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IT CAN STEAL YOUR MIND AND TAKE AWAY YOUR DIGNITY. IS IT SOMETHING THAT CAUSES GRIEF AND SUFFERING FOR FAMILIES ACROSS THE COUNTRY. NOW, WE'LL LOOK AT ONE OF THE MOST SERIOUS HEALTH PROBLEMS THAT WE FACE. COMING UP NEXT ON SECOND OPINION.
MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION. THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING. THE JOSIAH MACY JR. FOUNDATION AND THE PARK FOUNDATION.
DR. SALGO: WELCOME TO SECOND OPINION WHERE EVERY WEEK YOU CAN HELP SOLVE A MEDICAL MYSTERY AND LEARN MORE ABOUT YOUR OWN HEATH CARE, I'M YOUR HOST DR PETER SALGO AND TODAY WE'RE GOING TO DISCUSS A CASE ABOUT LOUISE. WE'VE ASSEMBLED A HEALTH CARE TEAM TO TACKLE THIS CASE SOME OF THE PANEL ARE DOCTORS, SOME ARE NOT. ONLY ONE PERSON ON THE PANEL HAS READ THE CASE FILE. THAT'S ELISSA ORLANDO OUR RESIDENT CIVILIAN. WELCOME BACK.
ORLANDO: HI PETER
DR. SALGO: AND EVERY WEEK WE HAVE A PRIMARY CARE PHYSICIAN ON THE PANEL TODAY IT'S DR LOU PAPA. LOU, GREAT TO HAVE YOU BACK WITH US TODAY.
DR. PAPA: HELLO.
DR. SALGO: LET'S GET RIGHT TO THE CASE, SHALL WE? AS I SAID WE HAVE A CASE HERE ABOUT A WOMAN NAMED LOUISE. SHE'S OLDER, SHE'S 72 YEARS OLD AND SHE'S SEEN IN THE EMERGENCY ROOM BECAUSE SHE'S BLEEDING FROM A CUT ON HER HEAD. SHE SAID SHE LOST HER BALANCE AND SHE FELL. NOW LOU, YOU'RE THE DOCTOR IN THE EMERGENCY ROOM. WHAT DO YOU DO?
DR. PAPA: WELL, FIRST OF ALL YOU ADDRESS THE BLEEDING- THAT'S THE MOST IMPORTANT THING. THE SECOND QUESTION IS WHEN YOU HAVE AN OLDER PERSON, IS THIS THE FIRST TIME THEY FELL, HOW DID THEY FALL AND WHY DID THEY FALL?
DR. SALGO: SHE SLIPPED AND SHE FELL, THAT'S ALL. SHE TELLS YOU THAT.
DR. PAPA: IF THAT'S TRULY THE STORY, I'D LIKE TO SEE HER AND FOLLOW UP AND SEE IF THAT CONTINUES TO BE THE ISSUE AND MAKE SURE THERE WASN'T ANYTHING ELSE, SHE DIDN'T HAVE ANY OTHER SYMPTOMS. NO CARDIAC SYMPTOMS, NO HEART SYMPTOMS, NO CHEST PAINS, NO SHORTNESS OF BREATH, NOTHING WHERE SHE FELT LIKE SHE WAS GOING TO PASS OUT.
DR. SALGO: SO YOU'RE GOING TO THE WHOLE DIZZINESS, FALLING WORKUP. IS IT BECAUSE SHE'S OLDER ?
DR. HALL: IT'S NOT NECESSARILY RELATED TO CHRONOLOGICAL AGE, BUT PERHAPS MORE RELATED TO BIOLOGICAL AGE. WE ALL AGE DIFFERENTLY. I THINK WHAT WE NEED TO DO IN THE CASE OF THIS LADY IS TO REMEMBER THAT A CUT SECONDARY TO A FALL MAY BE THE VERY FIRST INDICATOR WE HAVE THAT SOMETHING MORE SERIOUS IS GOING ON.
DR. WONG: WELL A COMPLETE THOROUGH HISTORY IS ALWAYS A WAY TO START, SO YOU WANT TO LOOK AT ALL THE DIFFERENT POSSIBILITIES. YOU DON'T WANT TO JUMP TO CONCLUSIONS AHEAD OF TIME, WHICH WE'RE ALL PRONE TO DO, EVEN AS DOCTORS.
DR. SALGO: WELL I'LL TELL YOU WHAT HAPPENS BECAUSE THEY DO TALK TO HER AND SHE SAYS, "I'M FINE, NOTHING IS WRONG WITH ME. I SIMPLY TRIPPED AND I FELL." THEY SAID, "HOW DO YOU FEEL NOW THAT YOU FELL? AND HOW DID YOU FALL?" AND SHE SAID, AND THIS IS A DIRECT QUOTE: "YOU REALLY DON'T NEED TO KNOW THAT." JUST LIKE THAT. SO THEY WENT AT IT AGAIN AND THEN THEY ASKED HER IF SHE HAD FALLEN BEFORE. AGAIN, THEY WERE TRYING TO GET SOME SENSE OF WHERE HER LIFE WAS, I SUSPECT FROM THE CHART. AND SHE RESPONDED: "THAT'S REALLY NONE OF YOUR BUSINESS." IT SOUNDS TO ME THAT THESE ANSWERS COULD BE VIEWED AS A COVER.
DR. PAPA: A LOT OF PATIENTS, THEY GO- THIS IS A HUGE FEAR -"COULD I BE FORGETTING THINGS? IT THIS STARTING?" I, YOU KNOW, IT'S A TERRIBLE FEAR, TO START THINKING THAT.
DR. SALGO: SO THE PATIENTS GO INTO DENIAL?
DR. PAPA: VERY OFTEN, THEY'LL TELL YOU- EVERYTHING'S JUST LIKE SHE SAID, EVERYTHING'S FINE.
