Nearly 25 percent of Florida’s population is age 60 years and older, and more than half a million of these seniors are living with Alzheimer’s. To learn more about the prevalence and treatment of Alzheimer’s, the Orlando Sentinel Editorial Board tapped the expertise of Rosemary Laird, M.D., a geriatrician at Florida Hospital’s Centre for Senior Health. As a backdrop, Florida’s Legislature is considering a $20 million budget cut that would affect seven memory disorder clinics in the state, even as Sen. David Simmons, R-Altamonte Springs, sponsors a bill to designate a memory disorder clinic at Florida Hospital in Orlando.
Q: What does treatment for Alzheimer’s involve?
A: Ideally, treatment for Alzheimer’s disease involves a team of professionals trained in the disease and experienced with the course of the illness assisting patients and their families through the course of this chronic illness. I say “ideally” because that type of team-based care is not readily available everywhere. Often it is found in academic medical centers and some community-based health systems. To address the range of needs an ideal care team includes a medical doctor, an advance-practice registered nurse, and a licensed clinical social worker, and perhaps even a pharmacist. Florida Hopsital’s Centre for Senior Health is an example of a team-based clinic providing full range of diagnosis and care support.
There are traditional, FDA-approved medications that have shown benefit in about 40 percent to 50 percent of the patients who take them. Benefits can include slowing the decline of cognitive ability or memory loss, and slowing the loss of function.
There is a misconception that because there is no “cure” for Alzheimer’s, there is no “treatment.” That cannot be further from the truth. There are many strategies we can take to assist the patient and family in coping with the changes of the illness, adapting their day-to-day routines, as well as the need to address symptoms that are common accompaniments of Alzheimer’s disease such as depression, anxiety, sleep disturbance, weight changes, etc.
Sadly, even among physicians sometimes there is a pessimistic outlook communicated that there is “nothing to be done,” so we try to make people aware of the availability of support.
Q: How prevalent are Alzheimer’s and other diseases that affect memory?
A: According to the Alzheimer’s Association, more than 5 million Americans are living with the disease. There are 480,000 people with Alzheimer’s disease or related disorders in the state of Florida. Here in Central Florida, we believe there are about 30,000 patients with Alzheimer’s living in Orange, Osceola and Seminole counties.
Q: Are certain populations more at risk?
A: Almost two-thirds of Americans with Alzheimer’s are women, and there are differences among different ethnic groups as well. African-Americans are about twice as likely to have Alzheimer’s or other dementias as older whites. And Hispanics are about one and one-half times as likely to have Alzheimer’s or other dementias as older whites. Studies have found that diabetes and cardiovascular risk factors — such as high levels of blood pressure, blood sugar and cholesterol — increase the risk of dementia.
Q: What are the trends in how many people will be diagnosed?
A: This is an interesting question. There was a study that found dementia rates are actually declining. The decline may be due to an increase in medications to treat risk factors such as cholesterol and high blood pressure, and to improved awareness of the need for brain health and wellness among many seniors. But simply being 85 years old and older is a risk factor, so as the population ages in the coming decades, we will still see many, many patients.
Q: Are there any improved treatments or breakthroughs on the horizon by drug makers on Alzheimer’s?
A: The short answer, unfortunately, is no. There are many, many issues with clinical trials involving Alzheimer’s. Since the diagnosis is so difficult, it is hard to know you are testing effectiveness against Alzheimer’s when you test a drug. Some scientists believe that by the time the brain shows signs of the disease, it may already be too late to treat the damage with drugs. People should know that it’s unlikely that there will be a cure in the next 20 to 30 years. Those of us with aging parents should be prepared for the possibility that we will need to act as caregivers.
Q: What advice do you have for caregivers to help handle the burden of caring for a loved one with the disease?
A: I co-wrote “Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One with Memory Loss” about this issue. And that’s a main point I would stress to caregivers. This is a long illness, involving the slow loss of ability and the increased need for care support over time, so the impacts are enormous not only on the patient but on the caregiver. You have to take care of yourself first, or the chronic stress of caregiving over such a long time horizon will add illness to your life, in addition to your loved one’s illness.
Q: What is the importance of pending legislation establishing a memory disorder clinic at Florida Hospital?
A: Since 2012, Florida Hospital has operated its self-funded memory disorder program, the Florida Hospital Maturing Minds Clinic. FHMMP provides early screening and diagnosis; helps patients manage their symptoms; provides education and training for caregivers; and conducts research. FHMMP currently conducts more than 360 new patient memory loss evaluations each year and provides services and referrals to other local organizations to additional patients and caregiver clients.
The pending legislation would add our clinic to the list of state-recognized memory disorder clinics. This change will give us a competitive advantage when we apply for state and national grants, potentially bringing federal funding home to Florida. It will also help us continue to grow our programs offering state-of-the-art diagnosis and care for patients with Alzheimer’s and related dementias and support for their caregivers here in Central Florida.