Every year, millions of people worldwide are diagnosed with Alzheimer’s disease, but what are the leading signs and symptoms of the disease? David Levitt, MD, a contracted physician at Aegis Medical Group in Clermont, Florida, discusses what to look for and available treatments available for people who have or are likely to develop Alzheimer's disease.
July 3, 2024
Docs in a Pod focuses on health issues affecting adults. Providers and partners discuss stories, topics and tips to help you live healthier with hosts Ron Aaron, Dr. Audrey Baria and Dr. Tamika Perry.
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Show transcript
Podcast transcript
INTRO
Welcome 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-host Dr. Audrey Baria and former television broadcaster Gina Galaviz will share information to improve your health and well being. And now here are Gina Galaviz and Dr. Audrey Baria.
GINA GALAVIZ EISENBERG
Welcome to the award winning Docs in a Pod, presented by WellMed. I'm your host, Gina Galaviz Eisenberg sitting in today for Ron Aaron. He's on special assignment. We are so pleased to have you with us today. Docs in a pod is available on podcast wherever you get your podcasts, and we're also on the radio in several cities in Texas and Florida. Each week, we talk about a variety of health and wellness-related issues as they impact Medicare-eligible seniors and others. Our co-host today is Dr. Audrey Baria. Let me just give you a little bit of insight into Dr. Baria. She's a medical director and has been part of the WellMed family for several years and is currently a provider at the WellMed at 9th Avenue North Clinic in St. Petersburg, Florida. Her interest in medicine began at a very young age, thanks to your uncle, and I didn't even know this until now, was a general practitioner. He would take you on house calls to see patients that couldn't visit the clinic, and that had an impact on you, Dr. Baria. You decided, hey, I can make a difference in people's lives. Is that correct?
DR. AUDREY BARIA
Absolutely, Gina. It's so great to be back. The short answer is yes. The longer answer is I was probably around four years old and knew generations of families because my uncle would take care of generations. This was in India, and he would make house calls. So, you would have the great-grandparents, the grandparents, the parents. So, four generations and children, and he would take care of all of them. That's where my love for family medicine came in.
GINA GALAVIZ EISENBERG
And you're continuing that, that tradition.
DR. AUDREY BARIA
Yes.
GINA GALAVIZ EISENBERG
Well, we're going to have a great call today because as we all know, millions of Americans are diagnosed with Alzheimer's. every year. In fact, one of our neighbors passed away about a year ago and she was living with that disease. But what do we really know about the disease? How is it diagnosed? What are the symptoms? We are going to be talking with Dr. Levitt. He's our special guest today and we're very excited to learn more about this doctor. You are an MD, of course, a contracted physician at Aegis Medical Group in Claremont, Florida. I think I butchered that first name of your group.
DR. DAVID LEVITT
No, Aegis is right.
GINA GALAVIZ EISENBERG
I got it right, all right. You earned your undergraduate degree from Sarah Lawrence College in Bronxville, New York, and you earned your medical degree from Hahnemann University College in Philadelphia. You've been happily married for 10 years and when you're not practicing medicine, you can, you ride roller coasters with your youngest daughter, and you walk your dog Benny with your wife. Roller coasters. Where did that interest come about?
DR. DAVID LEVITT
That is all hers. I have spent more time upside down than I really cared to measure. She is very brave from the time where she could barely fit into the strap down seats and she still loves it.
GINA GALAVIZ EISENBERG
And of course, you're her partner in crime when it comes to roller coasters, I guess, right?
DR. DAVID LEVITT
I'll ride it the first time and the last, and she'll go several times in between.
GINA GALAVIZ EISENBERG
How did you get this interest in this specialty on Alzheimer's? What was it for you that you said, this is a disease, and we need to study it more and we need to help patients with it?
DR. DAVID LEVITT
Essentially, my dad was a brilliant kind of guy. He was a neuro-biochemist. He did some of the original separations of norepinephrine, epinephrine and norepinephrine. By the end of his life he couldn't remember what he had for breakfast.
GINA GALAVIZ EISENBERG
Were you already practicing medicine at that time?
DR. DAVID LEVITT
Yes, and the current medications are mildly effective but for too many there's no response and it's just a terrible disease and too many people suffer from it.