DR TARIOT: YOU ALSO WONDER IF SHE'S UNUSUALLY IRRITABLE, WHICH MIGHT BE A CLUE.
ORLANDO: COULDN'T SHE JUST BE CROTCHETY?
DR. HALL: A GREAT MOMENT OF TRUTH FOR A MEDICAL STUDENT IS TO SEND THEM INTO A ROOM- OF LOUISE.
DR. SALGO: RIGHT.
DR. HALL: AND HAVE THEM COME OUT AND SAY, "WHAT DO YOU THINK?" AND THEY'LL SAY, "WELL, SHE'S THIS CROTCHETY OLD LADY." AND YOU SAY, "OH, REALLY?" INTIMIDATION IS A VERY GOOD DEFENSE MECHANISM.
DR. SALGO: WELL, THEY KEEP HER IN THE HOSPITAL, BY THE WAY, OVERNIGHT TO BE SURE THAT EVERYTHING IS OK; THE LACERATION ISN'T GOING TO BLEED AGAIN. SHE GOES HOME AND THEY DON'T HEAR ANY MORE FROM HER FOR TWO YEARS. SHE JUST DROPS OUT OF SIGHT, DROPS OUT OF THE SYSTEM. BUT TWO YEARS LATER A NEIGHBOR WALKING PAST HER HOUSE SEES A PILE OF MAIL AND THIS RAISES THE NEIGHBOR'S SUSPICIONS, WHICH I GUESS THE NEIGHBOR, LIKE ANY OTHER NEIGHBOR, DOESN'T WANT TO INTRUDE. BUT THIS NEIGHBOR LIKES LOUISE, KNOWS HER HABITS AND CALLS THE POLICE. THE POLICE BREAK INTO THE HOUSE AND THEY FIND THAT LOUISE HAS COLLAPSED. SHE'S TAKEN TO THE HOSPITAL AND SHE NEEDS SURGERY FOR A FRACTURED HIP. SO NOW, POST-OPERATIVELY, SHE'S CONFUSED.
DR. HALL: WELL IF THE CUT ON THE HEAD TWO YEARS AGO IS KIND OF AN EARLY WARNING SIGN THE FACT THAT SHE'S LIVING ALONE, HAS A HIP FRACTURE, NO ONE IS PAYING ATTENTION TO HER. THAT'S KIND OF A CLINCHER THAT WE NEED TO TAKE A MUCH BROADER LOOK AT HER OVERALL MEDICAL CONDITION. THE MEDICAL TERM THAT IS OFTEN USED FOR THIS SITUATION OF CONFUSION IS DELIRIUM. WE TALK ABOUT THE 3 D'S OF DELIRIUM, DEMENTIA AND DEPRESSION. SO, I THINK, THAT'S WHERE I'M STARTING TO THINK NOW, THAT SOMEWHERE IN THAT CONSTELLATION OF FINDINGS THAT WERE GOING TO FIND KIND OF A HOME FOR LOUISE.
DR. SALGO: WELL LET ME TELL YOU WHAT HAPPENS, BECAUSE THE NEXT STATE NOW WE'RE 48 HOURS AFTER HER SURGERY. LOUISE SEEMS TO WAKE UP. SHE'S ALERT, SHE'S ORIENTED, SHE RESPONDS TO QUESTIONS JUST FINE. HER DOCTORS TELL HER THAT BECAUSE OF HER HIP SURGERY, SHE IS GOING TO HAVE TO GO TO REHAB AND SHE THINKS THAT IS A GREAT IDEA AND SHE AGREES TO GO TO A SKILLED NURSING FACILITY AND EVERYTHING AGAIN SEEMS TO BE BACK ON TRACK, BUT NOW THE FAMILY SURFACES BECAUSE OF MONEY. IT'S OFTEN HOW THE FAMILY SURFACES, BECAUSE OF MONEY. LOUISE IT SEEMS HAD STARTED WRITING CHECKS, ODD CHECKS. SHE WROTE A CHECK FOR $100,000 MADE OUT TO THE BANK CLERK. THIS RED FLAG GOES UP ABOUT THE CHECKS AND NOW THEY CALL FOR NEURO-PSYCHIATRIC EVALUATION. THAT'S YOUR SPECIALTY SO WHY DON'T YOU TELL US WHAT'S GOING TO HAPPEN NEXT.
DR. WONG: A NEURO-PSYCHOLOGICAL EVALUATION; WELL ESSENTIALLY WHAT A NEURO PSYCHOLOGIST DOES IS TRIES TO RELATE TO THINKING VERSUS RELATE TO BRAIN FUNCTION.
DR. SALGO: THAT SOUNDS VERY COMPLICATED.
DR. WONG: IT'S REALLY A SERIES OF PAPER AND PENCIL TYPE TESTS, QUESTIONS THAT WE ASK AND THESE ARE TESTS THAT ARE GIVEN TO HUNDREDS OF THOUSANDS OF PEOPLE AND THERE ARE STATISTICAL PROPERTIES THAT ARE KNOWN ABOUT HOW PEOPLE PERFORM ON THESE TESTS WHAT'S NORMAL, WHAT'S THE NORMAL SCORE, WHAT'S THE NORMAL RANGE OF SCORES, WHICH YOU SHOULD FALL INTO FOR GIVEN RANGE OF AGE AND BACKGROUND.
DR. SALGO: I CAN GO FORWARD AND LET YOU KNOW WHAT THE DIAGNOSIS WAS. SHE'S BEEN DIAGNOSED WITH DEMENTIA. SPECIFICALLY THAT WORD, DEMENTIA, NOTHING ELSE. SO WHY DON'T WE START WITH THE DEFINITION. WHAT DOES DEMENTIA MEAN? ELISSA, WHAT DOES IT MEAN TO YOU IF YOU HEAR THE WORD "DEMENTIA"?
