Brainspan: The Science of Staying Sharp as You Age

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We all want to stay sharp as we age — but how much of that is in our control? What happens when genetics come into play? And what about health advice promising to boost brainpower or slow cognitive decline? In this episode, we dive into the science of brain aging, separating fact from fiction and discovering what helps you live your best.

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Matt Eaves
Dementia in the United States is expected to double by 2026, reaching 1 million new cases a year in the next five years. The number of people age 65 and older with Alzheimer’s is expected to reach 8.5 million, primarily due to the aging population, and neurological conditions are the leading cause of ill health and disability worldwide. Now, Macie was doing the research on this and when I saw that, I googled it a couple of times because with all we hear about heart disease and cancer that just didn’t seem right to me. But in fact it is, and over 3.4 billion people are impacted by neurological conditions.

Macie Jepson
And yet some people grow old so gracefully that you would never guess their age. They’re who you go to for the crossword puzzle. They have the stamina to go for a run on. Most days they’re always up to keep the grandkids all weekend long. When I see people like that, they truly inspire me. I want to be just like them when I get older, in mind and also in spirit.

Matt Eaves
But the question is how? What can we do to preserve our mental acuity in general, and especially when genetic factors are at play? How do we live our best lives when we get old? Are we to believe all the promises of supplement companies? The answer comes in a powder or pill form. But do they really work? What is the science behind aging gracefully? I am Matt Eaves.

Macie Jepson
And I’m Macie Jepson. And this is The Science of Health. We already know that diet and exercise factor into our longevity, as does our family history. We’ve talked on this podcast and a lot personally about my mom’s battle with Alzheimer’s disease. We lost her at a relatively young age in 2017, so I really should be encouraged by all of the brain boosting supplements, all the diets out there. But to be really honest, I’m not confident that I can use any of that and truly prevent what could be my fate.

Matt Eaves
Yeah, I miss hearing about your mom. Unfortunately, I think much like cancer, we all know someone in our lives that is dealing with or has dealt with dementia or Alzheimer’s. My grandmother had a rough go of it. It was probably 20 years ago, and I can still vividly remember the my interactions with her, especially the interactions my mom was having with her near the end.

Today we’re tackling the promises out there by separating myth from fact. Joining us is Dr. Mohamed Elkasaby. He’s a neurologist who specializes in memory and movement disorders at University Hospitals in Cleveland.

Mohamed Elkasaby, MD
Thank you so much for having me.

Matt Eaves
Let’s start with the big thing I was researching which is, is there a difference between Alzheimer’s and dementia? Are those different diseases or the same?

Mohamed Elkasaby, MD
People wonder about the difference between Alzheimer’s disease and dementia. And if we start just defining each one, I think dementia is more a category. So by itself it’s not a diagnosis, but it’s a constellation of symptoms. And I would say it’s used as an umbrella term. The main thing that characterizes this is interference with day-to-day function.

So, this is considered dementia. It’s a category can be caused by different etiologies, including Alzheimer’s disease, including vascular dementia, including frontotemporal dementia, dementia with Lewy bodies. And what is commonly seen in clinical practice is what we call multifactorial dementia or mixed dementia. If we talk about Alzheimer’s disease, it’s considered the most common type of dementia. It accounts for at least 60 to 80% of cases.

Alzheimer is a neurodegenerative disorder. On the pathological level, there are certain proteins that accumulate in the brain. When they accumulate in the brain, they can interfere with memory and learning. They can also interfere with other cognitive abilities, including judgment, problem solving and later on, can affect language. And it can also cause behavioral changes as well.

Macie Jepson
All right. You’ve just unpacked a lot. And under that umbrella, if you will, of dementia are the risk factors for everything that lives under that umbrella.

Mohamed Elkasaby, MD
So I think it’s a very good question. Maybe we need to differentiate between two main categories and risk factors. We have what we call non-modifiable risk factors like our age, our family history, our genes. But there are other modifiable risk factors that can vary, like history of head injury, history of hypertension, diabetes, excessive alcohol use, smoking history.