DR. AUDREY BARIA
It's interesting you say that about the medications, the current medications and how they're mildly effective. I've seen that in my patients that have been diagnosed with mild cognitive impairment. They start them on these medications and I'm like, I don't really see much of a difference, and they've been on it for years. The caregiver normally comes back and tells me that, and I'm thinking about this one particular couple in particular, that it's just getting worse. I think the medications are just keeping them at that baseline when they got started and maybe the progression isn't as noticeable. However, the caregivers do notice it because the biggest complaint that I get from this one particular couple is that the wife is the one that's been diagnosed and that she keeps repeating herself. The same question or comment over and over and over again, and it's kind of taking its toll on the caregiver, who's the husband, who's about five years younger than her, but they're still in their 80s. It's just not a good picture.
DR. DAVID LEVITT
That's very common. The diagnosis is best made with the assistance of an informant, whether it's a caregiver or a wife or a husband because the changes in mentation are so subtle and the change over time is also subtle. Very rarely do you see improvement. Sometimes with mild cognitive impairment, the name of the real game is to slow the decline. Which can be wonderful in that it can keep a loved one out of a nursing home, out of a memory unit, for a year, two years, then compared without it, but it's inevitable.
GINA GALAVIZ EISENBERG
Dr. Levitt, I'm going to ask you for the early warning signs first, but I'm just going to take a quick little break just to remind everyone who's listening that you are listening to the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. Our co-host is Dr. Audrey Baria, a WellMed physician and medical director, and our guest is Dr. David Levitt. We're talking about what everybody needs to know about Alzheimer's disease. How do we know we need to come to you? What are the early symptoms and warning signs?
DR. DAVID LEVITT
It's all about memory impairment, and it can be kind of global where it's part of natural aging to walk into a room and go, what the heck did I come in here for? But there's a point where that that's more than normal aging. You have trouble making more recent memories than before, where you forget where you've been. And, that can be from minutes ago to hours to days. Those normal memories are just not setting into long-term. It can be very subtle early on. Then you can talk about medications, and you talk about response to it versus the risk of taking a medication. It's very subtle memory issues.
GINA GALAVIZ EISENBERG
What happens next? I mean, is there a timeline of the progression of the disease from the time that we come in to see you and if medications aren't really doing what they should do, what do we do? What can a patient do? Or a caregiver who's watching the decline.
DR. DAVID LEVITT
That is the tough part. The decline is inescapable. The medications do not stop the disease, do not cure the disease. The best you can do is kind of live with what you have going on. And essentially, you have to make plans for the disease to get worse. There's very little good news. There's always research being done. They are trying to find more accurate ways or more objective ways to diagnose it rather than just based on discussion from caregivers and tests on the many mental status exams, trying to do better and better MRI imaging to find a better diagnosis. With a better diagnosis, with a more objective diagnosis, you're treating the same disease and research stands a better chance of being meaningful. But there's no good answer to it.
DR. AUDREY BARIA
In residency, I did a family medicine residency and as a third year, we were responsible for one or two nursing home patients. We would go to the nursing home and make rounds on these patients at least a minimum of once a month. My one patient had Alzheimer's and when I picked him up, he'd already been at this nursing home for several years and the decline that I saw over the year that I was taking care of him. Actually, let me rephrase that. I actually had him for the three years, and the decline that I saw over the three years was unbelievable, especially the last year that I had him, and then he died shortly after I graduated from residency, and it was awful. Towards the end, he didn't even know his own name, and he was nonverbal at the end. So that was also very jarring.
GINA GALAVIZ EISENBERG
Are there more cases that we hear about because it's happening, or are we just talking about it more?
DR. DAVID LEVITT
It's going to happen more and more as the population ages. It really begins to take hold at about age 65. Then about every five years it doubles. There are going to be more cases as the population ages. So, there are going to be more and more cases.
GINA GALAVIZ EISENBERG
So, at 65, when we come in to see our GP, is that something that you're conducting tests?
DR. DAVID LEVITT
Yes. Some screening tests should be done. It varies from office to office what type of screening test. We use the mini mental status exam. It's quick, it's effective. It can also be used to monitor treatment in that once you start treatment, you don't want to see the decline in the scores continue. That is a treatment failure. At that point you can add another medication to see if it works better in combination with memantine. But you're going to have a decline and I think that at this point in the science, the best offering is slowing the decline.
