Mercy Jefferson doctor encouraged by Alzheimer’s research

Memory issues are expected for aging adults, but consistent, frequent forgetfulness may be a sign of Alzheimer's or dementia.

This is the final part of a four-part series on Alzheimer’s, a disease that slowly destroys memory and thinking skills, and eventually the ability to carry out simple, daily tasks. The disease, often referred to as “the long goodbye,” is devastating to those who have it, as well as their family members and friends. The series focuses on the disease, how it is diagnosed, progress in research and resources available for caregivers.

Click here to read the first part of the series:

Click here to read the second part of the series:

Click here to read the third part of the series:

Dr. Tariq Alam, a board-certified neurologist who has practiced at Mercy Hospital Jefferson in Crystal City since 2012, says he is encouraged by recent advancements in Alzheimer’s research.

Alam, who has been practicing neurology in some form since 2006, said he has seen a lot of progress in research since then.

“It’s been a slow progress, and Alzheimer’s today is at the forefront of biomedical research,” Alam said. “I can tell you that the world over, medical personnel, scientists and doctors are working to try to figure out all the information we still don’t know about Alzheimer’s disease.

“(We) know a few things about Alzheimer’s, that Alzheimer’s is when microscopic changes start happening in the brain. There is abnormal protein deposition in the brain; then there are protein tangles in the brain, and all these things will cause the brain to shrink and brain cells to die.

“We have some treatment options for Alzheimer’s disease, and we’ve had these treatments for a few decades now. What they do is they slow down the deposition of these abnormal proteins and once they slow down the deposition of these abnormal proteins, it slows the progression of Alzheimer’s disease.”

Scientists have studied these proteins and whether there is a way to create a molecule to make these proteins ineffective, he said.

“Just recently, the FDA has approved a new treatment for Alzheimer’s disease, and that new treatment is a monoclonal antibody,” he said, referring to Leqembi. “The antibodies, once they’re given to the patient, they will hunt their scavenger protein and bind with those proteins, and it will make those proteins inactive or it will slow down what the natural progression of those proteins are,” he said. “Our hope is that with these new techniques, the way we are able to develop monoclonal antibodies, we will be able to slow down the Alzheimer’s disease.”

Alam said people sometimes ask him what good drugs like Leqembi are if they only slow the disease but don’t cure it or reverse the effects.

“Well, take the patient who is toward the end of his life now because of Alzheimer’s disease who is soon going to be institutionalized because of all the complications of Alzheimer’s disease,” he said. “If you can give them an extra number of years, extra number of months to slow it down, to still be able to recognize the family members, to still be able to recognize themselves, that’s a big deal for a lot of patients. That’s a big deal for a lot of family members.”

Alam said this is an exciting time in Alzheimer’s research.

“The amount of research that is going on is unprecedented,” he said. “And I’m hopeful that with the advent of this first monoclonal antibody that has been developed, going forward, we will be able to come up with more and more treatment options for this condition.”

The earlier the diagnosis, the better

As a neurologist, Alam has a lot of patients who come to him with memory problems and dementia.

“A good number of those patients turn out to be Alzheimer’s patients that we take care of,” he said. “Not every forgetfulness is going to be Alzheimer’s, and not (all) forgetfulness is going to be dementia. Not every dementia is going to be Alzheimer’s disease.”

There are many types of dementia, and Alzheimer’s accounts for 60-80 percent of dementia, according to the Alzheimer’s Association.

Alam said microscopic changes in the brain start five to 10 years before the first signs of memory loss.

If your family members or close friends have said something about your forgetfulness affecting your life, you should listen, he said.

“A lot of patients themselves might not even know that they are developing dementia or for that matter developing Alzheimer’s disease,” Alam said. “It’s usually the family members or friends who have noticed this first, and many times when family members and friends will point this out to the patient, the first reaction will be, ‘Oh, I was just being forgetful,’ or maybe ‘I have been stressed.’”

Alam said even if you don’t believe you have dementia, it is important for you to discuss those concerns with your doctor, especially if those around you have noted that your memory issues are accompanied by problems with reasoning, judgement, word retrieval or problems doing tasks or hobbies that were once easy to do.

“These are all red flags there’s something underlying going on in the brain, and you should seek medical care,” he said.