You know, all these factors could be modifiable, including lack of exercise, sedentary lifestyle, bad dietary habits. So it depends what we are talking about, but we can probably take some measures to improve the modifiable risk factors.

Macie Jepson
We’re definitely going to dig into that later because we want to know if there’s anything we can control and how do we make that happen. But first I want to talk more about the damage to the brain. What’s happening in the brain that causes these diseases.

Mohamed Elkasaby, MD
So if we look at Alzheimer’s disease, we have, you know, the most accepted framework is what we call ATN. And ATN stands for A is amyloid deposition and T is a tau deposition. And then we have the N which stands for the neurodegeneration. So this is basically the cascade of events that happen during that pathology. Like when the pathology of Alzheimer’s disease develops.

What we also know from the research is that the pathological changes for Alzheimer’s disease is starting to happen up to 20 years before patients start to have symptoms. So it’s a very slowly progressive disease that starts at different stages, until it comes to the point when the patients start to notice symptoms.

Matt Eaves
When you’re talking about the constellation of symptoms, at what point—you know, I’m getting to the age where I felt like when I was younger I had a sharp memory. I wouldn’t take notes and meetings. I could remember stuff from three days ago, right in the blink of an eye. And now I struggle sometimes to put those things together.And it’s like, now what was the name that I have to think back?

At what point is it just sort of well, you can differentiate between old age and there are probably some neurological issues starting to come on. And should people be reacting to just being a little forgetful, should that be worrisome? Or it’s like now it has to get to the point of X, Y and Z before you should start thinking about intervention.

Mohamed Elkasaby, MD
Yeah, I think this is a fantastic question, Matt. And the reason I’m smiling, because actually this is what I get when I see patients. Like I have the caregiver who is concerned over the patient’s memory, but the patients say it’s just that I’m getting old. What happens? We look at cognition as a continuum as we get older.

There are certain areas of our cognition that can change even when we are in our 30s. Like our processing speed is not as quick as when we were kids. And then if we look at the other stages of this continuum, we look at what we call age-related changes. We can see some changes in our cognition.

But the main thing if they are not considered extreme or considered abnormal for age and education, they need to look at the full picture. You need to see who you are talking to. What is their educational level? Are they tired or working? Are they having different co-morbidities? What are the medications? So we need to evaluate patients in their own context. This is very important.

So age-related changes can happen. But what is important is that it does not really interfere with their day-to-day function. And these changes are not considered abnormal for their age and education. Then you come to the next stage, which we call mild cognitive impairment. There are some cognitive changes that can be seen in day-to-day function. But patients are still able to independently manage their day-to-day function.

Then if things progress from here, we come to the next stage, which is mild dementia. So mild dementia is technically defined when we have interference with our day-to-day function. And typically I’m saying mild because usually this is how things progress. Like from mild cognitive impairment you go to the next stage, which is mild dementia. So people, when they start to struggle with certain areas in their day-to-day function, they start to struggle with the more complex tasks, like managing finances, driving a car, things like that. So multitasking. But they are still able to manage their basic daily living activities. And of course, what matters the most is what we call the longitudinal follow-up.

So we need to see patients over time to determine how the symptoms progress over time or they are stable, and it depends on what’s the underlying cause. Because sometimes patients have mild cognitive impairment and we follow them over time. And if it’s related to underlying Alzheimer’s disease pathology, it’s about a 10 to 15% of annual rate that they convert to mild dementia.

But if it’s unrelated to dementia, if it’s related to other things, that’s very important to clarify as well when we take the history. So let’s say some patients who have uncontrolled depression, some patients have untreated sleep apnea—all these comorbidities can lead to mild cognitive impairment. But this is not something that progresses over time if we treat the underlying cause.

Matt Eaves
So when you have a patient in front of you, it sounds like the line is there has to be some sort of disruption in daily life or something that used to be easy to do, or you would consider most people being able to complete a task like driving a car easily, that becomes disruptive. Like for example, just thinking in my head as you were saying, that I don’t know why this has happened lately, but every time we leave for a long weekend or a vacation, we get to the top of the neighborhood and I’ve convinced myself that I haven’t close the garage, and then we have to turn around and go back and look to see. Yep. It’s in fact closed and never been open. We’ve never left it open. So, you know, I think about those kinds of things like concerning or is it not. It has to get far worse than you’re not able to remember something you did 20s ago or you’re overthinking a situation.

