Dr. Rafool: Once it’s manifested, medicines have very little effect. The push is to diagnose it before the person has memory loss. There are all kinds of things going on now. There’s a blood test that’s recently been identified that looks at fat-carrying proteins. They are looking at testing to see if they are more prone to having a memory problem. There was a small study published in Science where they have identified these changes—things that carry the cholesterol as a possible factor in memory change.

That’s where all the drug research is going on now. They’re hoping to have disease-modifying medications. They’re even talking about a vaccine where you can immunize and it helps the person metabolize protein better so they don’t have the pathologic changes. But all that is up in the air. They’ve been looking at this for years.

As a rule, it’s good to keep your mind active. I’ve seen people that retire and they retire their mind. It’s good for them to learn something new every day. Word games are good. Staying physically fit is good. Keeping weight down and staying away from alcohol and drugs, even tobacco, are good.

CFHN: What are the benefits of early treatment? Is it possible to reverse it?

Dr. Rafool: Nothing can reverse it at this point. What we can do is keep it at a certain level by putting them on medications. We can keep them in this first phase or state of Alzheimer’s for a period of time. We know these medications have allowed them to stay active and out of nursing homes, and help with behavior. If we see somebody that comes in during the early stages, we can start them on these medications and, hopefully, keep them in that stage.

We know each person with Alzhiemer’s is unique. Some people can have a galloping disease. A majority of people will stay at this level for a period of time, and then progress to other stages inevitably.

CFHN: What are the symptoms?

Dr. Rafool: Memory loss, recent memory loss. That’s characteristic of Alzheimer’s. We can list activities of daily living as the disease progresses. They can’t fix meals. They can’t remember appointments. They can’t drive eventually. They can get lost very easily even going from room to room, even not remembering where the bathroom is. It is a progressive cognitive decline. They may even forget their loved ones or that they are married.

CFHN: Are there ways to prevent Alzheimer’s?

Dr. Rafool: Good nutrition. Keeping existing conditions under control: Diabetes, high blood pressure, and heart disease. Keeping weights down, minds active. Avoiding drugs, alcohol and tobacco, and staying relatively active physically.

CFHN: Is it possible to live with Alzheimer’s for many years?

Dr. Rafool: Yes, it is possible. In fact, we see that more and more, especially if the patient has a significant other that will take care of his or her daily needs. Each phase is different. The first phase (or mild phase) can last between one year and six years. The second phase is quicker, two or three years; the last phase can be one year.

It progresses differently in different people. What helps keep them in certain phases are their loved ones, along with medications.

CFHN: Does diet matter?

Dr. Rafool: We like to keep them on a good Mediterranean diet. Exercise and activity are important. If they have heart disease or vascular disease, we like to keep them in check. We don’t like them to drink alcohol or take medications that will make the decline more rapid. Older kinds of antihistamines can make the disease progress rapidly. A lot of them will buy them to sleep at night and that’s a big mistake.

CFHN: At what point is full-time care recommended?

Dr. Rafool: In later stages like the moderate and definitely in the severe. Most end up in nursing homes because it disrupts their caregiver. The caregiver cannot sleep and then is more likely to seek options for care in a nursing home. Also, if the patient has incontinence issues.

If there is anything that would cause the person to be more at risk for injury, that’s another reason. Like wandering or poor driving. Those are the main two things. That’s why we have silver alerts. They head to what they think is the grocery store and they end up in Tampa from here. Behavior is a significant factor.

Usually it’s the driver that gets into issues. That’s why we like them to have identification on them in the form of a bracelet or necklace.

We struggle with when to pull their license, but if they start having accidents or fender benders or dents on their car that no one can account for, that’s evidence they should pull the license. Caregivers should ride in the car with them and see how they do. If they see they are missing the red light and driving through, that’s an indication they should take the license.

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