Alzheimer's warning signs to watch for — as new drugs give patients hope
Dr. Jay-Sheree Allen is a family medicine physician practicing in central Minnesota and the host of the Millennial Health podcast.
Courtesy of Dr. Jay-Sheree Allen.
More than six million people in the United States have Alzheimer’s disease, a brain-wasting disease notoriously difficult to treat.
Earlier this month, new research came out from the drugmaker Eli Lilly about a potential new Alzheimer's drug called Donanemab. It was shown to slow cognitive decline by more than 30 percent.
That hopeful news comes right before Alzheimer's and Brain Awareness Month in June. With that in mind, we've asked Dr. Jay Sheree Allen from the Mayo Clinic to share warning signs and treatment for Alzheimer's disease. She talked with MPR News Host Cathy Wurzer.
Use the audio player above to listen to the full conversation.
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Audio transcript
CATHY WURZER: More than six million people in this country have Alzheimer's disease, a brain wasting illness that has been notoriously difficult to treat. Earlier this month, new research came out from the drugmaker Eli Lilly about a potential new Alzheimer's drug called Donanemab. It was shown to slow cognitive decline by more than 30%.
That hopeful news comes right before Alzheimer's and Brain Awareness month which occurs in June. With that in mind, we've asked Dr. Jay-Sheree Allen from Mayo Clinic to join us today to talk about warning signs and treatment for Alzheimer's. Welcome back, Dr. Jay, how have you been?
DR. JAY-SHEREE ALLEN: I am well. Thank you so much for having me again.
CATHY WURZER: It's great having you here too. As you know, I'm a big fan of making sure we are all familiar with terms. Dementia and Alzheimer's, one and the same?
DR. JAY-SHEREE ALLEN: No. They are often used interchangeably. But they actually have different meanings. So dementia, it's more of a-- how do I say-- like an umbrella term that's used to describe a wide range of symptoms, which a decline in memory is one, but also thinking skills, poor judgment, decreased focus and attention. And this, it needs to interfere with a person's daily life and activities.
And there are many different causes of dementia, also many different types of dementia. That's different from Alzheimer's, which is an irreversible progressive brain disorder. So it first affects the part of the brain associated with learning. And some of the memory issues become quite apparent early on in the disease process, but also thinking and reasoning. And as the disease progresses and becomes more severe, things like confusion, changes in behavior, those sorts of challenges become apparent.
CATHY WURZER: And when you hear about these symptoms, the changes that cause some of the first symptoms are thought to be in 20 years or more before you see these symptoms, which is just astounding.
DR. JAY-SHEREE ALLEN: Yes, it is. And sometimes it can be really hard to pick up because it's just so subtle. And then a lot of individuals are able to compensate in many different ways when they recognize maybe here or there that something is a little off, they find ways to go around that. So it really can take a while before we can put the entire picture together.
CATHY WURZER: What are the risk factors?
DR. JAY-SHEREE ALLEN: So risk factors, so there is no one per se. I'll debunk the first one that everyone's probably wondering about. There's no gene. There is no one Alzheimer's gene that's responsible for this.
So the greatest known risk factor, believe it or not, just for Alzheimer's but other dementias is increasing age. It is not a normal part of aging-- I hate the word normal, but it fits here-- it's not a normal part of the aging process. But as your age does increase, your risk for developing Alzheimer's does increase as well. Most individuals with the disease are over 65.
CATHY WURZER: We should say that there are some families, though, where there appears to be Alzheimer's running in the family.
DR. JAY-SHEREE ALLEN: Yes. So there does appear to be a family history being quite significant, but mostly, if you have more than one family member with the disease.
CATHY WURZER: And there are modifiable risk factors that include your fitness level, smoking, blood pressure, diet. If you work on those, can some of these changes be pushed off?
DR. JAY-SHEREE ALLEN: They can-- I was actually laughing as I was prepping for this segment, because I think this is like my standard line in all of our conversations that a nutritious diet and activity will help.
CATHY WURZER: You always say that.
DR. JAY-SHEREE ALLEN: I do, I do. But social engagement is also huge. And we spoke about loneliness and mental health earlier. But social engagement's a big one. Mentally-stimulating activities are also good, trying to stay as healthy as possible. Those are some of the big things.
But research is also looking into cognitive decline and vascular conditions. So that's like people who've had heart disease or a stroke or high blood pressure, what sort of relationship does that have to developing Alzheimer's or other types of dementias in your future?
CATHY WURZER: I mentioned and tripped over that new drug word, Donanemab-- I think that's how you pronounce it-- which shows a slowing in cognitive decline by more than 30%. That sounds like that's significant.
DR. JAY-SHEREE ALLEN: Yes. So with the pronunciation of the name, I'm just going to leave that one alone. I won't embarrass myself on your show.
CATHY WURZER: I just did it for both of us. Go ahead.