Mohamed Elkasaby, MD
No, not necessarily. This is what we call a function of attention. If we didn’t pay attention to what we did, this is something that can happen to everyone, like you are in the supermarket.

Macie Jepson
Myself on a regular basis.

Mohamed Elkasaby, MD
You are shopping, for example, and you went to a certain aisle and you start to ask, why did I come here? And then you start to check your shopping list. This is something that can happen, you know? It doesn’t necessarily mean that you have any kind of significant cognitive decline.

What matters most is when we are evaluating patients, we need to get history from the patient and what we call a knowledgeable caregiver. So someone who knows the patient well to tell you what is what we call the pre-morbid level. How did this patient perform in the last three or 4 or 5 years before all these symptoms started? And then you compare it to the current level of functioning. And then based on the difference, you can really determine where the patient at with their cognitive status.

Macie Jepson
This leads me to a memory that I think is worth sharing. We talk about disruptions for my mom. She was caring for my grandmother, who was ill, and she was on a mission. That gave her purpose, and she was hyper-focused on it. After my grandmother passed away, we saw an immediate decline in my mom’s mental health. The death isn’t what made her memory bad. But letting go, I think, is where she finally began to show the real signs of Alzheimer’s, if that makes sense.

Mohamed Elkasaby, MD
Yeah, I think it makes perfect sense. And we also get this a lot in the in the practice, with patients trying to correlate the beginning of cognitive decline with certain events like having Covid or being hospitalized for a UTI. And since that time patients never came back to their baseline. So I try to dig more into the history because I think what happens is there’s probably, as we mentioned, some subtle changes that patients don’t pay attention to and probably caregivers as well.

And then there is a major event that unmasks the underlying cognitive decline. And then we start to see things more clearly. And the other thing that can happen as well in this particular situation are losing the loved one or something. This could be like what we call a grief reaction. This can also present in terms of like lack of concentration, lack of attention, lack of interest, some apathy. And then we should we assess because patients can remain in this stage for up to one year.

So we need to see them actually frequently and try to determine if it’s really something related to that particular event. And they probably improve over time or this was just an unmasking event or something going on very slowly and then started to become more noticeable.

Matt Eaves
To build on Macie’s question or story a little bit. As I think about my family and friends circle, especially those who are older, it feels to me like the ones who are most mentally sharp or the healthiest have two things in common. One, they exercise or maybe exercise, probably stretch, they’re active, right? A bike, they go for walks, they’re outside, they’re doing things.

And then also they have a social circle. So they have things to do during the day, whether it’s yoga or there’s bowling or friends that they go watch a baseball game with. When you’re dealing with your patients, are there things that that people can do or things you recommended? Is my uneducated observation accurate in that being active and having a social circle are good things to maintain mental health or is it not? It’s just kind of coincidental or correlational.

Mohamed Elkasaby, MD
I think this is a wonderful question because this is definitely relevant, and this is part of my visit with every patient and caregiver to educate them on the management plan. So after we reach a diagnosis we talk about management. So I always tell them there are two main directions we need to go in parallel to each other.

One is what we call the non-pharmacological approach which contains different aspects including lifestyle changes. And these are mainly three main things. You know, staying active on a physical level. So exercising regularly is always helpful. And staying active on a mental level, doing things like brain games, reading crossword puzzles and also staying active on a social level so they stay around people. Because some patients, when they start to develop some cognitive decline, they become more withdrawn. They don’t feel comfortable staying around people for a long time. So definitely this would worsen symptoms.

So we need to always tell them stay active on these levels. And then the other aspect comes in, what we call the pharmacological approach. So it depends what type of dementia and what type of symptoms we determine. The management plan is based on that.

