AN OLD TAG LINE FOR THE AMERICAN EXPRESS CARD WAS "DO YOU KNOW ME? "

THE QUESTION THAT SOME PATIENTS WITH ALZHEIMER'S DISEASE MAY BE ASKING IS, DO I KNOW YOU?

PLEASE STAY WITH US AS WE TALK ABOUT DEMENTIA AND ALZHEIMER'S DISEASE WITH NEUROLOGIST Dr. GREGORY COOPER NEXT ON "KENTUCKY HEALTH."

NET ♪ IN THE POEM FOG, CARL SANDBERG OBSERVED THAT THE FOG COMES IN ON LITTLE CAT FEET AND THAT IT SITS LOOKING OVER THE HARBOR AND CITY ON SILENT HAUNCHES AND THEN MOVES ON.

WHILE THE FOG OF DEMENTIA MAY CREEP IN, UNFORTUNATELY, IT DOES NOT MOVE ON.

PAUL SIMON'S THE SOUND OF SILENCE BEGINS WITH HELLO DARKNESS MY OLD FRIEND, I'VE COME TO TALK WITH YOU AGAIN.

I DOUBT THAT HE WAS REFERRING TO DEMENTIA, BUT STILL, THESE WORDS APTLY DESCRIBE THE ANGUISH FELT BY VISITING FRIENDS AND FAMILY UPON GAZING UPON THE FACE THAT SHOWS NO OBVIOUS SIGNS OF RECOGNITION.

AS WE AGE, OUR RISK FOR DEMENTIA AND ALZHEIMER'S DISEASE IN PARTICULAR INCREASES.

WHILE THE DISEASE MECHANISM CAN BE EXPLAINED, UNFORTUNATELY, OTHER THAN AGE, THERE REMAINS UNCERTAINTY AS TO THE CAUSE.

IN YEARS PAST, THERE WERE NO PROMISING TREATMENTS AND THE ONLY OPTIONS WERE TO MANAGE THE SYMPTOMS AND PROVIDE FOR THE PATIENT AND THE CARING FAMILY MEMBERS.

FORTUNATELY THERE HAVE BEEN SOME SIGNIFICANT ADVANCES IN TREATMENT OF THE DISEASE ITSELF AND NEWER MEDICATIONS SEEM TO BE PROMISING.

TO TALK TO US ABOUT DEMENTIA IN GENERAL AND ALZHEIMER'S DISEASE IN PARTICULAR, WE HAVE AS OUR GUEST TODAY Dr. GREGORY COOPER.

Dr. COOPER RECEIVED HIS M.D.

AND Ph.D.

DEGREE FROM THE UNIVERSITY OF KENTUCKY AND THEN COMPLETED HIS RESIDENCY IN NEUROLOGY FOLLOWED BY FELLOWSHIP IN BEHAVIORAL NEUROLOGY AND COGNITIVE NEURAL SCIENCE AT THE UNIVERSITY OF IOWA AFTER BEING LURED AWAY FROM LEXINGTON, INTRODUCE COOPER IS THE CHIEF OF ADULT NEUROLOGY AND DREGHTOR OF THE MEMORY CENTER IN LOUISVILLE, KENTUCKY.

Dr. COOPER, GREGORY, CAN YOU FOR BEING WITH US TODAY.

>> THANK YOU FOR HAVING ME.

>> HOW MANY NEUROLOGISTS ARE THERE IN THE WORLD RIGHT NOW?

DO WE HAVE ENOUGH OR ARE WE LOW ON NUMBERS?

>> WE ARE LOW ON NUMBERS.

I DON'T KNOW THE NUMBER EXACTLY.

I CAN TELL YOU IN ALMOST EVERY CORNER OF THE UNITED STATES, THERE IS A SHORTAGE.

THERE ARE MANY STATES, KENTUCKY BEING ONE OF THEM, THAT ARE DECLARED A NEUROLOGY DESERT AND THE TRUTH IS, IT'S EVEN WORSE IN OTHER PARTS OF THE WORLD.

SO THERE IS A REAL SHORTAGE.

>> IS IT THAT PEOPLE JUST DON'T WANT TO GO INTO IT RIGHT NOW?

SPOTS AVAILABLE?

>> WE DON'T KNOW EXACTLY ALL OF THE REASONS.

PART OF IT I THINK, IS GETTING THE INTEREST OF PEOPLE GETTING OUT OF THE MEDICAL SCHOOL TO ENTER RESIDENCY.

CERTAIN CERTAINLY THERE ARE SOME PROGRAMS THAT DON'T FILL ALL OF THEIR SPOTS.

WE'VE DONE A LOT OF WORK OVER THE LAST FEW YEARS TO EXPAND THE NUMBER OF TRAINING SPOTS AND TO FILL THOSE SPOTS.

SO I THINK WE ARE GOING TO SEE SOME IMPROVEMENT IN THE FUTURE, BUT THERE IS A LOT OF WORK TO BE DONE.

