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Are your symptoms depression or dementia? Cognitive decline can play a huge role in the lives of older adults. Dr. Ruth Adell of USMD walks us through the early signs of dementia and strategies for better mental health care.
Sept. 18, 2024
Podcast transcript
INTROWelcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts, Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron, will share information to improve your health and wellbeing. And now here are Ron Aaron and Dr. Tamika Perry.
RON AARON
Well, thank you so much for joining us today on the award winning Docs in a Pod. I'm Ron Aaron, along with our special co-host today, Gina Galaviz Eisenberg. Gina pleads guilty to being my wife.
GINA GALAVIZ EISENBERG
I do.
RON AARON
She's an award winning television journalist. Covered crime for a whole lot of years. If you were shot and killed in San Antonio, she knew about it.
GINA GALAVIZ EISENBERG
Or broken into.
RON AARON
Yeah, or broken into. She was also on television in Dallas and way back in Laredo, and we're delighted to have a chance to work together here on Docs in a Pod. One of the issues that comes up, especially when you talk about people getting older, is depression and dementia. Dr. Ruth Adell is joining us. Dr. Adell grew up in Burleson, Texas, where she also has practiced medicine, earning a medical degree from the University of North Texas Health Science Center. She is board certified in family medicine and did a residency at Waco Family Medicine Institute, oddly enough, in Waco. Dr. Adell, one of the issues that you had to deal with when you moved back home in 2018 was when your father developed dementia. Were you one of his caregivers?
DR. RUTH ADELL
I was for a period of time.
RON AARON
What was that like?
DR. RUTH ADELL
I thought as a clinician, I was pretty good at managing dementia and supporting families through that. What that experience taught me is that I really didn't know jack and I look back on it now with hindsight and I realize all the places that I failed him, but it also helped me be a much better clinician for my patients going forward.
RON AARON
That's the old shoemaker's kids never have shoes.
DR. RUTH ADELL
Yup.
RON AARON
As you get interested, obviously, from a caregiver side and a medical side in dementia, I'm assuming it makes you a better doctor when it comes to your patients in helping to diagnose and treat depression and then in some dementia as well.
DR. RUTH ADELL
Absolutely. Absolutely. It's a little bit different depression in dementia, how it presents, and we can get into that in a minute.
RON AARON
Well, why don't we get into it? Depression is something that we know people 65 and older, there's an increasing number of folks diagnosed with depression. What are some of the symptoms? And if you have depression, do you know you have it?
DR. RUTH ADELL
Not always, and especially our older adults, it manifests less in feeling sad and crying, being weepy and emotional, and more so sometimes with apathy, not being interested in normal activities. In dementia, it's very difficult sometimes for patients with dementia to articulate, I feel sad, and to explain those feelings. So, that makes the diagnosis of dementia a bit of a challenge in that population.
GINA GALAVIZ EISENBERG
As a caregiver, you're around your loved one all the time. How do you know that what you're seeing is really what it is?
DR. RUTH ADELL
That's difficult because of our knee jerk. My knee jerk was, this is your fault. You're doing this on purpose. You just need to snap out of it. It wasn't a helpful attitude. So, I think assuming positive intent, assuming that they're remembering that there is biology that's happening in the background and making sure that you're bringing it up to their providers. It's very difficult when you're emotionally involved to be that objective observer. So, if you're seeing things that don't jive, you do need to bring it up to their provider.
RON AARON
Stay with us for just a minute. I want to let folks know who may have just joined us. You're listening to the award winning Docs in a Pod, our podcast available wherever you get your podcast. We're also on the radio in a number of markets in Texas and Florida as well. I'm Ron Aaron, along with our co-host today, Gina Galaviz Eisenberg and our special guest, Dr. Ruth Adell. Dr. Adell is a physician, Doctor of Osteopathy, who has practiced in the Burleson, Texas area, currently serves as a medical director for USMD in North Texas. Dr. Adell, as you think about your own situation, you moved back home when your dad developed dementia. What were the symptoms that you and your family were seeing?