GINA GALAVIZ EISENBERG
Dr. Levitt, I'm going to interrupt for just a moment. We're going to continue this discussion in just a moment. I'm Gina Galaviz Eisenberg with our co-host, Dr. Audrey Baria and our guest, Dr. David Levitt. You're listening to the award winning Docs in a Pod. We'll be right back.
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GINA GALAVIZ EISENBERG
Thanks so much for staying with us on the award winning Docs in a Pod. I'm Gina Galaviz Eisenberg, along with our co-host, Dr. Audrey Baria. Let's continue our discussion on Alzheimer's with our guest, Dr. David Levitt. Dr. Baria, you had a question.
DR. AUDREY BARIA
Yes. Dr. Levitt, do you recommend to your patients, especially if there's the caregiver and the patient to have some sort of routine for the patient that's afflicted with Alzheimer's and what kind of aids do you tell them to incorporate into their day-to-day life?
DR. DAVID LEVITT
Routine is very good. Within the household, a lot of visual cues. Have a large calendar with a today is, the weather is, the season is, upcoming holidays. All to keep small reminders on for the patient.
DR. AUDREY BARIA
I've even had my patients put post it notes around their living quarters or just as reminders that hey, this is where the knives and forks and utensils are or things like that.
DR. DAVID LEVITT
Right. Labels are fantastic for that. Things work differently for different people so a lot of it will be trial and error.
DR. AUDREY BARIA
That's true. I do tell my patients that as well, that what works for one person doesn't necessarily work for someone else. So, trial and error.
GINA GALAVIZ EISENBERG
It's definitely something that affects the entire family because I would imagine since it's happening to the patient, they're not really observing what's happening. Does that make sense?
DR. DAVID LEVITT
Yes.
GINA GALAVIZ EISENBERG
Your loved ones are watching the decline.
DR. DAVID LEVITT
What's interesting is patients that are more aware of their decline tend to be more depressed than patients that are unaware of their decline, who are more happy go lucky. But that's where becoming a doctor really is heart wrenching. That you have to tell someone, no, you shouldn't be driving anymore. You're not following the visual cues. You're going to run a red light, you're going to get into a bad accident and you have to do that. I tell patients, better a year too soon than a day too late. Very difficult decisions need to be reviewed with the family, the caretakers, as well as the patient.
GINA GALAVIZ EISENBERG
Is this hereditary? If my mom or my grandmother or someone has it, will I get it or will my children get it?
DR. DAVID LEVITT
There are definitely a few forms where it's very much an autosomal dominant hereditary disease, which is very rare, but having a family history of it also increases your likelihood. You have to do the things that help prevent it. They're very basic, very basic things like exercising, that the high blood flow through the brain seems to help prevent some of the toxins building up. Watching your blood pressure to avoid having a stroke. A stroke increases your chance of developing Alzheimer's. Two strokes more than doubles it. If I remember that stat correctly. Very basic things like avoiding diabetes, keeping your weight down, which is back to exercise and diet. The basics can be very effective.
GINA GALAVIZ EISENBERG
Obviously, I'm not a doctor, but I've often said, and I've often felt just by watching people that I know that the minute you stop using your brain and stop doing things and keeping active, I see a decline anyway, whether you have Alzheimer's or not. Is that important to keep your mental sharpness, to keep busy? I guess along with that, you really start moving around, you're exercising and what have you, too.
DR. DAVID LEVITT
Yep. Social isolation is both thought to be a cause of some of the progression as well as an effect of some of the progression. So, you got to stay busy, got to stay active in life.
DR. AUDREY BARIA
The sedentary lifestyle, which goes to the exercising and making sure that you're moving, but also brain exercises. I tell my patients that are very worried about getting Alzheimer's or cognitive impairment is like Sudoku puzzles or crossword puzzles. I was like, if you can conquer the New York Times crossword puzzle, you've got it made. You don't have to worry.
GINA GALAVIZ EISENBERG
Really?
DR. AUDREY BARIA
I mean, I was joking about that, but I find that crossword puzzle to be very difficult.
DR. DAVID LEVITT
If you think of all the activities needed to do a crossword puzzle, you not only have to be able to read, but you have to think of the associations from the clues. You have to be able to hold and adjust the newspaper or the iPad. You have to be able to write. All those things use different parts of the brain.
GINA GALAVIZ EISENBERG
How does alcohol affect this disease?
DR. DAVID LEVITT
Overindulgence leads to a different type of dementia. It's one of the things you look out for when someone is brought in saying, hey, they're losing their memory, and you check thymine because that's common in alcoholics, to be quite low, and it's actually one of the few reversible causes. But overindulgence, not a good thing.