>> WELL, I DO KNOW THAT WHENEVER WE REALLY WANTED AN ANSWER TO A CLINICAL PROBLEM, ALWAYS SAID CALL A NEUROLOGIST BECAUSE THEY'LL TELL YOU EXACT LIB WHAT-- EXACTLY WHAT IS WRONG WITH THAT PERSON.

SO TO GO INTO THAT, TELL ME, WHEN YOU USE THE TERM WE THROW IT AROUND, DEMENTIA AND THEN WE TALK ABOUT ALZHEIMER'S DISEASE.

ARE THEY THE SAME?

ARE THEY DIFFERENT?

OR JUST DIFFERENT SLICES OF THE SAME THING?

>> WELL, THINK OF DEMENTIA AS A BROAD UMBRELLA TERM.

>> OKAY.

>> AND THE SIMPLEST WAY TO THINK ABOUT THAT IS A DISORDER WHERE I HAVE IMPAIRMENTS IN MULTIPLE SPHERES OF COGNITION.

IT MAY BE MEMORY, IT MAY BE LANGUAGE.

IT MAY BE VISUAL SPATIAL FUNCTION, JUDGE MANY, EXECUTIVE FUNCTION BUT HAVE I IMPAIRMENTS IN SPHERES OF COGNITION TO THE DEGREE THAT NOW I HAVE IMPAIRMENTS IN MY ACTIVITIES OF DAILY LIVING.

SO I MAY NEED HELP WITH MANAGING FINANCES, MANAGING MEDICATIONS, MANAGING MEALS.

SO AN IMPAIRMENT TO THAT DEGREE.

NOW, WITHIN THAT BROAD CATEGORY OR MULTIPLE CAUSES SO ALZHEIMER'S DISEASE IS A CAUSE, AND MOST COMMON CAUSE OF DEMENTIA, 60 TO 80% OF PEOPLE WITH DEMENTIA, THE UNDERLYING CAUSE WOULD BE ALZ ALZ ALWAYS.

>> WHEN YOU TALK-- ALZHEIMER'S DISEASE.

WHEN ARE MAST-- WE USED TO TALK ABOUT SENILE DEMENTIA.

IS THAT A REAL THING OR SOMETHING WE MADE UP?

>> IT IS A REAL THING.

IT'S NOT A TERM THAT'S USED VERY MUCH ANYMORE.

IT SIMPLY MEANT DWEMENTIA-- DEMENTIA OVER THE AGE OF 6 AAND-- OVER THE AGE OF 65 AND FOR A LONG TIME IT WAS THOUGHT THAT DEMENTIA OVER THE ABLE OF 65 WAS NORMAL.

SEA NILT WAS A NORMAL THING.

AND WE WOULD THEN DESCRIBE PRESENILE DEMENTIA BEFORE THE AGE OF 65 IT MAY BE THE SAME CONDITION WHETHER IT'S 65 OR SEVENTH.

>> WHEN WE TALK ABOUT ALZHEIMER'S DISEASE, HOW WAS IT DISCOVERED AND WHO DID IT?

>> FIRST DESCRIBED BY A NEUROPATHOLOGIST IN GERMANY.

HE FIRST DESCRIBED THIS ON NOVEMBER 3, 1906.

SO WE ARE COMING UP ON THE ANNIVERSARY BEFORE TOO LONG.

HE DESCRIBED IT IN A RELATIVELY YOUNG WOMAN, HER NAME WAS FRAU AUGUSTINE.

HER AGE WAS 50.

AND SHE HAD INCREASING PARANOIA, MEMORY LOSS, CONFUSION.

HE FOLLOWED HER FOR A NUMBER OF YEARS AND WHEN SHE PASSED AWAY, HE WAS ABLE TO GET HER BRAIN TO STUDY UNDER THE MICROSCOPE AND HE WAS THE FIRST PERSON TO DESCRIBE THE PLAQUES AND TANGLES THAT WE NOW THINK OF AS HALLMARKS OF ALZHEIMER'S DISEASE.

AND ONE OF HIS COLLEAGUES NAMED THE DISEASE AFTER HIM.

HE DIDN'T NAME IT AFTER HIMSELF INITIALLY.

WHEN HE DESCRIBED IT, IS WAS THOUGHT TO BE A RELATIVELY RARE DISEASE BECAUSE WE WERE JUST DESCRIBING PEOPLE UNDER THE AGE OF 65.

AGAIN, WE THOUGHT PEOPLE OVER THE AGE OF 65 THAT DEMENTIA WAS NORMAL.

I DON'T KNOW OF THE EXACT TIMING, BUT I THINK IT WAS IN THE EARLY 70s, WE STARTED REALIZING HEY, WE SEE THE SAME PATHOLOGICAL CHANGES IN THE BRAINI OF SOMEONE WHO IS 70, 75, 80 YEARS OLD AND HAS DEMENTIA.

MAYBE THIS IS ALL THE SAME DISEASE.

YOU CAN HAVE AN EARLY ONSET EARLY ALZHEIMER'S DISEASE BEFORE THE AGE OF 65 OR LATE ONSET AFTER THE AGE OF 65.