DR. RUTH ADELL
A lot more irritability and anger. He wasn't necessarily a pleasant man to start off with, but it got worse and worse and worse. Again, that's one of those things that it's very easy to say, well, it's your fault. It's your problem. You need to stop it. And it wasn't possible for him. The damage from dementia made that happen. And depression was causing that also.
GINA GALAVIZ EISENBERG
So, what did you do? I mean, because you feel so helpless, right? You're thinking, okay, the tough love, you can do this. Come on, you can do this. You're a grown man. You can do this, but you can't.
DR. RUTH ADELL
There are some fantastic resources out there to help you with, as a caregiver, decreasing the risk of depression in your person. The Alzheimer's Association is amazing. Great resources, great online advice for how to manage difficult behaviors. There's a woman on YouTube that I rely on a lot named Teepa Snow that does some great videos on role playing and what to do in situations. My dad was an engineer and especially with those that have very specific trades, when they don't have that anymore and they don't have that sense of purpose, that can be what triggers the depression. So, being able to figure out how to include them in the family in a way that's safe, but still makes them feel valued is critical
GINA GALAVIZ EISENBERG
Yes. That's just like with everyone, give them their dignity. I mean, I guess they don't know that it's being stripped away, but that's what's happening.
DR. RUTH ADELL
Right.
RON AARON
As you deal with patients when you were practicing full time and patients presented with perhaps depression, perhaps some cognitive issues, what was your approach in trying to diagnose and then seek treatment for them?
DR. RUTH ADELL
Prior to my father's experience, more reassurance. Here's a few books. Go look at this website. Let's prescribe a drug. The drugs definitely have a role, but there are other things that I hadn't thought about, like counseling, some group therapy. Not for me, but for my dad. You think sometimes with dementia, that's just more of a withdrawal and you don't need to have them participate, but it can be a very valuable adjunctive therapy.
RON AARON
How did he respond?
DR. RUTH ADELL
My dad was a difficult fellow, right? So, he was not always open to it, but it was good for him to have somebody that he could talk to and vent to that wasn't me.
GINA GALAVIZ EISENBERG
Exactly. At what age did you see this start happening to him? Do you have other family members who live with dementia?
DR. RUTH ADELL
Yeah, his mother had had dementia, but he had been struggling with it, gradually worsening over a number of years. It had reached a point where my mother didn't feel safe and I was getting called on to come and help regularly, so I knew I needed to be back and close to help.
RON AARON
Was he becoming violent?
DR. RUTH ADELL
Verbally abusive, emotionally abusive, there were some threats of violence that never actually happened, but it was enough to spook my mom because it wasn't characteristic of his normal behavior. And again, that was part of that whole depression thing. You can sense when you're the patient, you may not recognize that it's depression necessarily, but you're recognizing that things aren't working the way that they should have. There are holes in the memory and it's terrifying.
GINA GALAVIZ EISENBERG
When that moment happened, what did you do as a family? I guess your mom was in the first line of trying to get the help and then reaching out to you. But what do you do as a family? I mean, I would imagine the feelings were just so overwhelming. Do you call your doctor? Do you set up an appointment? What do you do first?
DR. RUTH ADELL
I called his physician, and we went in, and we talked. It got to the point where he really wasn't safe at home, so I had to gain his trust and then we had to find a place for him to stay that was safe. That was a very difficult transition. When we talk about depression and dementia, individuals that are in a care home or a nursing home, assisted living, are at increased risk of having depression.
RON AARON
Just being there could make you depressed.
DR. RUTH ADELL
Amen to that.
GINA GALAVIZ EISENBERG
Once you come to that conclusion, that's where he needs to be. I mean, what do you do still as a family? It's not over, right? Cause you're not there. And I would imagine just the stress for you continues to grow.
