Missing Pieces
Alzheimer’s disease and other forms of dementia are difficult health burdens to carry—but understandingthe problem andreceiving proper care can make a world of difference.

Michelle Papka, PhD, like so many others in the healthcare community, is bracing herself for a population explosion. This one will have nothing to do with immigration or birth rates—just the opposite, really—but with aging. As an increasing number of Americans reach age 65 and beyond, we, as a nation, are about to be faced with the largest-ever number of people with some kind of dementia: the loss of intellectual and social abilities severe enough to interfere with daily functioning.

“The likelihood of developing dementia and Alzheimer’s disease increases with age,” says Papka, co-director with Overlook Chief of Neurology David P. Saur, MD, of the Memory and Cognitive Disorders Program at Overlook Hospital. “The concern about the number of people who are going to develop dementia or Alzheimer’s disease is at an all-time high. The elderly are one of the largest growing populations in the United States.” In fact, according to the National Alzheimer’s Association, a new case of Alzheimer’s disease occurs every 70 seconds; by mid-century, it is projected that a new case will occur every 33 seconds. What’s more, caring for patients with Alzheimer’s costs $148 billion annually.

Alzheimer’s disease, the most common type of dementia among the elderly, has been called “the long good-bye.” But for the millions of people suffering from Alzheimer’s and other forms of dementia—and for their caregivers as well—there are seemingly no words to describe it. “It’s a problem that really has a trickle-down effect,” says Papka. “It affects whole families, and society in general.”

Where to Turn

There is no cure for dementia, but medications, therapy, and proper care can all positively influence quality of life. The key, says Saur, is to differentiate for each patient the type of dementia he or she is coping with so that appropriate measures of care can be taken. A patient may have Alzheimer’s, but the causes of cognitive impairment are varied; Parkinson’s disease, metabolic problems, an exposure to toxins in the brain, tumors, and traumatic brain injury also must be considered.

“If you’re noticing a change in your ability to function socially or cognitively or if you’re memory is impaired, you should seek an evaluation,” says Saur. “If you’ve had these impairments all your life, you’re not looking at dementia. But if there is a sudden or gradual change, you should be evaluated.”

Patients who seek treatment through the Memory and Cognitive Disorders Program fill out a detailed questionnaire and are evaluated by Saur for a neurological assessment and by Papka for a neuropsychological assessment. Together, the pair reaches a diagnosis and treatment plan. This involves one-on-one examinations by each doctor, and a battery of tests that may include blood work, an EEG, and brain imaging in the form of an MRI, CT scan, or PET scan (see “A Clearer Picture,” below).

Papka’s tests include those related not only to memory but to language and other skills, decision-making ability, and the capacity to perform daily functions. “The primary objective of a neuropsychological assessment is to determine a diagnosis and treatment plan. Standardized tests are used to measure whether cognitive ability is consistent with what we would expect for a person of that age,” she says. “If not, then our task is to determine what is causing the problem, and what interventions will be helpful. There is no cookie-cutter way to handle patients. We assess each case individually.”

In many cases, Papka draws on both her clinical and research experiences to glean a better understanding of a patient’s mental state. Functional assessments, she says, can be especially helpful in weighing the level of care a patient requires. “I’ll have a patient use the phone, read a bill, write a check. Often the patient is unaware of any diminished capacity,” she says. “But this type of assessment gives detailed feedback of what a person is able to do day to day so that patients and families can make informed caregiving decisions. A family may be struggling to determine what to do. Our objective is to encourage patients to remain as independent as possible while ensuring their safety. But this is a harder goal for families to achieve if they don’t have adequate information.”

Additional services include psychotherapy—for the patient, the patient’s family, or for patients and family members together. “It’s always beneficial to have a safe place to talk about feelings, concerns, issues, and to defuse emotions,” says Papka. “Dementia changes a person from who they were before. That impacts everyone.”

Says Saur, “The program distinguishes itself by providing comprehensive care. We are able to care for neurological, neuropsychological, and psychiatric needs. Patients with dementia often have severe behavioral issues, and we have access to some geriatric beds in the psychiatric unit if that’s what a patient requires.”

Can You Prevent Dementia?

Researchers and pharmaceutical companies are working every day to develop treatments and a cure for Alzheimer’s disease. But can it be avoided in the first place?

“You certainly can control risk factors,” says Saur. Patients should actively set out to control hypertension, diabetes, or abnormal lipids. They should also make an effort to remain cognitively stimulated. “Doing the New York Times crossword has not been proven to prevent you from getting Alzheimer’s,” he says, “but if you stay mentally active, there’s evidence that that can help lessen the severity of disease.”

The scope of dementia is no doubt difficult to handle. It robs patients of their true selves and robs families of their loved ones. But Saur remains optimistic that science will improve outcomes for those who are afflicted by these diseases. “Ultimately we want to be able to restore lost ability,” he says. “It remains to be seen whether that will ever be possible, but that’s what we’re working toward.”

For more information on the Memory and Cognitive Disorders Program or for a referral to a physician,
call 866-478-5336.

A Clearer Picture
New technologies make it possible to get better assessments of brain function.

Doctors rely on brain imaging to see the physical manifestations of what’s really going on inside a patient’s head. PET/CT scans combine physiologic-based imaging (positron emission tomography) with precise anatomical imaging (computed tomography) to provide a complete picture of anatomy that appears abnormal and whether it actually is abnormal. At the Atlantic Neuroscience Institute at Overlook Hospital, PET/CT scans for Alzheimer’s disease evaluation go through a specialized processing program called Cortex-ID, where the image data is compared to age-adjusted standards of what is considered the national norm. This analysis enables the interpreting radiologist to more accurately diagnose a patient’s condition and supply the ordering physician with specific comparisons to improve the effectiveness of intervention and treatment.

November 2009


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