GINA GALAVIZ EISENBERG
Exactly. Well, that's good to know.
DR. AUDREY BARIA
I try to tell my patients moderation, everything in moderation. It's like when you tell the diabetic patient, no, they can't have sugar anymore. The first thing they're going to do when they leave your office is hit the donut shop or something.
GINA GALAVIZ EISENBERG
How do patients react when you give them the diagnosis and how long before they're able to, and the caregivers to get on track to tackle it, to begin their routines?
DR. DAVID LEVITT
Yes. Some with disbelief. They'll make excuses that they're not paying attention, that they don't notice it, or they've always been bad with these numbers. But on the test, I wish I had one with me, the testing is very basic that a problem completing it well is significant. We're not talking about doing rocket science in your head, but simple math and numbers. But a lot of times disbelief and if they believe it, very fearful.
GINA GALAVIZ EISENBERG
Do you recommend once you receive this diagnosis to perhaps start counseling or get in family counseling? What is the first step once you give a patient a diagnosis? What's what happens next?
DR. DAVID LEVITT
We kind of discuss the implications. Do they want to try the medications if they have side effects, but the side effects are not life threatening. We'll try them and there's just a few of them. We can give them a whirl, see if there's a good response, a medium response or no response. And then the next step would be adding a man team. I'm sometimes overly honest with my patients and I do let them know that these medications aren't a cure, that a good response would be slowing the decline. For some people they do want to pursue some counseling ahead of time. Some want to pursue not quite a bucket list, but the exact opposite. Not what they want to do, but what they need to do for their family as the disease progresses and they're able to do less and less.
DR. AUDREY BARIA
I also tell my patients to make sure that if there are any major decisions or anything where they require all of their faculties to make those decisions sooner rather than later because you're going to get into the whole who's your power of attorney, who's your medical surrogate and so on so forth and they won't be able to make those decisions and then it just becomes very convoluted and sometimes not in the patient's best interest.
DR. DAVID LEVITT
Correct.
GINA GALAVIZ EISENBERG
You mentioned that 65 is typically the age where you should start getting screened.
DR. DAVID LEVITT
Correct.
GINA GALAVIZ EISENBERG
Does it happen to younger folks than 65? How fast does it progress? Can you live like this for 20, 30 years?
DR. DAVID LEVITT
The younger patients, they're in their 40s and 50s, it's more likely one of the rare hereditary forms. People can survive 20 years, but thats definitely on the outside of the range. Typically, depending on where the patient's age is when the diagnosis is made, somewhere between three and eight years is generally average. But it can be more and it can be less.
GINA GALAVIZ EISENBERG
But get help, get screened and get the help. Dr. Baria, is there anything else you'd like to add or ask Dr. Levitt before we start winding down?
DR. AUDREY BARIA
No, I think that the biggest thing that he touched upon was the fact that start getting screened the earlier you can do that. There are so many facets to being the caregiver and being the patient and that there is help out there. Trying to get hooked up with area agencies on aging also has help that's out there. Getting into the community.
DR. DAVID LEVITT
Alzheimers.org
DR. AUDREY BARIA
Support groups and caregiver support groups as well so that you can get some relief and know that you're not alone.
DR. DAVID LEVITT
And again, prevention. Keep your blood pressure well managed, keep your sugars well managed, exercise both physically and mentally. If you're really worried, get a new hobby or get deeper into your current hobbies.
DR. AUDREY BARIA
Learn something new.
DR. DAVID LEVITT
Yes.
GINA GALAVIZ EISENBERG
Also know you are not alone. Dr. Levitt, we thank you so much for talking with us about this today. Dr. Baria, thank you so much. And to everybody listening, thanks for joining us today on the award winning Docs in a Pod. Thank you again, Dr. Baria for being our wonderful co-host and Dr. David Levitt. Thank you again for shining light on all of this. I'm Gina Galaviz Eisenberg and in the words of the late Charles Osgood, I'll see you on the radio.
OUTRO
Executive Producers for Docs in a Pod are Dan Calderon and Lia Medrano. Associate Producer is Cherese Pendleton. Thank you for listening to Docs in a Pod, presented by WellMed. We welcome your emails with suggestions and comments on this program at radio@wellmed.net. Be sure to 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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