Alam recommends a visit to a primary care physician because there are other medical issues that can cause memory difficulties, like vitamin B12 deficiencies and thyroid problems.

“The primary care doctor is usually your first stop where you can get these basic things checked out,” he said. “And if these basic things are normal, your primary care for sure will refer you to a neurologist so that you can be tested more accurately and more in detail.”

Diagnosing Alzheimer’s

Alam said neurologists are very careful when it comes to diagnosing dementia or Alzheimer’s.

“Because really, Alzheimer’s is a diagnosis that will change your lifestyle,” he said. “And we know that Alzheimer’s does not just affect the patient, but also it affects the family; it affects the caregivers. We are very careful when we diagnose someone with Alzheimer’s that we have given them the right diagnosis.”

Alam said for a diagnosis, patients will need a complete neurological examination.

“You will need a complete testing of your mental faculties,” he said. “You will need some brain imaging and, in some cases, we also do spinal tap or other fancy tests like PET scan that can pick up Alzheimer’s disease.

“There’s also something known as neuro psych evaluation. Neuro psych evaluation is when you sit with a neuropsychologist or a person who’s trained in memory testing, and you spend at least three or four hours with them and they go over every aspect of your memory by asking you questions. It’s a non-invasive test. That can tell us to a very large extent that the kind of dementia the patient is having is Alzheimer’s disease.”

Alam said when he breaks the news to the patient, he likes to have family members present to talk about what is happening to the patient’s brain, how to seek treatment and what to expect.

“I think when patients and family members have a clear understanding as to what the disease is and what they can expect in the next two years, five years or more, they are better able to deal with all the complications that arise or that happen with this disease,” he said.

Alam said the earlier the stage, the more doctors can help in terms of slowing the progression of the disease.

Alzheimer’s has seven stages, but the length of each stage is different for every person, he said.

“The reason for this is because Alzheimer’s disease is a function of our genes, of our environment and of our social surroundings,” he said. “So many different things play a role in Alzheimer’s disease.

“Someone who has good family support, someone who has less co-morbid conditions, someone who exercises regularly, they will progress slowly to the severe stages rather than someone who has made lifestyle choices where they have uncontrolled hypertension, uncontrolled diabetes and about the kind of food that they eat – processed food and things like that – and, of course, if they have a strong genetic link, those patients will proceed faster.”

This list shows some of the early signs of Alzheimer’s disease to look for.

Empathy and compassion helps

Those with Alzheimer’s lose their independence over time, and tough decisions have to be made about when patients should stop driving, when they should turn over their finances to someone else and when guns should be removed from their home, Alam said.

He said he deals with those issues every day in his practice.

Alam said he doesn’t have those conversations with the patient alone because his or her spouse and adult children, if they have any, need to be present.

“Having these family members is always helpful to understand the gravity of the situation, because the family members can also help the patient to realize that this (giving up driving or turning over their finances to someone else) is in their interest,” Alam said. “Of course, we have a patient-physician relationship and we can tell them (information) from a medical perspective or from a physician perspective, but when the family comes in, holds their hand and tells them that we care for you and we don’t want you to be a cause or source of harm for yourself, or even cause harm to others.”

Empathy and compassion are most important, he said.

“These two words, in conjunction with the patient’s loved ones, will basically make you succeed in a conversation like this,” Alam said.

He said it takes a while for doctors to build trust with the patient and their families so they can have those tough conversations.

“You cannot have this conversation on the first visit,” he said. “You can tell the patient or the family ‘be careful with driving’ or ‘I’m putting you on driving restrictions right now until we find out more information,’ but you cannot just tell them on the first visit you cannot drive now. There will be a reaction. That’s how we approach, with compassion, with empathy, giving scientific reasons for safety concerns and the family members being a resource to help us.”

Alam said he sees patients at different stages of the disease and with a variety of backgrounds and family situations.

Sometimes, social workers are needed. Sometimes psychiatrists are needed, he said.

“It’s a multidisciplinary approach where your neurologist, your primary care physician, your psychiatrist, and all your ancillary health staff, will have to play a role to make sure that this difficult time of one’s life is properly managed, not just for the patient but for the family members also.”

To read writer Teresa Inserra's column on her personal experiences with Alzheimer's, click here:

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