BUT AT ITS ROOT, IT'S STILL ALZHEIMER'S DISEASE AND THAT'S WHEN WE REALIZE WHAT A COMMON CONDITION THIS IS.

>> IT'S NOT THAT OR MAYBE IT IS THAT WE ARE BETTER AT MAKING THE DIAGNOSIS OR IS THE INCIDENTS ACTUALLY INCREASING?

>> WELL, IT GETS A LITTLE BIT COMPLICATED.

YES, WE ARE BETTER AT MAKING THE DIAGNOSIS.

THE OVERALL PREVALENCE IS GROWING ALMOST EXPONENTIALLY, I WOULD SAY.

SO RIGHT NOW WE HAVE BETWEEN 6 AND 7 MILLION IN THE UNITED STATES THAT HAVE ALZHEIMER'S DISEASE.

AND THAT NUMBER IS GOING TO DOUBLE OVER THE NEXT 25 YEARS.

SO IT IS A LARGE PROBLEM.

THE ONE SORT OF GLIMMER OF HOPE THERE IS OUR INDIVIDUAL RISK MAY BE GOING DOWN A LITTLE BIT.

>> REALLY?

>> THE NUMBERS ARE INCREASING BECAUSE THE NUMBERS OF PEOPLE OVER THE AGE OF 65 ARE GROWING AND THAT'S THE MAIN RISK FACTOR FOR ALZHEIMER'S DISEASE.

BUT AS WE DO A BETTER JOB-- IT'S SPECULATED ANYWAY-- THAT WE DO A BETTER JOB OF CONTROLLING HIGH BLOOD PRESSURE, DIABETES, AS WE TAKE BETTER CARE OF OURSELVES, OUR INDIVIDUAL RISK MIGHT BE GOING DOWN.

NOT TO GET TOO LOST IN THE WEEDS, THE INCIDENTS ARGUABLY MIGHT BE GOING DOWN SLIGHTLY BUT THE OVERALL PREVALENCE IS BALLOONING.

>> BUT IF I CAN TAKE A LITTLE NUGGET OF HOPE OUT OF THAT, THERE ARE THINGS THAT WE CAN DO TO MITIGATE OR AT LEAST LESSEN OUR CHANCES OF GETTING ALZHEIMER'S DISEASE.

>> I BELIEVE, YES, AND I'M NOT ALONE.

WE DON'T HAVE DEFINITIVE PROOF THAT WE CAN DO A, B, C AND PREVENT THIS DISEASE BUT WE ARE GETTING CLOSE.

THE LANCET COMMISSION HAS PUT OUT TWO POSITION PAPERS AND THEIR MOST RECENT ONE SAID THAT 40% OF DEMENTIA WORLDWIDE IS PREVENTIBLE.

>> 40%?

>> THAT'S A BIG, BIG NUMBER.

AND THE RISK FACTORS THEY IDENTIFIED-- A LOT OF THEM ARE UNDER OUR PERSONAL CONTROL.

CONTROLLING OUR BLOOD PRESSURE, CONTROLLING OUR BLOOD SUGAR.

AVOIDING SEDENTARY ACTIVITY.

BEING ACTIVE.

AVOIDING OBESITY, NOT SMOKING.

A LOT OF THOSE THINGS WE HAVE SOME CONTROL OVER OURSELVES.

THERE ARE OTHERS LIKE POLLUTION.

WELL, THAT'S MORE OF A SOCIETAL PROBLEM.

BUT IT'S STILL TRUE.

IF WE CONTROLLED POLLUTION, WE WOULD DECREASE THAT OVERALL PREVALENCE AND INCIDENTS OF DEMENTIA TO SOME DEGREE.

>> SO ANOTHER REASON THAT WE NEED TO START LOOK LOOKING AT OUR ENVIRONMENT.

>> EXACTLY RIGHT.

>> YOU TALKED ABOUT THE PLAQUES THAT WERE IDENTIFIED.

IS THIS THE AMYLOID THAT WE ARE HEARING AND WHAT IS THIS AMYLOID STUFF ANYWAY?

>> IT IS.

THAT'S EXACTLY RIGHT.

SO MORE SPECIFICALLY IT'S BETA AMYLOID.

AMYLOID COMES FROM OR BETA AM AMYLOID COMES FROM A LARGE PROTEIN THROUGHOUT THE BODY CALLED THE AM EMPLOYED PRECURSOR PROTEIN.

WE DON'T EXACTLY KNOW THE PURPOSE OF THIS PROTEIN.

IT MAY HAVE A NUMBER OF DIFFERENT FUNCTIONS.

BUT IT'S FOUND NORMALLY.

WHEN WE METABOLIZE IT, WHEN WE BREAK IT DOWN IN A CERTAIN WAY, WE RELEASE THESE FRAGMENTS OF BETA AM AMYLOID.

THE TRUTH IS YOU AND I ARE DOING THAT RIGHT NOW AS WE SPEAK.

BUT WE SEEM TO BE CLEARING THAT OUT.

