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Alzheimer’s Awareness Month: Huntsville geriatrician answers your questions

Published: Jun. 16, 2022 at 7:43 AM CDT
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HUNTSVILLE, Ala. (WAFF) - June is Alzheimer’s Awareness Month. You likely know someone with the disease, or maybe even lost a loved one to it. It’s a scary diagnosis, but there is hope as doctors work to develop new detection methods and treatments.

Alzheimer’s disease is the most common form of dementia, and affects millions of people. It causes a person to progressively lose their independence over time. WAFF 48′s Kellie Miller spoke to Dr. Linnea Pepper about the disease. Pepper is a geriatrician at Huntsville Hospital and assistant professor of medicine at UAB.

What is Alzheimer’s Disease?

“Alzheimer’s disease is the most common form of dementia,” Pepper said. “It is a neurodegenerative dementia that causes patients, usually older adults, to progressively lose independence over time.”

Alzheimer’s disease is characterized by a combination of cognitive and functional decline. As the disease progresses, patients require total assistance with simple daily tasks.

Dr. Pepper said it’s important for patients to understand the difference between Alzheimer’s and dementia.

“Dementia describes a clinical syndrome where a person develops problems with memory and thinking,” Pepper said. “Alzheimer’s is a subtype of dementia.”

Alzheimer’s is most common in adults over the age of 65. However, it doesn’t discriminate.

“It’s a disease of aging but it can affect younger people, most commonly when there is a family history or a genetic predisposition,” Pepper said.

Dr. Pepper said people who have down syndrome also have a higher risk of developing Alzheimer’s.

How is Alzheimer’s diagnosed?

Alzheimer’s disease is diagnosed through a variety of steps. That may include a physical exam, blood tests, and an MRI of the brain.

“History is crucially important in the diagnosis,” Pepper said. “I usually like to talk to the patient and to a family member or someone who knows the patient very well.”

Dr. Pepper said she must first understand why the patient is seeking care, and when their problems with memory and thinking began.

“Then, we usually do some form of cognitive testing,” Pepper said. “That might take ten minutes, or hours of testing that involve even a psychologist.”

After reviewing the patient’s medical history, Dr. Pepper said most doctors conduct blood tests and brain imaging.

“In special circumstances, we’ll do a PET scan of the brain that shows us areas where the brain is not as active, and that can increase our confidence in the diagnosis of Alzheimer’s.”

What are some causes and risk factors of Alzheimer’s?

Dr. Pepper said there is research that shows lifestyle factors and medical conditions like untreated sleep apnea have been linked to cognitive decline and impairment. Midlife high blood pressure that is not well controlled, is also associated with an increased risk of Alzheimer’s.

“The bottom line, I always tell patients, you want to construct a day that is social and safe and active,” Pepper said. “So, the more you can be physically active, the more you can be socially engaged in the community with your family, with your friends, etc.”

Alterations in circadian rhythm that result from lifestyles such as shift work over many years, is also associated with an increased risk of dementia or Alzheimer’s.

“Overall, the prevalence of Alzheimer’s dementia is increasing based on the epidemiologic studies we have available,” Pepper said.

Are there any new detection methods or treatments?

Dr. Pepper said there is a lot of emerging and ongoing work in biomarkers. Those are blood tests or scans of the brain that help doctors track the progression of Alzheimer’s.

“Studies have shown that the biochemical changes in the brain actually occur years before anyone has symptoms,” Pepper said. “So there is a lot of excitement about trying to intervene upstream and in the time that we call preclinical Alzheimer’s disease.”

Alzheimer’s disease is not reversible. However, there are ways to slow it down.

“The best we can do right now is try to slow the rate of cognitive decline,” Dr. Pepper said. “So I always tell patients, the available therapies we have right now, change the slope of the line for a brief period of time so that you are not progressing as fast as you might otherwise.”

Dr. Pepper said some patients get comfort with their diagnosis by knowing that they can contribute to a cure one day. There are ongoing clinical trials that patients can enroll in if they are interested.

“By diagnosing it earlier, we can help patients and their families prepare for the future and sometimes avoid a lot of frustration,” Pepper said. “I have seen a wide range of emotions that people experience and there is a lot of stigma of course associated with the development of cognitive impairment.”

Why did you choose your profession?

“When I was in high school I thought I was going to be a lawyer,” Pepper said. “But at the same time, my family was taking care of my elderly grandparents. My grandmother had Alzheimer’s disease and my grandfather was physically frail but cognitively intact. I actually lived with them in the summer and took care of them after school.”

Pepper said she soon realized her love for biology and chemistry, and knew she wanted to become a geriatric physician.

“It requires a lot of patience,” she said. “But it’s tremendously rewarding. I get to know these patients on a personal level, and get to provide a personalized level of medicine.”

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