DR. JAY-SHEREE ALLEN: No. So the thing with these drugs, these are still very early. They're still very early. I recall I was working at ABC News a couple of years ago. And I wrote a big article about another one of these drugs that came out. And they don't end up being as promising as we would like. So I think the jury's still out. Let's see where this goes with time.
There is no cure. There is no one medicine that stops this. But addressing some of the issues related to Alzheimer's like some of the behavioral challenges, there are drugs out there that have been on the market for a very long time that are effective in those areas. The jury's still out on the new drugs.
CATHY WURZER: If you have a loved one, and I'm thinking you have your Millennial Health podcast, there are millennials out there whose parents are starting to show some signs of problems, which is really scary. So if you have a loved one showing signs of Alzheimer's, what should they do?
DR. JAY-SHEREE ALLEN: This one is so hard. It's hard, especially if you are the child or a loved one, it's hard to bring issues like this to the awareness or the attention of the elders in your life. But it's a necessary conversation.
I think if you want to pull your physician into the conversation, I think that's a good idea, going and getting evaluated. Because one of the things when we were clarifying the difference between Alzheimer's and dementia, there are some reversible causes of dementia depending on what's causing it.
And so you do need to undergo a workup to ensure that there are no reversible or identifiable causes that we have within the medical space that we can address. So I think the first step is maybe getting your doctor involved. Let's rule out the reversible issues.
And then if we get to a point where we're like, OK, where we're making a diagnosis here that is a progressive and irreversible one, then I think some of their conversations need to follow.
CATHY WURZER: Also, of course, I'm mentioning caregivers. And that is so important. Because they are the ones that are going to be living with this person that's dealing with dementia and Alzheimer's. What recommendations do you have for supporting the caregivers out there?
DR. JAY-SHEREE ALLEN: Yes. That is so important. I think this goes back to the important conversations that you're going to have to have with your family members who have these conditions. I think one of the best ways to support everyone involved in this process is to have the wishes of the individual with the diagnosis expressed in detail and in plain writing.
I think it takes some of the guilt, some of the burden, some of the stress off of the caregivers to constantly wonder whether or not they're acting in their loved one's best interest. And I think it would also help the individual to know that the things that are being done for them and to them are the things that they would desire. So I think the most important thing is get those wishes in writing.
CATHY WURZER: In terms of an advanced care directive, perhaps, power of attorney when it comes to health and finances?
DR. JAY-SHEREE ALLEN: Yes. Yes, yes, and your will. And so there's a legal aspect-- we should do a whole segment on this, Cathy,
CATHY WURZER: We should, yeah.
DR. JAY-SHEREE ALLEN: So there's a legal component to this. But there is also a component of this conversation that needs to happen with your physician as well. Because God forbid something should happen, you end up in the ER or in the hospital, the doctors need to readily have your wishes available. And we have actually a section in the medical record for that.
CATHY WURZER: Excellent. Dr. Jay, Thank you so much. Always great having you here.
DR. JAY-SHEREE ALLEN: Thank you for having me, Cathy. Until next time.
CATHY WURZER: Exactly. That was Mayo Clinic family medicine physician, Dr. Jay-Sheree Allen. She also hosts the podcast, Millennial Health.
That hopeful news comes right before Alzheimer's and Brain Awareness month which occurs in June. With that in mind, we've asked Dr. Jay-Sheree Allen from Mayo Clinic to join us today to talk about warning signs and treatment for Alzheimer's. Welcome back, Dr. Jay, how have you been?
DR. JAY-SHEREE ALLEN: I am well. Thank you so much for having me again.
CATHY WURZER: It's great having you here too. As you know, I'm a big fan of making sure we are all familiar with terms. Dementia and Alzheimer's, one and the same?
DR. JAY-SHEREE ALLEN: No. They are often used interchangeably. But they actually have different meanings. So dementia, it's more of a-- how do I say-- like an umbrella term that's used to describe a wide range of symptoms, which a decline in memory is one, but also thinking skills, poor judgment, decreased focus and attention. And this, it needs to interfere with a person's daily life and activities.
And there are many different causes of dementia, also many different types of dementia. That's different from Alzheimer's, which is an irreversible progressive brain disorder. So it first affects the part of the brain associated with learning. And some of the memory issues become quite apparent early on in the disease process, but also thinking and reasoning. And as the disease progresses and becomes more severe, things like confusion, changes in behavior, those sorts of challenges become apparent.
CATHY WURZER: And when you hear about these symptoms, the changes that cause some of the first symptoms are thought to be in 20 years or more before you see these symptoms, which is just astounding.
DR. JAY-SHEREE ALLEN: Yes, it is. And sometimes it can be really hard to pick up because it's just so subtle. And then a lot of individuals are able to compensate in many different ways when they recognize maybe here or there that something is a little off, they find ways to go around that. So it really can take a while before we can put the entire picture together.
CATHY WURZER: What are the risk factors?
DR. JAY-SHEREE ALLEN: So risk factors, so there is no one per se. I'll debunk the first one that everyone's probably wondering about. There's no gene. There is no one Alzheimer's gene that's responsible for this.