WE MAY CLEAR IT OUT MAINLY IN OUR SLEEP, IT HAS BEEN SPECULATED BUT THE BOTTOM LINE IS THAT WE CREATE BETA AMYLOID AND CLEAR IT OUT OF THE BRAIN SO MAYBE IT DOESN'T CAUSE PROBLEMS.

BUT IF WE DON'T CLEAR IT OUT OR IF WE MAKE TOO MUCH OR SOMETHING ELSE HAPPENS, IT STARTS TO BUILD UP.

IT STARTS TO CLUMP TOGETHER.

IT STARTS TO FORM PLAQUES IN THE BRAIN.

AND WHEN IT FORMS THOSE PLAQUES, AT LEAST THE PREVAILING IDEA IS THAT'S WHEN WE START SEEING A WHOLE CASCADE OF EVENTS AND IT LEADS TO TOXICITY TO THE BRAIN, ULTIMATELY LEADS TO MEMORY LOSS AND DEMENTIA.

>> WOW.

IS THIS SOMETHING HOW WE HANDLE THE AMYLOID, IS THAT FROM GENETICS THAT WE INHERIT THIS FROM SOMEBODY IN OUR FAMILY?

>> PARTLY YES.

>> SO MY MOTHER OR FATHER HAD ALZHEIMER'S DISEASE, I'M AT INCREASED RISK.

>> YOU ARE AT INCREASED RISK.

IF YOU HAVE A PARENT OR FIRST DEGREE RELATIVE.

PARENT OR SIBLING, YOUR RISK IS DOUBLE WHAT IT WOULD BE OTHERWISE.

IT IS HARD TO GO BEYOND THAT.

THERE ARE LOTS OF PEOPLE WITH VERY STRONG FAMILY HISTORY THAT WILL NEVER DEVELOP DEMENTIA.

AND THERE ARE LOTS OF PEOPLE WITH NO FAMILY HISTORY THAT DO DEVELOP DEMENTIA SO YOU DO INHERIT THAT RISK, BUT FOR NEARLY EVERYONE, IT'S NOT IN A WAY THAT WE CAN UNDERSTAND OR PUT A FINE POINT ON IT.

>> IS THERE ANY DIFFERENCE IN RACIAL OR SEXUAL INCIDENTS?

>> ALREADY.

THERE ARE.

IT SEEMS TO BE THAT WOMEN ARE AT HIGHER RISK.

WE DON'T ENTIRELY KNOW WHY.

AND RACIALLY, AFTERSHOCK-- AFRICAN-AMERICANS ARE AT DOUBLE THE RISK.

HISPANICS HAVE A 1.5 TIMES RISK OF DEVELOPING THAT.

AT ONE TIME WE THOUGHT THAT MAY BE A GENETIC ISSUE.

THE THINKING IS NOW GETTING AWAY FROM THAT AND THINKING IT HAS TO DO MORE WITH OTHER SOCIAL DETERMINANTS OF HEALTH.

AND TO A CERTAIN DEGREE, THE STRESS OF BEING A MARGINALIZED MINORITY IN OUR CURRENT CULTURE MAY ACTUALLY BE WHAT PUTS US AT RISK FOR DEMENTIA LATER ON.

>> WOW.

HOW DO I KNOW OR WHAT ARE SOME OF THE WARNING SIGNS THAT EITHER I MAY OR MY FAMILY MEMBER MAY BE DEVELOPING ALZHEIMER'S DISEASE?

>> SO I ALWAYS THINK THIS IS DIFFICULT BECAUSE THERE IS NOT A CLEAR LINE THAT WE CROSS.

IT IS NORMAL TO FORGET THINGS.

IT IS NORMAL TO MISS A TURN WHEN WE ARE DRIVING.

IT IS NORMAL TO... >> I WANT MY WIFE TO HEAR THAT.

SAY THAT AGAIN.

>> IT IS COMPLETELY FORMAL.

>> OKAY, THANK YOU.

>> BUT I WOULD SAY FIRST A CHANGE.

SO IF I AM BECOMING MORE FORGETFUL THAN I WAS BEFORE, THAT'S A CONCERN.

AND IT'S USUALLY GOING TO BE FORGETFUL OR LOSS OF MEMORY FOR RECENT THINGS.

I FORGOT A CONVERSATION.

I I REPEAT MYSELF MORE OFTEN.

I'LL OFTEN HEAR PEOPLE SAY WELL YEAH, THEIR SHORT-TERM MEMORY IS AFFECTED BUT THEY REMEMBER THEIR CHILDHOOD BETTER THAN I POSSIBLY COULD.

THAT'S STILL CONSISTENT WITH ALZHEIMER'S DISEASE.

IF-- IT REALLY IS A PROBLEM WITH LEARNING NEW INFORMATION.

AT LEAST EARLY ON OUR SHORT-TERM MEMORY IS AFFECTED.

MEMORIES WE MADE YEARS AGO, THAT'S HANDLED A LITTLE BIT DIFFERENTLY IN THE BRAIN.

