Now, is this disease hereditary?
Some forms of it may be hereditary, especially when it presents earlier in life, like, you know in patients who are in their 50s or 60s. But if you take a sample of patients in their 90s, a large majority may have dementia, and that’s not necessarily a form that’s associated with inherited illnesses.
Are there any ways to prevent it?
Well what I tell my patients is you have to lead a healthy lifestyle. You have to eat right and exercise, and not only exercise your body, but exercise your mind. So staying active mentally is the key to delaying functional decline, so I encourage people to do puzzles – Sudoku puzzles – all kinds of learning. Going to social activities is very important – discussion groups, book clubs, you name it.
Are men or women more likely to have it?
I think it’s fairly equal among the sexes, except that we have a larger population of elderly females – just because in the past they’ve lived longer. So I think in my practice, I see maybe a skewed population of women, but I think it’s fairly equal.
We read that Latinos tend to have a higher risk of developing Alzheimer’s. Do you know why that might be?
Actually I’m not familiar with that quote, but I think part of it may be related to lifestyle or – not education – but just the ability to access healthcare. So maybe when people present, they present a little bit more advanced.
In recent years, it seems more and more people appear to be developing this disease. Is there an answer as to why?
I think we’ve gotten better at diagnosing. In the past, I think people took for granted that grandma was just forgetful. And people would take care of their loved ones at home – I think that the Latino community tends to do that more than other communities. But I think that we just didn’t have the tools to diagnose and treat, so I think that’s part of the reason why it may seem like it’s more prevalent.
I think that Latinos tend to be very family-oriented and often times have multi-generational households in which, you know, grandma helps take care of the children and then in turn the children will help take care of grandma later on. And it’s just, you know, we take that for granted, and we don’t take grandma to the doctor necessarily when she’s forgetting because that’s just tradition.
Nowadays with families being so fragmented and kids going off to college -- I guess it’s part of the American Dream -- it’s sort of changing the way that we live. And we have to take care of our growing elderly family members in a different way because we just don’t have that family structure that we used to have.
Do you have any advice or tips for someone who is being the caregiver for a person with Alzheimer’s? Because taking care of someone suffering from any form of dementia can become very stressful and even frustrating.
Sure. It’s a full-time job. Caregiver stress is a known entity that we see in those caring for people with dementia. There’s a book out there called The 36-hour Day, and that’s basically what it feels like. It feels like a day that is never ending. It’s a book by Mace and Rabins. It is a book that I refer patients to and families to because it’s another way of taking care of your loved one instead of giving him or her medicines to control behavior. In the past, we used to use typical anti-psychotics to control behavioral disturbances of dementia. Those had a lot of side effects. Later on, we started using a-typical anti-psychotics to control behavioral disturbances, but these medications are not FDA approved for this kind of use. In fact, there is a black box warning that says there is an increased use for morbidity and mortality when used for the elderly. So I tend to try to try to leave these as a last resort, and anything that we can do to redirect or to, you know, assist our caregivers in taking care of their loved ones is much better.
I think sometimes holding somebody’s hand and guiding them through is easier than to prescribe a pill – on the patient that is. I think respite care is something that we often forget about. So if a caregiver is stressed, and they just need some time, to have someone come in and take over the care for a while is ideal. We have boarding care, assisted living facilities, and certainly nursing homes that can take over the care when the caregiver is just no longer able to do it. And just having support groups – having family members that are able to assist -- is ideal.
I think caregivers need some time to themselves, and sometimes caregivers are their own worst enemies ‘cause they know nobody’s gonna do it like they do it, and they have a hard time letting go. And sometimes you just need to protect yourself and get some free time. Understand that your loved one is going to be okay even though maybe their food might not be cooked the same way you want it or the structure of the house may not be the same. But it’s for a long term good so that we can keep the patient at home longer.
The number one reason why dementia patients get placed in long-term facilities is incontinence. Incontinence of urine or stool because once you get to that point, the caregiver is really stressed out trying to keep the patient clean [and] the household clean. And it seems like the burden escalates at that point.
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