The difference between Alzheimer's disease and dementia [Music playing] Gail Hogan: Alzheimer's disease is the most common cause of dementia. Expert Dr. Maria Kataki is here to share information on both and why they're different. Dr. Kataki, Alzheimer's disease causes dementia? [Text on screen: Maria Kataki, MD, PhD Neurologist The Ohio State University Wexner Medical Center] Maria Kataki, MD, PhD: Alzheimer's disease is one of the most common causes of dementia for patients older than 65 years of age. This is correct. [Music fades] [Text on screen: Gail Hogan The Ohio State University Wexner Medical Center] Gail Hogan: What's the difference between Alzheimer's and dementia? Maria Kataki, MD, PhD: Most of my patients, when we talk about their family history, they're telling me that the mother or the father had some type of dementia, but not able to specify. We diagnose dementia when people have cognitive or behavioral symptoms that would interfere with the ability to function at work or usual daily activities would represent a decline from previous level of functioning and there is no delirium or any major psychiatric disorder that could explain those symptoms. So this is the clinical syndrome, the constellation of symptoms that represent the change from previous level of functioning. Now, when we identify that, we need to see what's causing the dementia. And Alzheimer's disease is the most common type of dementia, but there are several other causes that could also cause dementia. Gail Hogan: What causes Alzheimer's? [Text on screen: Maria Kataki, MD, PhD Neurologist The Ohio State University Wexner Medical Center] Maria Kataki, MD, PhD: What we know is that there are neuropathological changes in the brain, amyloid plaques and neurofibrillary tangles that would show up 20 to 25 years before people would have any symptoms of the disease. There is a complicated hypothesis, research hypothesis to identify the etiology of those changes in the brain. We have several research projects to see how we could develop medications that could alter the course of the disease, prevent the disease, or eventually cure the disease. So we're in the process of learning more about the true cause of Alzheimer's disease. Gail Hogan: There are some medications though that are now being used that appear to be working, right? [Text on screen: Maria Kataki, MD, PhD Neurologist The Ohio State University Wexner Medical Center] Maria Kataki, MD, PhD: So in the year 2021, the FDA approved medication called aducanumab, which is an amyloid clearing medication. This is the first medication that modifies the course of the disease in Alzheimer's disease and was the second medication in the year 2021, next to a medication for amyotrophic lateral sclerosis, as this is modifying treatment for a neurodegenerative disease. Now, in April of 2022, CMS decided that they will no longer cover the cost of the drug unless patients are part of a clinical trial, either CMS or NIH sponsored, because we need to define the true clinical efficacy of the drug. However, it opens the door for a new era in the treatment and management of neurodegenerative conditions and specifically Alzheimer's disease. And there are several more medications that are awaiting evaluation and hopefully in January we'll hear FDA's review for lecanemab, which is another amyloid clearing medication, and many more are coming. So we're hopeful that we'll be able to have efficacious medications in the future to treat the disease, prevent the disease, or one day cure the disease. The research is ongoing. Gail Hogan: Many people believe that dementia is just a part of aging, but is that correct? [Text on screen: Maria Kataki, MD, PhD Neurologist The Ohio State University Wexner Medical Center] Maria Kataki, MD, PhD: This is not correct. If patients experience symptoms of memory loss or any decline from previous level of functioning, any behavioral changes, should request an evaluation by the primary care doctor who then could initiate a referral to a cognitive specialist to establish a diagnosis and treatment. Sometimes there are treatable conditions that would cause dementia and that's always our first basic evaluation. Is there any treatable cause of memory loss, of dementia that we should address immediately so the patient would improve? If this is not a treatable cause of memory loss or dementia, then we need to consider other causes and provide appropriate management. Gail Hogan: Are there risk factors tied to this? [Text on screen: Maria Kataki, MD, PhD Neurologist The Ohio State University Wexner Medical Center] Maria Kataki, MD, PhD: There are risk factors. If we're talking for Alzheimer's disease in particular, age is a major risk factor and accounts for maybe for 99% of sporadic cases of Alzheimer's disease. 1% of the cases could be familial cases. In other words, might be a genetic component. There are some mutations that have been identified with an earlier age of onset of the disease, usually associated with these familial cases. Apolipoprotein epsilon genotype has been identified as a genetic risk factor and several other genes have been identified recently and represent the target of treatment. Lifestyle can definitely represent an era for modifications, prevention, and risk factors. And of course the better people take care of their health or especially cardiovascular health, the higher chance they have to prevent dementia, cognitive issues later in life. Several risk factors have been associated. We try to see which one would be the most efficacious to represent a target for treatment. There are simple things like exercise that might delay progression to dementia, and this is something we all can do without a prescription, even though it's nice when there are programs that people could participate. Mediterranean diet has been found to delay progression to dementia. So little things like... It's not that little to pay attention to our diet and exercise with our complicated lifestyle, but these are things that hopefully we can control and can have a great impact in our good health of the brain, of the heart, and our whole body. Gail Hogan: Does keeping your mind busy help? [Text on screen: Maria Kataki, MD, PhD Neurologist The Ohio State University Wexner Medical Center] Maria Kataki, MD, PhD: Mental stimulation is always a good friend and we have the slogan use it or lose it. This is absolutely true in the era of dementia. And there is also the big basically research related to cognitive reserve of the brain. And this is why basically so many studies have been done to evaluate whether education earlier in life could prevent dementia later in