SO LOOKING FOR A CHANGE IN SHORT-TERM MEMORY, REPEATING ONE'S SELF, MISPLACING ITEMS.

HAVING TROUBLE COMING UP WITH WORDS, THAT SORT OF TIP OF THE TONGUE PHENOMENON MIGHT WORRY ME.

GETTING LOST IN A FAMILIAR AREA WOULD BE A PROBLEM.

NOW IF I'M DRIVING DOWN AND MISS MY TURN AND REALIZE I MISS MY TURN, THAT'S BECAUSE I JUST WASN'T FOCUSED.

I WAS DISTRACTED.

THAT'S NOT THE SAME.

IF I CAN'T REMEMBER WHY I WALKED INTO ANOTHER ROOM, THAT'S MORE OF AN ISSUE WITH ATTENTION OR FOCUS AND SOMETHING WE ALL DO.

IF I FORGET WHAT I'M TALKING ABOUT IN CONVERSATION, THAT'S NOT REALLY WHAT WE TYPICALLY SEE WITH ALZHEIMER'S DISEASE.

BUT FORGETTING A CONVERSATION, REPEATING YOURSELF, MISPLACING THINGS.

GETTING LOST IN FAMILIAR AREAS, THOSE THINGS WOULD CONCERN ME MUCH MORE.

I'LL ADD ONE THING TO DO THAT.

>> PLEASE.

>> IF I THINK THAT I'M HAVING PROBLEMS WITH MEMORY, THERE IS A GOOD CHANCE THAT I'M OKAY.

IF MY FAMILY THINKS I HAVE A PROBLEM AND I THINK THEY'RE CRAZY, I KNOW I'M DOING FINE, THAT'S WHEN I'M MORE WORRIED ABOUT IT.

AND IT SOUNDS SILLY TO SAY THIS, BUT IF I HAVE A MEMORY DISORDER, I DON'T REALLY REMEMBER THAT I DON'T REMEMBER.

IT SOUNDS SILLY BUT THERE IS A LOT OF TRUTH TO THAT.

SO IT'S WHEN THE FAMILY IS CONCERNED THAT I AM MOST CONCERNED MYSELF.

>> SOUNDS LIKE THE OLD BILL RUMSFELD THING.

YOU KNOW WHAT YOU KNOW, YOU KNOW WHAT YOU DON'T KNOW AND YOU DON'T KNOW WHAT YOU DON'T KNOW AND THAT'S WHEN YOU GOT TO WORRY.

>> EXACTLY RIGHT.

>> HOW DO YOU MAKE THE DIAGNOSE?

>> SO THIS IS OLD FASHIONED MEDICINE.

THE DIAGNOSIS TO AT LEAST 90 TO 95% IS MADE ON TAKING A CAREFUL HISTORY AND PARTICULARLY A HISTORY FROM A LOVED ONE, A FRIEND, A FAMILY MEMBER, SOMEONE ELSE WHO IS REPORTING AND BASED ON AN EXAM.

A GENERAL NEUROLOGICAL EXAMPLE I CAN DO IN A MINUTE.

THAT PART IS EASY THEN YOU HAVE TO TO DO SOME TYPE OF MEMORY TESTING.

THAT COULD BE AS SHORT AS FIVE TO 15 MINUTES.

HAVE YOU TO TEST ORIENTATION, MEMORY, LANGUAGE, THINGS LIKE THAT.

AND I WOULD SAY 95% OF THE TIME YOU HAVE THE ANSWER AT THAT POINT.

WE WILL DO ADDITIONAL TESTING.

WE WILL DO SOME BLOOD WORK TO RULE OUT THYROID DISEASE OR VITAMIN B-12 DEFICIENCY AND SCAN OF THE BRAIN, MRI.

WHAT WE ARE REALLY DOING THERE IS RULING OUT THINGS LIKE STROKE OR TUMOR.

WE MAY GET TO THE POINT WHERE WE CAN DO SCANS TO MAKE A MORE POSITIVE DIAGNOSIS, BUT RIGHT NOW IT'S REALLY TO RULE THINGS OUT.

>> YOU GET A CT SCAN, M MRI, PET SCAN OR ALL THE ABOVE.

>> PREFER AN MRI SCAN.

IF I'M BEING VERY HONEST, RARELY HAVE I NOT SEEN EVERYTHING I NEEDED TO IN A C.T.

SCAN BUT AN MRI IS BETTER IF WE CAN GET THAT.

>> WHAT ARE YOU LOOKING FOR?

>> REALLY LOOKING FOR-- MORE THAN ANYTHING ELD, EVIDENCE OF STROKE OR YOU MAY SEE EVIDENCE OF VASCULAR DISEASE IN GENERAL THAT WOULD POINT YOU TOWARDS A VASCULAR DEMENTIA RATHER THAN ALZHEIMER'S DISEASE.

NOW I SIT THERE AND I STRIKE MY CHIN AND IMAGINE THAT I SEE ATROPHY, SLINKAGE IN SHRINKAGE THAT MAY POINT TO ALZHEIMER'S DISEASE BUT I DON'T THINK WE CAN REALLY GO TOO FAR WITH THAT.