DR. RUTH ADELL
Right. I mean, there's a lot, and we're kind of veering off into other subjects, but when I had my father in assisted living, we had him in memory care for a time, there's a lot of guilt that I dealt with. How often should I be there? Are people judging me because I'm not there every day? How scary is it for him? What can I do to make things better for him? We had to do some legal things on the back end to make sure that he wouldn't drive when he wasn't supposed to. That he couldn't own guns anymore. So, that's pretty intensive, too. That also contributes to the whole depression thing. He knew that his freedoms were one by one going away.
RON AARON
Made him angry.
DR. RUTH ADELL
Yes.
GINA GALAVIZ EISENBERG
He had a family. He had advocates. What about seniors who don't have that support system? You live alone, you're 65 and you're like, Hey, this is pretty good. I've got the next 20, 30 years. But then you notice something's happening. What do you do?
DR. RUTH ADELL
First of all, make sure that they're safe. If it's in a situation where they're not, oftentimes we'll do a home visit, get to see the lay of the land, and we can involve adult protective services. There are guardians that can be appointed to assist with decision making in that situation.
GINA GALAVIZ EISENBERG
What about treatment? Do you have the problem, or do you need treatment right away? If you really start losing things, what's normal aging as opposed to dementia and Alzheimer's?
DR. RUTH ADELL
We talk about major and minor cognitive dysfunction, and the big thing that distinguishes it is whether or not it affects your ability to take care of yourself. Your activities of daily living. So, once you cross that threshold, that there's some aspect of your daily being able to take care of yourself that you can't, that's when you're hitting into dementia and it's not just this mild cognitive impairment situation anymore.
GINA GALAVIZ EISENBERG
Not just forgetting somebody's name or where did I put the keys or my glasses.
DR. RUTH ADELL
Exactly. Yes. Depression can hit at any point on that spectrum. Oftentimes it's even earlier just because they are more able to recognize.
GINA GALAVIZ EISENBERG
They're able to say, I'm not myself. I'm feeling sad. Or your friends will notice you haven't been the same lately. What's wrong?
RON AARON
We'll pick that up in a moment. Hold that thought. I'm Ron Aaron, along with our co-host Gina Galaviz Eisenberg, and we're talking with Dr. Ruth Adell about depression and dementia. Don't necessarily go hand-in hand. You can certainly be depressed and not have dementia. We'll talk more about that on the award winning Docs in a Pod.
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RON AARON
Thank you so much for sticking with us right here on the award winning Docs in a Pod. Our podcast is available wherever you get your podcast. We also are on the radio in a number of markets in Texas and Florida as well. I'm Ron Aaron, along with our cohost, Gina Galaviz Eisenberg. We're talking with Dr. Ruth Adell. She's a DO, a Doctor of Osteopathy, and she's currently a USMD medical director. Has a private and clinical practice in North Texas, and we're so pleased to have her with us. We're talking about depression and dementia. Talk to us about what family members might be seeing, as in your own case with your dad. What would you look for? What would be the warning signs? The radar goes up when you hear certain things about your loved one.
DR. RUTH ADELL
Of course, depressed mood. Any sadness, being down consistently. Apathy is another. Not caring to do the things that have brought you joy in the past. Not interested in participating in any activities. Social withdrawal and isolation. Trouble concentrating. Inability to complete tasks. Impaired thinking. That's what makes dementia and depression especially difficult is that you can have impaired thinking with just depression that mimics dementia and then that impaired thinking could be just dementia and not the depression. The other thing that happened with my dad, especially was the irritability and the anger of it.
RON AARON
You said he was difficult to begin with. What was the difference between old grumpy dad and irritable dad?
DR. RUTH ADELL
He was more volatile. More likely to throw things, more likely to yell, more likely to call you names. He would, at times, refuse to allow people in the house. It was above and beyond.
RON AARON
Some of that Frontal Temporal Dementia, FTD.
DR. RUTH ADELL
He had vascular dementia, so his brain essentially was like Swiss cheese. So, parts of it just weren't functioning anymore.
GINA GALAVIZ EISENBERG
Ugh.
RON AARON
How did you discover that?