life. There is no harm from mental stimulation, can only improve the cognitive function. There is though one thing that we always advise our caregivers, they should encourage the patients to do as much as they can because sometimes if they have the disease, might be things that might be hard to do. Mental stimulation is always one of the best friends. [Text on screen: Gail Hogan The Ohio State University Wexner Medical Center] Gail Hogan: What do you do if you see signs of dementia in someone you love? [Text on screen: Maria Kataki, MD, PhD Neurologist The Ohio State University Wexner Medical Center] Maria Kataki, MD, PhD: Initiate a visit with the primary care doctor, request a referral for a cognitive specialist. Another easy thing to do while waiting for an evaluation or even before a discussion has been started is you can access the website of the Cognitive and Memory Disorder Center at the Department of Neurology and try to download the SAGE test, the basically Self-Administered Geriatric Cognitive Evaluation that was developed by our director, Dr. Scharre and our team and has been extremely helpful and easy to take. There are instructions in the website how to score the test. If there are any difficulties there, then there is a good reason to request a referral and further evaluation. And if somebody can have basically a very good score with the SAGE, there is a good chance there are no true difficulties and there is what we call a subjective cognitive decline. However, we're always open to evaluate our patients because sometimes if people get concerned or somebody else get concerned, might be some medical condition that requires further attention, evaluation and management. Gail Hogan: Can you tell by looking at a brain through imaging if someone has dementia? [Text on screen: Maria Kataki, MD, PhD Neurologist The Ohio State University Wexner Medical Center] Maria Kataki, MD, PhD: Imaging can be very helpful to differentiate some types of dementias, vascular dementias, demyelinating diseases, inflammatory conditions of the brain. Trauma can be diagnosed by imaging. So by looking at the brain, I don't know if you're referring just to structural imaging like an MRI of the brain or a CAT scan. And of course normal pressure hydrocephalus, subdural hematomas, there are several conditions we could identify just by looking at the brain. Another thing that we have available nowadays is basically an amyloid brain PET. And sometimes can be covered by Medicare on a case-by-case basis and we can see actual amyloid in the brain. And if we see that, that supports the biological diagnosis of Alzheimer's disease. We can also image tau in the brain. There are tau PETs available, still in development, still in the research era, but we're able to view the histopathologic changes associated with the biological diagnosis of Alzheimer's disease. So imaging can be extremely helpful. It's not the only thing that we should do to diagnose dementia or Alzheimer's disease, but it's definitely part of the standard of care recommendations, structural imaging. Functional imaging involving PET require a more sophisticated evaluation and approval process, but they're both very helpful in the diagnostic process. Gail Hogan: Research plays a huge role in this. So where are we at Ohio State? [Text on screen: Maria Kataki, MD, PhD Neurologist The Ohio State University Wexner Medical Center] Maria Kataki, MD, PhD: I think we live in really very exciting times for the treatment of these conditions because the approval of the aducanumab last year, even though it was very controversial, opened the era for treatments that would modify the course of the disease. And this is really a very big thing in Alzheimer's disease. The medications we have approved up to date, they would all offer a symptomatic management. It is significant, might delay progression from one stage of the disease to another. However, none of them would modify the course of the disease. The new category of drugs that basically would clean amyloid from the brain or tau, they represent the disease modifying treatments for Alzheimer's disease and we're hopeful that we'll have better treatments in the future to help our patients. Gail Hogan: How close are we to FDA approval for some of these drugs? [Text on screen: Maria Kataki, MD, PhD Neurologist The Ohio State University Wexner Medical Center] Maria Kataki, MD, PhD: We have several clinical trials at the Cognitive and Memory Disorder Center at the Ohio State University. We're part of several national and international projects and most of them offer a disease modifying approach. In January of 2023, we'll find out what FDA feels about the lecanemab, which is basically a medication that also cleans amyloid from the brain. And we recently had a press release of positive results in a phase three clinical trial. So we're all looking forward to the final assessment for this drug and there are many more to follow. We definitely live in exciting times and we're hopeful that we'll have better drugs in the future to help our patients. Gail Hogan: You've said the term amyloid several times. Is this a medication? And if so, what is it? [Text on screen: Maria Kataki, MD, PhD Neurologist The Ohio State University Wexner Medical Center] Maria Kataki, MD, PhD: So amyloid is one of the proteins that aggregates in the brain when people have Alzheimer's disease and seems to be a leading hypothesis in explaining the pathophysiological mechanism of the disease. What causes the amyloid deposition in the brain is still under a lot of research. Several clinical projects try to explain what happens in the brain. This is the protein that's causing the plaques, the amyloid plaques, the sticky plaques in the brain that cause a lot of trouble with cognitive function. The toxic amyloid that causes the amyloid plaques is not a good protein for the brain. It causes damage. It triggers a neuronal dysfunction, cerebral degeneration, neuronal death, and basically loss of function. So it's not a good thing to be there. That's why we're so excited when we see that the medication can clean the amyloid plaques from the brain. What remains to be seen is how we can improve the cognitive function, if we have drugs available to clean the toxic amyloid from the brain. So the amyloid that causes the amyloid plaques is not a good protein from the brain. There is a way that a good amyloid can be derived and that's another target for future treatments. [Music playing] Maria Kataki, MD, PhD: The one though we see in Alzheimer's disease is not a good protein for the brain. [Text on screen: Ohio State Health & Discovery health.osu.edu] [Music fades]