WE MAY BE DOING A PET SCAN IN THE NEAR FUTURE, AND WHAT WE WOULD BE DOING WITH A PET SCAN IS LOOKING FOR AMYLOID, THAT PROTEIN WE TALKED ABOUT.

RIGHT NOW, CMS IS MAKING PROPOSALS TO START PAYING FOR THE PET SCAN.

IF YOU ASKED ME A YEAR AGO I WOULD TELL YOU THAT EITHER OUT OF POCKET OR PART OF A RESEARCH STUDY.

BUT THAT LOOKS LIKE IT MAY CHANGE AND DOING PET SCANS MAY BECOME A MUCH MORE ROUTINE PART OF PRACTICE.

>> YOU'VE MADE THE DOO I GO NOSES.

-- DIAGNOSIS, CAN YOU TREAT THE DISEASE?

>> SO UP UNTIL RECENTLY, THE ANSWER HAS BEEN YES.

BUT UP UNTIL RECENTLY IT WAS SYMPTOMATIC.

WE HAVE SOME MEDICATIONS WE WOULD CALL COGNITIVE ENHANCERS.

THEY HELP WITH MEMORY THINKING IN A BROADWAY, NOT VERY SPECIFICALLY.

AND THEY TEND TO BE MODESTLY EFFECTIVE.

THEY'RE NOT PERFECT.

THEY'RE NOT GREAT BUT MOST PEOPLE WILL SEE A MOD MODEST IMPROVEMENT AND WE STILL USE THOSE.

WE ARE NOW AT THE BEGINNING OF, I THINK, A NEW ERA IN THIS DISEASE, WHERE WE HAVE MEDICATIONS AND MORE COMING THAT GET AT WHAT WE THINK IS THE ROOT CAUSE HERE.

SO IF THE ROOT CAUSE OF ALZHEIMER'S DISEASE IS AMYLOID, MEDICATIONS THAT REMOVE AMYLOID OUGHT TO MAKE A DIFFERENCE.

AND WE NOW HAVE RECENT MEDICATION.

THERE IS ANOTHER ONE THAT WILL PROBABLY ABVEILABLE IN JANUARY WOULD BE MY GUESS.

AND THESE ARE MONOCLONAL ANTIBODIES GIVEN THROUGH AN I.V.

THEY GO TO THE BRAIN, THEY ATTACH ON TO AM AMYLOID AND REMOVE FROM IT THE BRAIN.

I CAN DO A PET SCAN THAT SHOWS SOMEBODY HAS AMYLOID AND AFTER BEING ON THIS TREATMENT POSSIBLY FOR A YEAR OR TWO YEARS, REPEAT THE PET SCAB AND WE MAY SEE THE AMYLOID ALL GONE.

IT CLEARLY DOES WHAT IT IS SUPPOSED TO DO.

NOW, IN TERMS OF BENEFIT.

IT LOOKS LIKE IT SLOWS DOWN PROGRESSION BY ABOUT 30%.

SO IT'S NOT 100%.

IT'S NOT WHAT I WANT.

SOME OF THE NEWER MEDICATIONS THAT ARE IN STUDIES, THERE IS THE SUGGESTION THAT IF WE CAN START THE RIGHT PATIENT VERY EARLY ON, THE BENEFIT MAY BE EVEN MORE THAN THAT.

SO IT'S NOT REVERSING THE DISEASE.

IT'S NOT CURING THE DISEASE BUT IT'S THE FIRST STEP WE HAVE WHERE AT LEAST, TO ME, CONVINCINGLY, IT'S SLOWING PROGRESSION OF THE DISEASE.

>> DOES THAT SUGGEST THAT THE AMYLOID MAY NOT NECESSARILY BE THE PRIMARY AGENT GIVING RISE TO THE ALZHEIMER'S DISEASE BUT HARBINGER OR PERHAPS SOMETHING ASSOCIATED WITH THE PRIMARY EVENT?

>> I THINK WE CAN SAY FOR SURE IT'S NOT AS SIMPLE AS JUST AMYLOID.

ONE OF THE SPECULATIONS IS, AND I TEND TO BUY THIS THAT AMYLOID MAY START THE PROCESS, BUT AFTER THE PROCESS IS STARTED, YOU MAY NO LONGER NEED THE AMYLOID, WHICH IS WHY YOU HAVE TO START IT VERY EARLY ON.

WE MAY-- AND THIS IS GETTING A LITTLE TOO FAR OUT IN THE FUTURE.

WE ARE DOING STUDIES THIS RIGHT NOW.

WE MAY FIND THAT-- WE THINK AMYLOID STARTS TO BUILD UP ABOUT 20 YEARS BEFORE WE HAVE SYMPTOMS.

I HOPE NOT BUT IT'S POSSIBLE THAT I HAVE AMYLOID BUILDING UP IN MY BRAIN RIGHT NOW AND DON'T KNOW IT.