ORLANDO: WELL, WHEN I HEAR DEMENTIA, I IMMEDIATELY HEAR "ALZHEIMER'S" IN MY HEAD. SO I THINK THOSE TWO THINGS GO HAND IN HAND.
RUPPERT: I HAVE TO DISAGREE. I DON'T THINK DEMENTIA AND ALZHEIMER'S IS THE SAME THING. THERE'S LOTS OF KINDS OF DEMENTIAS. YOU KNOW, MANY, MANY OTHER KINDS, SOME OF WHICH WITH GOOD IDENTIFICATION AND TREATMENT, CAN BE CORRECTED.
DR. WONG: I THINK JIM IS ABSOLUTELY CORRECT. THERE ARE A LOT OF DIFFERENT KINDS OF DEMENTIA. ALZHEIMER'S IS ONLY ONE OF THEM. IT IS TRUE WHEN PEOPLE HEAR DEMENTIA, THAT'S WHAT THEY THINK OF AUTOMATICALLY. THAT'S WHY IT'S VERY IMPORTANT TO BE SPECIFIC, BECAUSE TO HAVE THE DIAGNOSIS OF ALZHEIMER'S IS VERY DEVASTATING. IT'S A VERY DEADLY DIAGNOSIS AND THERE ARE A LOT OF OTHER REASONS WHY PEOPLE MIGHT HAVE MENTAL DECLINE, WHICH MIGHT BE CALLED A DEMENTIA. IT'S A VERY GENERIC, A VERY GENERAL TERM.
DR. SALGO: WELL THEY DON'T MAKE IT; THEY DON'T CALL LOUISE ALZHEIMER'S. THEY SAY THAT SHE HAS DEMENTIA.
DR. TARIOT: THAT'S NOT A DIAGNOSIS. THAT'S A DESCRIPTIVE TERM LIKE A FEVER. IT DOESN'T TELL YOU WHY SOMEONE HAS IT.
ORLANDO: WHAT'S IT DESCRIBING?
DR. TARIOT: IT'S DESCRIBING BRAIN FAILURE: THE LOSS OF INTELLECTUAL FUNCTION, THE LOSS OF THE ABILITY TO TAKE CARE OF YOURSELF ON A DAILY BASIS, AND FREQUENTLY THE GRADUAL EROSION OF PERSONALITY.
ORLANDO: TO ME, WHAT YOU SAID PIERRE, IT JUST SOUNDS LIKE THINGS THAT HAPPEN NATURALLY AS WE GET OLDER.
DR. TARIOT: WHAT HAPPENS WITH AGE THAT WE WOULDN'T CONSIDER WORRISOME WOULD BE MILD LOSS OF MEMORY FOR WORDS AND NAMES, MILD DECREASE IN PROCESSING SPEED, AND SOME DIFFICULTY FOCUSING ATTENTION WHEN THERE'S A LOT GOING ON IN THE ENVIRONMENT. THAT'S OKAY. BUT IF IT GOES BEYOND THAT AND IT'S DETERIORATING OVER TIME, WE WORRY.
DR. PAPA: THAT'S WHY FAMILY IS VERY HELPFUL AND OCCASIONALLY THE PATIENT- THE THING THAT ALWAYS WORRIES ME IS WHEN THE PATIENTS COMES IN AND SAYS, "SOMETHING'S WRONG".
RUPPERT: YOU ALSO WANT FAMILY HISTORY.
DR. SALGO: OK
RUPPERT: BECAUSE THIS MAY NOT BE THE FIRST PROBLEM THAT SOMEBODY IN THAT FAMILY'S HAVING LIKE THAT.
DR. SALGO: I DON'T THINK OUR VIEWERS KNOW THIS, AND WE HAVEN'T REALLY MENTIONED THIS UNTIL NOW, BUT I THINK THIS IS THE APPROPRIATE TIME. YOU WERE DIAGNOSED WITH ALZHEIMER'S.
RUPPERT: YES.
DR. SALGO: AND YOU'RE SITTING HERE TALKING TO US TODAY KNOWING YOUR DIAGNOSIS.
RUPPERT: AND I'M NOT THE FACE OF ALZHEIMER'S.
DR. SALGO: AND YOU'RE NOT THE FACE OF ALZHEIMER'S THAT MOST PEOPLE SEE. WHAT WAS IT LIKE SITTING ON THE OTHER SIDE OF THE DESK NOW HEARING SOMEONE TELL YOU, "YOU'VE GOT ALZHEIMER'S"?
RUPPERT: A RELIEF AND ALSO DEVASTATING.
DR. SALGO: WHY WAS IT A RELIEF?
RUPPERT: I HAD STRUGGLED FOR ABOUT 10, 12 YEARS NOTICING SUBTLE CHANGES. MY WIFE WAS NOTING THEM, RECORDING THEM AND NOT TELLING ME. I WAS MENTALLY RECORDING THEM AND NOT TELLING HER-
DR. SALGO: OK
RUPPERT: -FOR A NUMBER OF YEARS AND FINALLY WE DID DISCUSS WHAT WE WERE WORRIED ABOUT, WHICH OBVIOUSLY BROUGHT US TO THE CLINIC TO GET THE DIAGNOSIS. SO IT WAS A RELIEF TO KNOW WHAT WAS GOING ON. I HAVE A TREMENDOUS FAMILY HISTORY OF IT IN TERMS OF THE GENETICS. IT'S NOT GOOD.
DR. SALGO: BUT IT COULDN'T HAVE BEEN A PLEASANT MOMENT.
RUPPERT: NO, IT CERTAINLY WAS NOT A PLEASANT MOMENT, IT BASICALLY THE DEVASTATING PART OF IT WAS OUR RETIREMENT YEARS THAT WE'RE ENTERING NOW ARE GOING TO BE VERY DIFFERENT THAN WE HAD ENVISIONED THAT THEY WOULD BE. SO WE'VE CONDENSED THOSE RETIREMENT YEARS IN THE LAST COUPLE YEARS SINCE THE DIAGNOSIS AND ARE REALLY ENJOYING OURSELVES.
