Summit Q&A

Q: What is the name of the first medication people are on after being diagnosed with dementia?
A: Donepezil (Aricept) is usually the first dementia medication prescribed when a medication is indicated for dementia. It is approved for use in all stages of dementia.  However, the choice to start a medication should be thoroughly discussed with the clinician before making this decision. 

Q: Are pituitary adenoma and hormonal issues/endometriosis a huge risk? Where do I find ketogenic drinks OTC or is there a recipe you can send?
A: Hormonal insufficiencies can be a dementia risk factor if untreated, but severity can be minimal to severe depending on circumstances and the results of lab testing. Often there are other risks adding to dementia risk that may also be treatable. b) By ketogenic drinks, do you mean compatible with a ketogenic diet? If so, any safe drink that has protein, very little sugar and some fiber might be OK. If you mean a drink that causes elevation of ketones in the body, then any safe drink to which you add medium chain triglycerides (MCT) powder would qualify. Or, you could add coconut oil to a safe hot drink to get slightly longer ketogenic effect, but this has some saturated fat to consider if you have cholesterol problems. These should only be used if kidney function is good and your clinician approves. 

Q. Is it better to plan to stay in one’s home vs. moving to a facility when the caregiver is still able to manage daily living with a spouse who has dementia?
A: Depends entirely on your particular situation – would need to know lots of details to best advise you.  Your clinician, an occupational therapist or a social worker would be qualified to give you best advice after hearing your whole story.

Q. How do you differentiate between Alzheimer’s and Lewy Body Dementia?
A. There are many differences but they often co-exist in the same person.  Lewy body dementia is often associated with good days/bad days cycling, visual hallucinations and patients may not tolerate sedating meds very well, but there are many more differences that you can read about. 

Q. I am curious about the program that is offered for healthcare professionals. Details are in the initial forms I submitted.
A. I assume you mean training in something like the Bredesen Protocol?  If so, just go to the Website at Apollo Health to check out their training program.  

Q. How do drugs used for anesthesia affect the patient with dementia in the early stages as well as the late stages.
.A. Post-op delirium especially if more than once can be a dementia risk factor. Close monitoring for hypoxia or hypercapnia during anesthesia would be a given for an elderly person with dementia having a procedure under anesthesia along with gradual, careful post-op recovery management. The anesthesia clinician would likely chose the best anesthetic based upon the patient’s status at the time of surgery.

Q. My group includes those with memory challenges – a couple of them are confused about why the group split up and that they are being analyzed. They don’t remember asking the question 3 minutes later and keep asking me. Do you have any suggestions for making them feel safe when the group splits?
A. Joan Thralow’s support group at Whitney Senior Center “splits” also.  The 2 volunteers that take the persons living with dementia to the next room have many different fun activities that the patients enjoy and look forward to.  Call Joan Thralow through the St. Cloud Whitney Senior Center to discuss. 

Q. How is medical information regarding cognitive impairment results protected from other type of insurances obtaining the data (ex: long term care insurance, auto insurance etc)?
A. This is more of a medical-legal question, but important. You would have to ask for the data policy of each of the vendors you mention to find out how they obtain and use your data. 

Q. Do you have an opinion on the studies that are currently testing an AD vaccine?
A. There are several Alzheimer’s disease vaccines in trial currently that mostly target Beta amyloid or tau protein or offer immune modulation to reduced neuroinflammation.  Trials are ongoing and results may take years to find out about safety and effectiveness.  My opinion is that they should focus more on prevention of the pathology before it occurs or goes on too long to fix.  I think the best time to administer some type of Alzheimer’s vaccine or other therapeutic modality would be as soon as some predictive biomarker test (not for sure invented yet) shows risk (maybe as young as 35-50), then give the shot or other modality to prevent moving into Alzheimer’s pathology. 

Q. Where is Medicare at in funding such a program?
A. Congress is considering new ways to fund proven dementia management methods, but things like this take a long time to craft, approve then operationalize.