WE, IN THE FUTURE, MAY BE ABLE TO IDENTIFY PEOPLE WITH AMYLOID BUT NO DEMENTIA, TREAT THEM WITH ONE OF THESE ANTI-AMYLOID AGENTS AND PREVENT THE DISEASE BEFORE IT EVER CLINICALLY TAKES HOLD.

THAT WOULD BE THE DREAM.

AND WE ARE DOING STDY STUDIES TO TRY TO GET THERE.

I CAN'T SAY WE ARE THERE TODAY BUT I HOPE WE GET THERE.

>> MAYBE AS WE SCREEN FOR COLON AND BREAST CANCER AND PROSTATE, PEOPLE CAN SCREEN AND START A MEDICATION.

>> WHEN I REACH THE AGE OF 50 OR 55, IT'S TIME FOR MY AMYLOID SCREENING.

MAYBE.

>> INTERESTING.

>> WE TALK ABOUT THE IMPACT ON THE PATIENT WHICH IS TREMENDOUS.

BUT THERE IS ANOTHER SIDE AND THAT'S WHAT HAPPENS TO THE FAMILY.

WHAT IS GOING ON NOW?

WHERE ARE WE AS FAR AS HELPING THEM?

>> WELL, NOT WHERE WE NEED TO BE.

AND THANK YOU FOR POINTING THAT OUT.

BECAUSE I HAVE OFTEN SAID ALZHEIMER'S DISEASE IS NOT A DISEASE OF INDIVIDUALS.

IT'S A DISEASE OF FAMILIES.

AND IT VERY DEFINITELY IMPACTS THE WHOLE FAMILY AND TAKES A TRUE PHYSICAL AND PSYCHOLOGICAL TOLL ON THE FAMILY.

SO IT'S IMPORTANT NOT TO FORGET THEM.

WHAT WE TRY TO DO EVERYWHERE I HAVE BEEN, IS TO CREATE SUPPORT FOR THE FAMILY.

THAT CAN BE IN THE FORM OF EDUCATION.

THAT CAN BE IN THE FORM OF SUPPORT GROUPS.

THAT CAN BE IN THE FORM OF CONNECTING WITH OTHER RESOURCES LIKE WE ARE FORTUNATE WE HAVE A RESOURCE CENTER AT NORTON.

THE ALZHEIMER'S ASSOCIATION HAS RESOURCES FOR PEOPLE.

SO IT IS IMPORTANT TO HELP CONNECT FAMILIES WITH AS MANY RESOURCES AS YOU CAN.

I ALWAYS FEEL LIKE WHAT WE DO IS NOT SUFFICIENT.

WE NEED TO DO A BETTER JOB OF THAT.

BUT I THINK THAT'S CRITICALLY IMPORTANT.

I'M GLAD YOU BROUGHT THAT UP.

>> OFTEN WONDER ABOUT THAT.

THIS IS ONE OF THOSE DISEASES THAT YOU BRING EVERYBODY IN TO TRY TO TAKE CARE OF THAT ONE PATIENT.

WE OFTEN TIMES HEAR IT SAID THAT SO AND SO DIED FROM ALZHEIMER'S DISEASE.

HOW DOES SOMETHING THAT CAUSE BRAIN FUNCTION IMPAIRMENT CAUSE US TO DIE.

>> THROUGHOUT MOST OF THE DISEASE, THERE REALLY IS NO PHYSICAL MANIFESTATION IN A SENSE WE ARE NOT BECOMING WEAK OR LOSING OUR ABILITY TO WALK ACROSS THE ROOM BUT IN THE END STAGES YOU SEE THE PHYSICAL MAN MANIFESTATIONS.

I MAY BECOME BED RIDDEN OR DEVELOP PRESSURE SORES.

I MAY NOT CLEAR MY SECRETIONS AND DEVELOP PNEUMONIA.

PNEUMONIA WOULD BE THE MOST COMMON CAUSE OF DEATH.

I MAY NOT TAKE IN AWED QUART FLUIDS OR FOOD.

IT'S A COMPLICATION AT THE END OF THE DISEASE THAT USUALLY WILL TAKE US.

>> THAT IS SOMETHING ELSE WE HAVE TO WORRY ABOUT THEN.

WHEN YOU TALKED ABOUT COGNITIVE ENHANCERS.

THERE IS SOMEBODY-- JUST LIKE GOLFERS TAKE BETA BLOCKERS TO MAKE THEM MORE STEADY AND PEOPLE GET LASIX SURGERY FOR IMPROVING SEEING FOR BASEBALL.

IS THIS SOMETHING PEOPLE SHOULD TAKE TO MAKE THEM THINK CLEARER?

>> I WOULD SAY NO.

>> GREAT.

>> IN THE PAST PEOPLE HAVE CONSIDERED THAT BUT THAT NEVER REALLY TOOK OFF.

WHAT I WOULD TELL PEOPLE TO DO IS REALLY FOCUS ON A HEALTHY LIFESTYLE.

