Theresa Redling is a board-certified geriatrician trained at Mt Sinai Medical School. Her interests include caring for elders over 65, diagnosing and treating conditions like Alzheimer’s and related dementias, conducting new drug trials and improving the health care system for seniors.
In an interview with Elder Care Review, Redling shares insights on how dementia care is currently addressed, the latest developments in its treatment and broader approaches to improving senior healthcare.
The Growing Need for Specialized Dementia Care
There is an increasing need for specialized senior care services as the global population ages, particularly in the U.S. The number of Alzheimer’s disease and related dementia cases is also rapidly rising. A large portion of a geriatrician’s practice typically involves patients with dementia or mild cognitive impairment (MCI). Alzheimer’s disease is the most common cause of dementia, responsible for approximately 65 percent of all cases.
Early Diagnosis for Effective Treatment
Dementia is typically diagnosed when memory problems are accompanied by the inability to perform daily activities independently. While catering to patients suffering from dementia related-diseases, it is necessary to identify MCI or memory problems in the early stage itself, as early diagnosis and intervention can have a greater impact on the course of the illness. The treatment of Alzheimer’s disease has improved significantly in recent times. Newer treatment options are most effective when administered during the early stages of the condition, particularly for people with pre-dementia.
An active lifestyle, a healthy diet, maintaining good relationships and a spiritual life help lower the risks of dementia. Studies have shown that up to 50 percent of dementia cases could be prevented or delayed through good lifestyle T and dietary changes.
One of the biggest challenges in dementia care is making an early and accurate diagnosis. Previously, neuropsychological testing and brain imaging were important to the diagnostic process. Recent advancements in dementia medicine include using biomarkers, which help precisely identify Alzheimer’s disease. This includes spinal taps, which involve collecting spinal fluid to test for certain proteins, or a special type of brain scan called an amyloid PET scan.
Advancements like serum biomarkers and blood tests also complement different types of biomarker testing. These biomarkers help make earlier, more accurate diagnoses, which are crucial for starting patients on the appropriate treatment course.
For those with early Alzheimer’s or MCI, monoclonal antibody drugs like Leqembi and Kisunla are a suitable treatment option. These drugs clear the amyloid plaques—which cause Alzheimer’s—from the brain.
Effective treatment for Alzheimer’s requires a multimodal pharmaceutical approach, more than just monoclonal antibodies.
Role of Lifestyle in Dementia Care
Beyond medication, lifestyle changes play a greater role in preventing dementia. The concept of blue zones, a region where people live long and healthy lives with lower rates of dementia, is an ideal example of the same. An active lifestyle, a healthy diet, maintaining good relationships and a spiritual life help lower the risks of dementia.
Studies have shown that up to 50 percent of dementia cases could be prevented or delayed through good lifestyle and dietary changes. Managing diseases like obesity, diabetes, hypertension and vascular diseases that increase the risk of developing Alzheimer’s and other types of dementia is also equally important.
Improving Dementia Care with Adequate Support
Abnormal amyloid deposition is not the only issue in Alzheimer’s. Scientists are also studying the role of tau protein buildup in the brain. There are ongoing clinical trials that explore ways to treat abnormal tau deposition, which could provide another avenue for managing Alzheimer’s.
When I started practicing over 30 years ago, two drugs, Donepezil and Memantine, helped to manage some of the cognitive symptoms of Alzheimer’s. These are still used today, but they don’t cure the disease. They just help manage symptoms. Another big area of dementia care is managing behavioral and psychological symptoms of dementia (BPSD), which includes agitation, hallucinations, depression and insomnia. Symptoms like wandering behaviors are also persistent in BPSD cases and are often not responsive to medication. These challenges are tremendously stressful for caregivers, making it necessary to support them.
In response, Medicare is sponsoring a program called ‘GUIDE’ to assist caregivers in providing patients with an improved dementia experience. This program supports caregivers by offering financial assistance for respite care and providing a caregiver navigator to help with referrals for supportive care for both the individual and the caregivers. This initiative by Medicare enhances the care experience for patients with dementia and their caregivers by offering additional support, guidance and resources.