DR. SALGO: DID YOU DISCUSS IT WITH YOUR WIFE? WHAT WAS HER RESPONSE WHEN YOU BOTH HEARD- WAS SHE WITH YOU BY THE WAY, WHEN YOU BOTH HEARD?
RUPPERT: OH YES, VERY SUPPORTIVE. SHE'S BEEN GREAT ALL THE WAY ALONG THE LINE.
ORLANDO: THERE MUST BE TIMES WHEN YOU FEEL ALONE. HOW FAR DOES SUPPORT GO FOR FAMILIES?
RUPPERT: WELL, THERE'S A DIVIDE THAT'S DIFFICULT TO BREACH, BETWEEN THE FAMILY AND FRIENDS AND THE PERSON WITH DEMENTIA. THERE'S ONLY SO FAR YOU CAN GO. AND SO IT'S A MATTER OF A DANCE YOU DO BETWEEN EACH OTHER. MY WIFE, VICKY, WOULD ASK QUESTIONS ABOUT ME: "CAN YOU DO THIS? CAN YOU NOT?" I EXPLAIN THE BEST I CAN AS TO MAKING EXAMPLES OF THINGS BEFORE THE DEMENTIA THAT I CAN MAKE AN ANALOGY TO, SO SHE CAN RELATE TO. SO IT'S REALLY GRASPING THE WHOLE TIME, LOOKING FOR, SEARCHING THE WHOLE TIME FOR WORDS TO KIND OF EXPLAIN WHAT THE EXPERIENCE FOR ME IS AND I THINK THAT'S TRUE FOR OTHER PEOPLE WITH DEMENTIA.
DR. SALGO: YOU SAID THAT YOU SENSED SOMETHING WAS WRONG FOR QUITE SOME TIME.
RUPPERT: I SURE DID.
DR. SALGO: WHAT WAS THAT SENSE LIKE? WHAT WAS WRONG?
RUPPERT: AGAIN, MY FAMILY HISTORY. MY GRANDMOTHER, MY FATHER, HIS BROTHER AND MY MOTHER HAD ALZHEIMER'S, SO THAT OBVIOUSLY WAS RIGHT IN THE FOREFRONT OF MY MIND. BUT THINGS SUCH AS HAVING MORE DIFFICULTY WRITING REPORTS. I WORKED AS A PSYCHOLOGIST AND FAMILY THERAPIST. REMEMBERING NAMES, AS A FAMILY THERAPIST, I WAS BEGINNING TO HAVE TROUBLE REMEMBERING THE NAMES OF PEOPLE THAT I WAS JUST INTRODUCED TO. THAT'S A NO-NO IF YOU'RE DOING FAMILY THERAPY. SO I HAD TO VIDEOTAPE SESSIONS SO I COULD LOOK AT THE SESSION AFTERWARD AND MAKE SURE I REMEMBERED WHAT WE TALKED ABOUT.
DR. SALGO: HAVE YOU NOTICED A PROGRESSION SINCE THE DIAGNOSIS WAS MADE?
RUPPERT: YES, IT'S PROGRESSED QUITE A BIT.
DR. SALGO: WHAT'S BEEN GOING ON?
RUPPERT: CURRENTLY, I'M PROBABLY GOING TO BE GIVING UP DRIVING THIS FALL- I'D LIKE TO GET THROUGH THE SUMMER. MY AGREEMENT WITH MY WIFE IS THAT, I TOLD HER THAT IF I HAVE ANY CONCERNS, I WILL GIVE IT UP. EVEN IF I DON'T HAVE ANY CONCERNS AND SHE TELLS ME TO GIVE IT UP, I WILL, BECAUSE I DON'T WANT TO PUT ANYBODY ELSE IN DANGER. AND THAT'S A WHOLE OTHER ETHICAL ISSUE WITH PEOPLE WITH ALZHEIMER'S: DRIVING OR NOT. THAT'S ONE OF THE SIGNS I HAVE, MENTAL FATIGUE. SOMETIMES I'LL HAVE TO TAKE A NAP OR TWO A DAY. WITHOUT THAT IT'S LIKE I'VE BEEN UP ALL NIGHT STUDYING FOR AN EXAM IN COLLEGE OR GRADUATE SCHOOL OR MEDICAL SCHOOL LIKE I KNOW YOU ALL HAVE. THAT'S KIND OF HOW YOUR BRAIN IS FUNCTIONING.
DR. SALGO: NOW YOU'RE ONLY 57. I GUESS WHEN YOU FIRST SAID THAT YOU'RE NOT THE FACE OF ALZHEIMER'S, THAT'S ONE OF THE THINGS YOU PROBABLY MEANT. YOU'RE QUITE YOUNG.
RUPPERT: YES.
DR. SALGO: WHEN MY GRANDMOTHER WAS IN HER LATER YEARS, SHE BEGAN TO FORGET THINGS. SHE SAID TO ME THAT SHE WAS TERRIFIED THAT SOME OF WHAT SHE COUNTED ON IN HER LIFE WAS SLIPPING AWAY. IS THERE TERROR HERE FOR YOU?