DR. RUTH ADELL
We knew that because he had started to have seizures, actually, and from imaging, we were able to see that he had amyloid angiopathy, and then that progressed over time.
RON AARON
Amyloid angiopathy doesn't sound good.
DR. RUTH ADELL
No.
RON AARON
What does it mean?
DR. RUTH ADELL
It's deposition of the protein amyloid in the vessels in the brain, and that causes them to be more friable or breakable. In his case, he would bleed inside the brain or the circulation would just cut off. Amyloids have been linked to Alzheimer's, but in his situation, it was a different presentation.
GINA GALAVIZ EISENBERG
Oh, geez. There's so much research, and I guess the question is, what can we do to mitigate even a little bit if we know there's family history? I mean, is that even possible?
DR. RUTH ADELL
Absolutely. Making sure that you're keeping yourself mentally sharp, learning new things, being active. Don't smoke. Limit your alcohol intake. Eating healthy. Stay away from processed foods. Those are key. You better believe I do all of that.
GINA GALAVIZ EISENBERG
I was going to ask, and that was like, okay, how do I ask this question? Exactly. At what point did you say, it's time. I need to. I can't be like this for my family. I can't do this.
DR. RUTH ADELL
Being more intimately involved in my father's care definitely made me more aware of that, but it also made me extremely passionate in how we deal with our dementia patients because someday that very well may be me. I want to make sure that the people around me that I may come in contact with are going to do it in the right way.
RON AARON
One of the things when a doctor says, eat better, eat healthy, bye bye, see you soon, most of us don't know what that means.
DR. RUTH ADELL
There's a lot of information that you can pull up online for that. But if you think about it, just as a rule of thumb, try to stay away from processed foods. There is a particular diet called the Mediterranean diet that has great research behind it for decreasing the risk of dementia and then decreasing the risk of cardiovascular disease. So, if you just want something easy, that's a playbook, Mediterranean diet is a good place to start.
RON AARON
That's a lot of fruits and vegetables I would guess.
DR. RUTH ADELL
Fish and such, yes.
GINA GALAVIZ EISENBERG
I was going to ask, what is your like a typical day in your diet? How did you change what you were eating before to what you're eating now? Cause we're always on the go. We want something quick and fast.
DR. RUTH ADELL
Right. I try to prep better. So, more fruits and vegetables in my fridge, ready to go. I eat a lot more salad than I used to. My kids, we might take them out to eat fast food, but Im more likely to just come home and grab something here rather than eating out.
GINA GALAVIZ EISENBERG
How many years can you add onto your life doing that? I always say I want to add at least another 30 years.
DR. RUTH ADELL
The longevity isn't so important as much as the quality. If I can have the years that I am alive not be dementia years, I'm all for that.
RON AARON
Yeah, but in our case, we've got young kids. So, both of us want to see them go to college, find the right person, get married, have kids. We want to be there for as much of that as we can and that involves longevity.
DR. RUTH ADELL
I have a 13-year-old and a 14-year-old.
GINA GALAVIZ EISENBERG
We have a 12 and two 11-year-olds.
DR. RUTH ADELL
Look at y'all.
GINA GALAVIZ EISENBERG
I know. I was listening to some 40-year-olds yesterday. One had torn something or other doing something and another one had broken a toe and I'm thinking, do I look as old as they do? And I'm way older than they are, but luckily I haven't had those issues. I just try to prevent. I try to mitigate and prevent.
RON AARON
You said you're in you're in your 50s?
DR RUTH ADELL
I'm in my 50s now. I was a late starter on the kids, and as I age and see my body changing, much more urgent to be more strict and better on my diet and other activities.
GINA GALAVIZ EISENBERG
Exactly. Same thing with like with alcohol. I want to be around and I don't want to be a burden when I'm 80 or 90, I want to be active. I'm not going to run marathons, but I think that baseline will help mitigate all kinds of health problems. Maybe, we'll see.