GOOD MEDICAL FOLLOW-UP, GOOD DIET, FOLLOWING THE MEDITERRANEAN OR SOME DIET THAT IS GOOD FOR THE BRAIN.

GETTING GOOD REGULAR EXERCISE, GETTING MENTAL EXERCISE, LEARNING NEW TASKS, LESCHING AN-- LEARNING AN INSTRUMENT OR A LANGUAGE, SOMING THAT KEEPS US MENTALLY SHARP AND KEEPING A GOOD SOCIAL NETWORK.

AND ALL OF THOSE THINGS CERTAINLY REDUCE OUR RISK FOR DEVELOPING A DEMENTIA.

BUT THERE IS SOME EVIDENCE THAT THEY MIGHT EVEN ENHANCE OUR COGNITION IN THE SHORT RUN.

SO THERE IS A LOT OF BENEFIT THERE.

>> SO WHEN DOES A PERSON-- OKAY START DOING THE CROSSWORD PUZZLES, WHATEVER.

WE ARE 50 YEARS OLD, HAVEN'T DONE IT BEFORE.

NEVER TOO LATE TO START?

>> NEVER TOO LATE TO START.

>> LEARN NEW TASKS.

>> WE CAN BUILD UP RESILIENCE OR COGNITIVE RESERVE IT IS OFTEN CALLED, ANY TIME IN OUR LIFE.

THERE IS NEVER A POINT THAT IT IS TOO LATE.

>> THE CONCEPT THAT THE BRAIN IS STATICKINGS WRONG.

>> IT'S NOT REALLY TRUE-- NOW WE MAY NOT BE CREATING A LOT OF NEW BRAIN CELLS BUT WE ARE CONSTANTLY MAKING NEW CONNECTIONS, SIN SYNAPSES IN THE BRAIN.

THE MORE RESILIENT WE HAVE TO DISEASES LIKE ALZ ALZHEIMER'S DISEASE ALZ.

>> WITH ABOUT A MINUTE OR SO LEFT, I WANT YOU TO GIVE ME THREE BIG TAKE HOME POINTS THAT WE SHOULD KNOW ABOUT ALZHEIMER'S DISEASE.

>> SO WOULD I SAY FIRST OF ALL, IT'S COMMON.

IT IS VERY, VERY COMMON.

SECOND OF ALL, EARLY RECOGNITION, EARLY DIAGNOSIS CAN MAKE A DIFFERENCE.

AND SOME OF THE NEW TREATMENTS COMING OUT NOW AND PARTICULARLY THE RESEARCH OF NEW TREATMENT AND PREVENTION GIVE US A LOT OF HOPE FOR THE FUTURE.

I THINK WE ARE AT AN EXCITING TIME IN MY FIELD.

>> AND THERE ARE SOME THINGS WE CAN DO THAT MAY PREVENT US FROM DEVELOPING THE DISEASE?

>> CORRECT.

CERTAINLY CAN LOWER OUR RISK.

GOOD HEALTHCARE, BEING ACTIVE PHYSICALLY, MENTALLY, SOCIALLY, GOOD DIET AND THE OTHER THING I DIDN'T MENTION IS GOOD SLEEP.

TRYING TO GET A GOOD 7-8 HOURS OF SLEEP.

AND ONE OF THE THEORIES BEHIND THAT IS THAT'S THE TIME THAT WE CLEAR AMYLOID OUT OF OUR BRAIN.

SO IF WE ARE NO THE GETTING-- IF WE ARE NOT GETTING THE SLEEP, WE MAY NOT BE CLEARING OUT THE AMYLOID.

>> I THINK THE FIRST THING I'M GOING TO DO IS GO HOME AND GO TO SLEEP.

SOMEBODY ASK ME WHY I'M DOING THAT, I'M FOLLOWING DOCTORS ORDERS.

THANK YOU VERY MUCH.

THIS HAS BEEN VERY INTERESTING AND I REALLY APPRECIATE YOU COMING BY HERE TODAY.

THANK YOU FOR BEING WITH US TODAY.

I HOPE THAT YOU HAVE A BETTER UNDERSTANDING OF THE SCIENCE AND SYMPTOMS OF ALZHEIMER'S DISEASE AND ARE ENCOURAGED BY THE PROGRESS MADE IN TREATING THIS SCARY DISEASE.

IF YOU WITH ISSUE TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVED VERSION OF PAST SHOWS, PLEASE GO TO WWW.ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KY HEALTH@ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NECK "KENTUCKY HEALTH."

BUT IN THE MEANTIME, DO A CROSSWORD PUZZLE, START READING, GET SOME EXERCISE, EAT WELL.

I GUESS YOU OUGHT TO GET SOME SLEEP.

IF YOU HAVE ANY QUESTIONS, MAKE SURE YOU TALK TO YOUR PRIMARY HEALTHCARE PROVIDER OR SEE A NEUROLOGIST AND IF YOU HAVE ANY QUESTIONS ABOUT THIS, LET'S GET STARTED TREATING IT EARLY RATHER THAN LATER.

THANK YOU FOR BEING WITH US.

SEE YOU NEXT TIME.