RUPPERT: EXACTLY THE WORD I USE. ABSOLUTELY. WE SPEND OUR WHOLE LIVES, ALL OF US, NOT ONLY LEARNING IN SCHOOL OR PURSUING ADVANCED DEGREE IS IN THE CASE OF MY OTHER PANELISTS HERE, BUT ALSO BEING GOOD AT WHAT YOU DO AT WORK, BEING A GREAT MOTHER OR FATHER, LEARNING HOW TO FILL OUT YOUR INCOME TAX . ALL OF THOSE THINGS THAT YOU LEARNED TO DO OVER A LIFETIME ALL OF A SUDDEN START TO BE TAKEN AWAY, THAT YOU FOUGHT SO HARD TO GET AND NOW WHEN YOU'RE IN A TIME OF YOUR LIFE WHEN YOU WANT TO ENJOY THEM, YOU START LOSING THEM ONE BY ONE BY ONE. AND THEN FIND YOURSELF IN A DEPENDENT POSITION WHEN UP UNTIL NOW, YOU'VE BEEN THE PERSON THAT'S BEEN TAKING CARE OF PEOPLE.
DR. SALGO: I'LL TELL YOU, ONE OTHER THING THAT SURPRISES ME ABOUT YOU IS THAT YOU HAVEN'T LOST YOUR SENSE OF HUMOR. YOU'RE A FUNNY GUY.
RUPPERT: MY WIFE AND I TELL ALZHEIMER'S JOKES ALL THE TIME.
ORLANDO: YOU DO?
RUPPERT: I'VE KIDDED MY WIFE AND DR. TARIOT I KNOW HAS HEARD THIS ONE, BUT OCCASIONALLY SHE OR ONE OF MY FRIENDS WILL HAVE TROUBLE REMEMBERING SOMETHING AND I'LL SAY, "AND THEY THINK ALZHEIMER'S ISN'T CONTAGIOUS."
(LAUGHTER)
DR. SALGO: IS THIS THE TYPICAL ALZHEIMER'S PATIENT WE'RE TALKING TO, JUST THE PERFECT EXAMPLE OF ALZHEIMER'S? WHAT ARE THE OTHER SIGNS AND SYMPTOMS OF ALZHEIMER'S, CLINICALLY?
DR. HALL: THERE ARE MANY. WE'RE TALKING HERE ABOUT MEMORY AS OPPOSED TO NECESSARILY EXECUTION. SOME PEOPLE WILL PRESENT WITH PROBLEMS WITH CALCULATION, WITH JUDGMENT. IT'S ONE THING TO FORGET YOUR CAR KEYS, QUITE ANOTHER TO FIND THEM IN THE FREEZER FOR EXAMPLE. BUT REALLY IT'S ORDERS OF MAGNITUDE THAT ARE REALLY DIFFERENT. BUT THE THING THAT I THINK MOST OF THE PEOPLE IN THE UNITED STATES FOCUS ON IS MEMORY AND THE TREMENDOUS FEAR AND ALMOST SHAME THAT SOMETIMES GOES ALONG WITH IT. IF YOU, JIM, FOR INSTANCE HAD SURVIVED A TRIPLE, QUADRUPLE BYPASS, YOU WOULD BARE YOUR CHEST AND SAY, "LOOK AT THIS, I'VE GOT THIS BADGE OF COURAGE." BUT WHEN IT COMES TO ANTHINING TO DO WITH MENTAL FUNCTION, IT'S KIND OF TABOO, BECAUSE I THINK THIS IS WHERE THE PROBLEM OF DEVELOPING A SUPPORT SYSTEM OF GETTING A FAMILY OR LARGER PART OF SOCIETY INVOLVED IS SO DIFFICULT.
RUPPERT: I THINK IT'S SO CRITICAL, THAT IS A DISEASE THAT, EXCUSE MY LANGUAGE, SCARES THE HELL OUT OF PEOPLE.
DR. SALGO: WHAT ABOUT THE DISTINCTION THAT WE HAVE TO MAKE? WE ALWAYS SAY THAT PEOPLE WHEN THEY GET OLD, THEY GET SENILE. HOW DO YOU MAKE THE DISTINCTION BETWEEN ALZHEIMER'S DISEASE AND NORMAL AGING?
DR. TARIOT: DEMENTIA IS THIS DESCRIPTIVE TERM FOR THE LOSS OF BRAIN FUNCTION, LOSS OF INTELLECTUAL FUNCTION, LOSS OF ABILITY TO FUNCTIONS ON A DAILY BASIS AND USUALLY EVENTUALLY CHANGE IN TEMPERAMENT OR PERSONALITY. AND IN TERMS OF THE INTELLECTUAL FUNCTIONS, WE ASSESS IT AS MEMORY, LANGUAGE, ATTENTION, KNOWING WHERE YOU ARE IN SPACE AND TIME, THE EYES AND THE BRAIN TALKING TO EACH OTHER PROPERLY. THOSE ARE THE THINGS WE'RE ASSESSING AND IN TERMS OF DAILY FUNCTIONING, HANDLING THE BILLS, DRIVING, YOU KNOW EARLY ON ARE THE THINGS THAT CAN CHANGE AND LATER ON IT'S SIMPLER THINGS LIKE USING APPLIANCES, HANDLING THE TELEPHONE, EVEN THINGS LIKE DRESSING.
DR. SALGO: SO HOW MANY PEOPLE OUT THERE HAVE ALZHEIMER'S? HOW BIG A PROBLEM IS THIS? PUT THIS IN CONTEXT HERE.
DR. TARIOT: RIGHT NOW IN THE UNITED STATES, THE BEST ESTIMATE IS ABOUT FOUR AND A HALF MILLION AMERICANS.
DR. SALGO: FOUR AND A HALF MILLION PEOPLE HAVE THIS DISEASE. THIS IS AN EPIDEMIC, THIS IS HUGE!
DR. TARIOT: ACTUALLY, THE WORLD HEALTH ORGANIZATION CALLS THIS THE "PANDEMIC OF THE WEST" BECAUSE WE ARE, IT'S AN AGE-RELATED ILLNESS USUALLY, AND WE'RE AGING SUCCESSFULLY. SO AS SOCIETY AGES, THE RISK GOES WAY UP.