RON AARON
Dr. Adell, you were talking earlier about the kind of things that you can do to mitigate the risk of developing cognitive disorder, dementia, and among that is to keep your brain working. What are the things that you do to do that?
DR. RUTH ADELL
I do CME. I try to read and learn as much as I can. I'm also doing Duolingo to learn a new language.
GINA GALAVIZ EISENBERG
Oh, that's cool.
DR. RUTH ADELL
Just trying to make sure that my brain stays used to learning. The other thing that we have seen when we talk about developing dementia is that social connection is really important. This is interesting, when you retire for the first 18 months, cognitive function is the same. It's fine. After that, it declines. The thought is that you're not having that social connection that you used to when you were working and interacting with people in that way. So, if you are retired, make sure that you have social connections and people that can keep that brain alert.
GINA GALAVIZ EISENBERG
That's what I mentioned about Ron because Ron still works, and it keeps him active. I don't know if you know how old he is but take a guess.
RON AARON
That's not fair.
DR. RUTH ADELL
I know, you're putting me on the spot.
GINA GALAVIZ EISENBERG
That's okay. There is no wrong answer, but I agree with you. He's 82.
RON AARON
The answer is 82.
GINA GALAVIZ EISENBERG
Yes.
DR. RUTH ADELL
No way.
GINA GALAVIZ EISENBERG
Yes.
DR. RUTH ADELL
I was going to say 60, and I thought that's going to be an insult.
RON AARON
82 is the new 60.
DR. RUTH ADELL
There you go.
GINA GALAVIZ EISENBERG
I'm 61. He's a little older than I am, but I think that that is true because he's always having to do something. His brain is constantly thinking.
DR. RUTH ADELL
One of the other things that's come up in our family, my husband's experienced hearing loss and becoming more aware of that hearing loss and not using hearing aids increases your risk of dementia.
GINA GALAVIZ EISENBERG
I did not know that.
DR. RUTH ADELL
I have a lot of patients that are resistant to using hearing aids. They feel like it's too much of a burden, but there's good data out there supporting that hearing aids decrease your risk of dementia.
RON AARON
Well, it's interesting. I have hearing aids, and I finally got them after Gina spent months saying to me, you can't hear a thing. Get help.
GINA GALAVIZ EISENBERG
I didn't say that.
RON AARON
Well, she did, and when I went to the audiologist, who's got a great name, Roger Johns, two first names. Dr. Johns ran a test, and he said, you've got some deficits. He said, what brought you in? And I told him the story, and he laughed and he said almost every single male who comes in here comes in here because the wife said, you can't hear, get help. You're shaking your head yes.
GINA GALAVIZ EISENBERG
Were the best referral system.
DR. RUTH ADELL
It is true.
GINA GALAVIZ EISENBERG
But his life got so much better when he could hear. He was more alert. He's more active. He's engaged. I said, be part of the conversation, you know, be present with all of us.
RON AARON
You have to look at hearing aids like eyeglasses. You don't resist wearing eyeglasses and hearing aids provide the same kind of support. You're right. I've done programs, Dr. Adell, on that very subject of hearing deficit can lead to dementia. Part of the reason, and Dr. Johns has been on the air with us, he talked about it, is you spend so much time with your brain trying to adjust, adapt and refocus to help you hear that you develop deficits in the brain.
DR. RUTH ADELL
Yup.
RON AARON
So, when you say to your patients, get a hearing aid, or you're going to soon have dementia, how do they respond?
DR. RUTH ADELL
It's so much easier to have that conversation now. I've been practicing for a long time. Now that we have the data, there's a lot that patients are willing to do to not end up like their grandmother or their friend that has advanced dementia. I think thats one of the things were all scared of.
RON AARON
I got to stop you right here. We're having too much fun, and we are flat out of time. Thank you so much for being here, Dr. Ruth Adell and Gina Galaviz Eisenberg. I'm Ron Aaron. We'll talk with you soon on the award winning Docs in a Pod.
OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherise Pendleton. Thank you for listening to Docs in a Pod, presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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