So the greatest known risk factor, believe it or not, just for Alzheimer's but other dementias is increasing age. It is not a normal part of aging-- I hate the word normal, but it fits here-- it's not a normal part of the aging process. But as your age does increase, your risk for developing Alzheimer's does increase as well. Most individuals with the disease are over 65.
CATHY WURZER: We should say that there are some families, though, where there appears to be Alzheimer's running in the family.
DR. JAY-SHEREE ALLEN: Yes. So there does appear to be a family history being quite significant, but mostly, if you have more than one family member with the disease.
CATHY WURZER: And there are modifiable risk factors that include your fitness level, smoking, blood pressure, diet. If you work on those, can some of these changes be pushed off?
DR. JAY-SHEREE ALLEN: They can-- I was actually laughing as I was prepping for this segment, because I think this is like my standard line in all of our conversations that a nutritious diet and activity will help.
CATHY WURZER: You always say that.
DR. JAY-SHEREE ALLEN: I do, I do. But social engagement is also huge. And we spoke about loneliness and mental health earlier. But social engagement's a big one. Mentally-stimulating activities are also good, trying to stay as healthy as possible. Those are some of the big things.
But research is also looking into cognitive decline and vascular conditions. So that's like people who've had heart disease or a stroke or high blood pressure, what sort of relationship does that have to developing Alzheimer's or other types of dementias in your future?
CATHY WURZER: I mentioned and tripped over that new drug word, Donanemab-- I think that's how you pronounce it-- which shows a slowing in cognitive decline by more than 30%. That sounds like that's significant.
DR. JAY-SHEREE ALLEN: Yes. So with the pronunciation of the name, I'm just going to leave that one alone. I won't embarrass myself on your show.
CATHY WURZER: I just did it for both of us. Go ahead.
DR. JAY-SHEREE ALLEN: No. So the thing with these drugs, these are still very early. They're still very early. I recall I was working at ABC News a couple of years ago. And I wrote a big article about another one of these drugs that came out. And they don't end up being as promising as we would like. So I think the jury's still out. Let's see where this goes with time.
There is no cure. There is no one medicine that stops this. But addressing some of the issues related to Alzheimer's like some of the behavioral challenges, there are drugs out there that have been on the market for a very long time that are effective in those areas. The jury's still out on the new drugs.
CATHY WURZER: If you have a loved one, and I'm thinking you have your Millennial Health podcast, there are millennials out there whose parents are starting to show some signs of problems, which is really scary. So if you have a loved one showing signs of Alzheimer's, what should they do?
DR. JAY-SHEREE ALLEN: This one is so hard. It's hard, especially if you are the child or a loved one, it's hard to bring issues like this to the awareness or the attention of the elders in your life. But it's a necessary conversation.
I think if you want to pull your physician into the conversation, I think that's a good idea, going and getting evaluated. Because one of the things when we were clarifying the difference between Alzheimer's and dementia, there are some reversible causes of dementia depending on what's causing it.
And so you do need to undergo a workup to ensure that there are no reversible or identifiable causes that we have within the medical space that we can address. So I think the first step is maybe getting your doctor involved. Let's rule out the reversible issues.
And then if we get to a point where we're like, OK, where we're making a diagnosis here that is a progressive and irreversible one, then I think some of their conversations need to follow.
CATHY WURZER: Also, of course, I'm mentioning caregivers. And that is so important. Because they are the ones that are going to be living with this person that's dealing with dementia and Alzheimer's. What recommendations do you have for supporting the caregivers out there?
DR. JAY-SHEREE ALLEN: Yes. That is so important. I think this goes back to the important conversations that you're going to have to have with your family members who have these conditions. I think one of the best ways to support everyone involved in this process is to have the wishes of the individual with the diagnosis expressed in detail and in plain writing.
I think it takes some of the guilt, some of the burden, some of the stress off of the caregivers to constantly wonder whether or not they're acting in their loved one's best interest. And I think it would also help the individual to know that the things that are being done for them and to them are the things that they would desire. So I think the most important thing is get those wishes in writing.
CATHY WURZER: In terms of an advanced care directive, perhaps, power of attorney when it comes to health and finances?
DR. JAY-SHEREE ALLEN: Yes. Yes, yes, and your will. And so there's a legal aspect-- we should do a whole segment on this, Cathy,
CATHY WURZER: We should, yeah.
DR. JAY-SHEREE ALLEN: So there's a legal component to this. But there is also a component of this conversation that needs to happen with your physician as well. Because God forbid something should happen, you end up in the ER or in the hospital, the doctors need to readily have your wishes available. And we have actually a section in the medical record for that.
CATHY WURZER: Excellent. Dr. Jay, Thank you so much. Always great having you here.
DR. JAY-SHEREE ALLEN: Thank you for having me, Cathy. Until next time.
CATHY WURZER: Exactly. That was Mayo Clinic family medicine physician, Dr. Jay-Sheree Allen. She also hosts the podcast, Millennial Health.
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