DR. SALGO: SO HERE'S SOMETHING OUR VIEWERS REALLY NEED TO KNOW THEN: THAT EXTREME MEMORY LOSS, EXTREME FORGETFULNESS, IS NOT A NATURAL CONSEQUENCE OF AGING. PEOPLE DON'T DO THIS AS THEY GROW OLDER, YOU DON'T FIND YOUR CAR KEYS IN THE FREEZER AS A NORMAL CONSEQUENCE OF GETTING OLDER. THIS IS IN FACT A PATHOLOGY AND YOU DON'T JUST SAY, "GRANDMA IS GETTING OLD, SHE'S GETTING SENILE." SOMETHING ELSE IS GOING ON. SO LET US TAKE OUR CASE WITH LOUISE A LITTLE BIT FARTHER BECAUSE I HAVE SOME MORE INFORMATION FOR YOU. FIRST OF ALL, I WANT TO ASK THIS LITTLE QUESTION AGAIN: SHOULD THAT FIRST FALL HAVE TRIGGERED AN EVALUATION OR WAS IT OK TO LET HER RIDE FOR TWO YEARS?
DR. HALL: ABSOLUTELY IT SHOULD OF TRIGGERED AND EVALUATION.
DR. TARIOT: SURE WE'VE TALKED ABOUT HER. PETER IS TRYING TO PAINT US INTO A CORNER, I THINK.
DR. SALGO: WELL, I'M TRYING!
DR. TARIOT: WE'VE TALKED ABOUT DEMENTIA AS A SYNDROME. ALZHEIMER'S DISEASE IS THE MOST COMMON FORM OF DEMENTIA. THERE ARE OTHERS. JIM'S MADE THAT POINT AS WELL, AND SO HAVE WE REALLY TURNED OVER ALL THE STONES AND CONSIDERED ALL THE OTHER POSSIBILITIES? AND SOMEBODY WHO FALLS, FOR INSTANCE, IS VULNERABLE TO BLEEDING BETWEEN THE SKULL AND THE BRAIN, SOMETHING CALLED SUBDERMAL HEMATOMA, WHICH CAN MAKE YOUR BRAIN NOT FUNCTION PROPERLY, AND SO THAT WOULD BE AN EXAMPLE OF SOMETHING ELSE TO WORRY ABOUT.
DR. SALGO: LET'S SAY IT'S TWO YEARS BEFORE. IF THEY HAD PICKED UP ON IT, WHAT COULD HAVE BEEN DONE WITH LOUISE'S DEMENTIA THEN, IF WE'RE ASSUMING SHE WAS DEMENTED, THAT MIGHT OF SLOWED IT OR STOPPED IT? COULD ANYTHING OF BEEN DONE? DOES IT MAKE SENSE?
DR. PAPA: FROM THE PRIMARY CARE PHYSICIAN'S POINT OF VIEW, THERE ARE SOME SIMPLE TESTS YOU CAN DO IN THE OFFICE THAT ARE RELATIVELY QUICK AND CAN KIND OF GIVE YOU AN IDEA IF THERE'S PROBLEM.
DR. WONG: I DON'T LIKE TO USE THE TERM "DEMENTIA", OR EVEN MORE SPECIFIC TERMS, TOO EARLY, BECAUSE THAT'S A VERY WEIGHTY DIAGNOSIS. I WANT TO BE VERY CAREFUL. I LIKE TO TALK TO THE PATIENT AND FAMILY ABOUT WHAT'S HAPPENED. LET'S TALK ABOUT SPECIFIC SYMPTOMS. LET'S TALK ABOUT SOME OF THE REASONS- WHAT MIGHT BE CAUSING THOSE SYMPTOMS? LET'S TALK ABOUT HOW WE'RE GOING TO APPROACH IT.
RUPPERT: THIS IS AN ELDERLY WOMAN THAT'S AT RISK.
DR. SALGO: AT RISK FOR WHAT?
RUPPERT: WELL, THIS IS NOT HER FIRST HOSPITALIZATION.
DR. SALGO: OK.
RUPPERT: AND SHE'S NOT EXACTLY FUNCTIONING REAL WELL DURING THE INTERVIEWS, SO SOMEBODY HER AGE WITH JUST ANOTHER RECENT FALL IS, I THINK, COMES CLOSE TO, IF NOT REACHING THE CRITERIA FOR SOCIAL SERVICES TO GET INVOLVED AND CHECK WHAT'S GOING ON.
(AGREEMENT AMONG GROUP)
DR. SALGO: SOCIAL SERVICES, THEY MIGHT HELP HER COPE. BUT I THINK- ELISSA, CORRECT ME IF I'M WRONG -MOST PEOPLE IN THE COMMUNITY DON'T WANT TO COPE, THEY WANT A CURE, THEY WANT TO REVERSE IT, THEY WANT TO GET BETTER.
ORLANDO: I'M SURPRISED TO EVEN HEAR THE WORLD "REVERSIBLE" WITH THIS, BECAUSE WHEN I THINK "DEMENTIA" I THINK "FINAL".
DR. PAPA: THERE ARE REVERSIBLE CAUSES, BUT THEY'RE FEW AND FAR BETWEEN. I REALLY HAVEN'T SEEN ANYTHING- THEY NEED T BE LOOKED AT BECAUSE YOU NEED TO LOOK FOR THEM AND YOU CAN REVERSE IT. BUT FOR MOST INSTANCES, IT'S GOING TO BE A SITUATION WHERE IT'S RELATED TO-
DR. SALGO: BUT JIM KEEPS HEARING THESE STORIES ABOUT NEW MEDICATIONS. IS ANYTHING OUT THERE THAT'S GOING TO REVERSE THIS OR SLOW IT DOWN? PIERRE?
DR. TARIOT: ABSOLUTELY.
ORLANDO: WHAT IS IT?
DR. TARIOT: AT THE RISK OF REPEATING MYSELF, YOU PATIENTLY GO THROUGH ALL THE POSSIBLE CAUSES OF THIS SYNDROME. SOME OF THEM ARE COMPLETELY OR PARTIALLY REVERSIBLE AND CAN BUY YOU TIME. IF IT'S PROBABLY ALZHEIMER'S DISEASE, AND ACTUALLY YOU'RE NOT 100 % SURE WITHOUT BRAIN TISSUE TO LOOK AT, THERE'S A LOT TO DO. YOU HELP INSURE SAFETY, YOU HELP INSURE TRANSPORTATION CAN BE TAKEN CARE OF, LEGAL AND FINANCIAL AFFAIRS, NUTRITION, SOCIAL STIMULATION, PHYSICAL STIMULATION. THESE THINGS REALLY MATTER.
DR. SALGO: DO BRAIN EXERCISES HELP?
DR. TARIOT: ABSOLUTELY. THEY CAN HELP YOU IF YOU HAVE THE DISEASE ALREADY, THEY CAN HELP YOU PREVENT IT. BRAIN HYGIENE GOES A LONG WAY.
DR. SALGO: JIM, ARE YOU ON MEDICATIONS NOW FOR THIS?
RUPPERT: YES I AM.
DR. SALGO: AND WHAT DO YOU TAKE?
RUPPERT: I'M TAKING ARICEPT AND I'M TAKING A MEDICATION INITIALLY DEVELOPED IN GERMANY, I BELIEVE CALLED MEMANTINE AND IT'S BEEN APPROVED IN THE UNITED STATES. IS THAT THE CORRECT NAME FOR IT?
(YES)
ORLANDO: WHAT DO THEY DO?
DR. SALGO: WHAT DO THE MEDICATIONS DO AND ARE THEY REALLY GOING TO HELP HIM?
DR. TARIOT: IF YOU HAVE THE ILLNESS ALREADY AND IN ADDITION TO THESE OTHER THINGS THAT I MENTIONED, WHICH REALLY MATTER- WE DON'T TALK ABOUT MEDICATIONS WITHOUT TALKING ABOUT THOSE THINGS -THEN WE ALWAYS DISCUSS THE IMPORTANCE OF ANTI-OXIDANTS, VITAMINS LIKE VITAMIN E, AND WE TALK ABOUT THESE MEDICINES CALLED CHOLINESTERASE INHIBITORS, WHICH CAN IMPROVE THINKING AND FUNCTION OR AT LEAST STABILIZE IT FOR A PERIOD OF MANY MONTHS, AND IN SOME CASES MORE. AND THERE'S THIS NEWER MEDICINE CALLED MEMANTINE, WHICH HAS BEEN STUDIED PRIMARILY IN FOLKS WITH ADVANCED ILLNESS.
DR. SALGO: JIM, CAN YOU TELL IF IT'S WORKING?
RUPPERT: MY WIFE AND I NOTICED CHANGES IN ME IN 1993, SO I SHOULD BE MUCH FURTHER ALONG IN THE DISEASE PROCESS THAN I AM, THE WAY I'M LOOKING AT IT. SO WHETHER IT'S THE MEDICATIONS, OR IF I'VE BEEN VERY LUCKY, AND I THINK PARTLY, OUR LIFESTYLE, WE'VE BEEN PRETTY PHYSICALLY ACTIVE AND SOCIALLY ACTIVE AND OPEN ABOUT THE DISEASE HELPS YOUR BRAIN THE WORST THING YOU CAN DO IS TO RETREAT.
DR. SALGO: SO I GUESS ANOTHER IMPORTANT POINT THAT WE NEED TO MAKE OVER HERE-IS THAT THE DIAGNOSIS IS IMPORTANT BECAUSE THERE ARE THINGS THAT YOU CAN DO. THERE ARE MEDICATIONS, THERE ARE LIFESTYLE CHANGES AND THERE'S PLANNING THAT YOU CAN DO TO HELP YOU SLOW THE PROGRESSION OF THE DISEASE AND HELP YOU DEAL WITH THE DISEASE AS IT PROGRESSES. AND THAT'S A VERY IMPORTANT POINT. THIS ISN'T OVER YET. SHE STAYS IN THE NURSING HOME FOR A WHILE AND WHAT THE FAMILY DECIDES TO DO, IS TO SELL THAT HOUSE. LOUISE LOVED THAT HOUSE. AND ONE OF HER PASSIONS WAS GARDENING. SHE'S BEEN DESCRIBED AS BEING IN THAT GARDEN EVERY DAY ON HER HANDS AND KNEES PLANTING THINGS, WORKING THE EARTH. AND WHEN THEY EXAMINE THIS HOUSE PRIOR TO SALE THEY FIND THAT THE PAINT IS OLD, IT'S LEAD-BASED PAINT AND IN THE EARTH WHERE SHE'S BEEN WORKING EVERY DAY FOR DECADES, THE LEVELS OF LEAD ARE EXTRAORDINARILY HIGH. SO THEY GO BACK, AND USING THIS AS A GUIDE, AND TEST LOUISE FOR LEAD. AND WHAT THEY FIND IS THAT LOUISE HAD VERY HIGH LEAD LEVELS IN HER BODY.
ORLANDO: IN OTHER WORDS IT COULD'VE BEEN PART OF THE CAUSE OF DEMENTIA IS THAT WHAT YOU'RE SAYING?
DR. TARIOT: DEMENTIA CAN BE CAUSED BY MANY THINGS.
DR. SALGO: WHAT'S ON YOUR LAUNDRY LIST OF OTHER THINGS?
DR. TARIOT: TRAUMA, TUMOR, INFECTION, TOXIC, STRUCTURAL OR DEGENERATIVE, METABOLIC- MEANING BLOOD CHEMISTRY AND SUGARS AND THINGS OUT OF WHACK. ABOUT 1% OF US AT AGE 60, NEARLY 40% OR 50% OF US BY AGE 85, WILL HAVE SOME FORM OF DEMENTIA. SO LOOK TO YOUR LEFT, LOOK TO YOUR RIGHT. ONE OF THOSE TWO PEOPLE, IF THEY LIVE LONG ENOUGH.
DR. SALGO: THERE ARE SOME HABITS AND LIFESTYLE THINGS THAT CAN LEAD TO IT AS WELL.
DR. TARIOT: ABSOLUTELY. YOU CAN RAISE YOUR RISK- LET'S DO IT POSITIVELY -YOU CAN DECREASE YOUR RISK WITH DIET INCLUDING ANTI-OXIDANTS, FRUITS AND VEGETABLES, MORE FISH, LESS MEAT, THE RIGHT KIND OF OILS- OLIVE OIL, FOR INSTANCE -PHYSICAL EXERCISE, DON'T SMOKE, DON'T GET DIABETES, KEEP YOUR BLOOD PRESSURE AND CHOLESTEROL UNDER CONTROL-
ORLANDO: REGULAR HEALTH STUFF!
DR. TARIOT: SOME ALCOHOL IS OK, PARTICULARLY IF IT'S WINE, IT APPEARS. SO REALLY A HEART-HEALTHY DIET TURNS OUT TO BE GOOD FOR YOUR BRAIN.
DR. SALGO: I THINK THIS IS AN IMPORTANT THING TO REALLY EMPHASIS HERE BECAUSE DEMENTIA IS NOT ALL THE SAME AND THERE ARE SOME THINGS THAT YOU CAN DO WHICH CAN MAKE DEMENTIA LESS LIKELY, WHETHER IT'S CHECK YOUR HOUSE FOR LEAD PAINT, WHETHER IT'S BE SURE YOU'RE TAKING FOLATE FOR EXAMPLE, STOP SMOKING, STOP DRINKING TOO HEAVILY. THERE'S A WHOLE LIST OF THESE THINGS. YOU PROBABLY SHOULD BE TALKING TO YOUR DOCTOR ABOUT IT NOW, NOT 20 OR 30 YEARS FROM NOW WHEN THE DAMAGE IS DONE, FOR EXAMPLE, BY LEAD, IS IRREVERSIBLE. JIM, DO YOU HAVE ANYTHING ELSE TO SHARE WITH US ABOUT THIS? I MEAN, YOU'RE THE ONE WHO'S GOING FORWARD HERE WITH THIS DISEASE. WHAT'S YOUR ADVICE FOR PEOPLE WHO ARE WATCHING US TODAY?
RUPPERT: TO NOT HIDE YOUR DIAGNOSIS FROM PEOPLE, TO FIND OUT AS MUCH AS YOU CAN ABOUT IT. GET DIAGNOSED AS SOON AS POSSIBLE AND TO GO ON WITH YOUR LIFE. IT'S THE OLD EXPRESSION THAT I'M SURE EVERYBODY'S HEARD: "YOU'RE EITHER BUSY DYING OR BUSY LIVING." I CHOOSE THE LATTER. AND IF YOU'RE FOCUSED ON STAYING PHYSICALLY ACTIVE AND SOCIALLY ACTIVE, IT'S BETTER FOR YOUR BRAIN AND YOU'RE NOT GOING TO BE DEPRESSED, WHICH IS NOT GOOD FOR THE BRAIN EITHER. SO GET ON WITH YOUR LIFE. DON'T GIVE THE DISEASE ANY MORE CONTROL THAN IT HAS.
DR. SALGO: I HEAR YOU SAYING THAT THERE IS LIFE AFTER THE DIAGNOSIS.
RUPPERT: THERE SURE IS.
DR. SALGO: THAT YOU'VE GOT AN EXTENDED PERIOD OF TIME THAT YOU CAN LIVE A FRUITFUL, MEANINGFUL EXISTENCE.
RUPPERT: ABSOLUTELY.
DR. SALGO: I'M SURE I CAN SPEAK FOR ALL OF US HERE: WE'RE JUST DELIGHTED YOU CAME.
RUPPERT: THANK YOU.
DR. SALGO: AND THANK YOU SO MUCH FOR BEING HERE. AND I WANT TO THANK ALL OF YOU AS WELL. WE ARE UNFORTUNATELY OUT OF TIME FOR TODAY. WE COVERED A LOT OF GROUND IN THE LAST HALF HOUR. I THINK IT'S TIME TO SUMMARIZE A BIT OF WHAT YOU NEED TO REMEMBER. FIRST OF ALL, MEMORY LOSS AND CONFUSION ARE NOT A NATURAL PART OF GETTING OLDER. THE PROGRESSION O DEMENTIA MAY BE SLOWED DOWN BY INTERVENTION, SO MAKING THE DIAGNOSIS IS IMPORTANT AND THERE ARE REVERSIBLE CAUSES OF DEMENTIA, SO ONCE AGAIN, IT'S IMPORTANT TO TALK TO YOUR DOCTOR ABOUT IT. AGAIN, THANK YOU ALL OF YOU, ESPECIALLY YOU FOR JOINING US TODAY. REMEMBER, TAKING CHARGE OF YOUR HEALTH MEANS BEING INFORMED AND HAVING QUALITY COMMUNICATION WITH YOUR DOCTOR. I'M DR PETER SALGO, AND I'LL SEE YOU NEXT TIME FOR ANOTHER SECOND OPINION.
SEARCH FOR HEALTH INFORMATION AND LEARN MORE ABOUT DOCTOR/PATIENT COMMUNICATION ON THE SECOND OPINION WEB SITE. THE ADDRESS IS PBS.ORG.
MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION. THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING. THE JOSIAH MACY JR. FOUNDATION AND THE PARK FOUNDATION.
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