Macie Jepson
I seem to notice especially with commercials out there to just drink this, eat this, don’t drink alcohol. That’s a big one right now. I mean, is it really that simple or that important? You just mentioned some other things that that help. But what about alcohol and diet?

Mohamed Elkasaby, MD
There is a lot of research in this area regarding alcohol. Excessive alcohol is harmful. Moderation is good. They ask me like what type of diet they can follow. There is a recommendation for what we call the mind diet. The mind diet is a hypertension diet, part of a mediterranean diet that’s used to help reduce the risk of hypertension. In simple words, I would say just food that’s rich in vegetables and fruit and also whole grains, less saturated fat, less fried food, less sugars, less pastries.

Good things include a diet that’s rich in omega three like salmon, olive oil, nuts, things like that. Those are things that can be helpful or that are considered a healthier type of diet. So diet definitely would be a helpful part of the management. But I want to also say that we don’t have definitive evidence of this, that a certain type of diet could prevent Alzheimer’s. And the effect of diet could be modest and could be very individually based.

Matt Eaves
That is good to hear you say that. Working in healthcare, it part of my role is to stay on top of what’s coming out in terms of the latest trends. And then we alsouse social media and experts like yourself to say, what do you think about this? And one of the things that’s confusing for us is it feels like, especially around the topic of dementia, is anything that is slightly healthy, you know, keeps it away, and anything that is slightly unhealthy is going to mean your onset is later in life. And so for the average person, to your point about moderation, there are things that we do that are slightly unhealthy, but it’s enjoyable. Or we like to have a piece of cake or some snacks every once in a while. But I think putting this fear in people’s heads that if you’re not on this perfect track all the time, then you’re off the rails down the road. Now you’re on the road to dementia. And I think it creates this fear. And so hearing you say well, yeah, you should eat a healthy diet, but it’s not this idea that there’s one path and that’s the path that you have to stay on.

Mohamed Elkasaby, MD
You need to be reasonable in your recommendations in order to be followed. And the other thing I would say, they need to enjoy their life too. So I would say that’s important to maintain that balance. I think the main message is everything in moderation is good, and having a balanced diet is very important. And the other thing I noticed, especially in older people, is that they don’t pay attention to hydration. Hydration is very important. So they keep working in the yard and it’s very hot outside and they feel dizzy. And then some of them experience falls. So I always encourage them to hydrate and make sure that they drink enough water during the day.

Macie Jepson
Can we get what we need with a good diet, or can we get more of what we need with a supplement? Is there any science behind that?

Mohamed Elkasaby, MD
There are some concerns about using supplements. First of all, we don’t have well-controlled studies that actually involve the supplements and compare them to placebo as we have with regular FDA-approved medications. The environment of testing those supplements is not controlled, so don’t really know how much this would be a real effect versus placebo effect.

And the other thing is the interactions with other medications that the patients on. We know that most of the patients have other comorbidities and they are on different medications. So we want to make sure that those supplements don’t interfere with other medications they are using.

Macie Jepson
What are you seeing in your office as far as, common interactions with medications?

Mohamed Elkasaby, MD
Patients for example who are anticoagulation or patients who are taking certain anti-seizure medications, the level of these drugs in the bloodstream can get affected with certain supplements. So this is very important to review the medications, including supplements, and make sure that we document that. And talk to the patients about it for sure.

Macie Jepson
Don’t do it on your own for sure.

Mohamed Elkasaby, MD
Yes. It has to be a separate question during the history. And of course, we have the medication list that we go over with the patients, what’s active, what’s inactive, and also ask them if they have any other medications that are not listed or supplements.

Matt Eaves
You mentioned hydration earlier and the importance of that. I never really thought about that. Another interesting one that I hear often, and I don’t know that you can tell me if this is true or not, is the correlation between sleep and dementia. People who have poor sleep habits earlier in life or in their 40s and 50s are far more likely to get dementia because they’re not sleeping well. And maybe the answer the question has two things. One, what happens at night to our brain when we go to sleep? What is going on there? And then two, is lack of sleep correlated or causative to the dementia?

Mohamed Elkasaby, MD
So I cannot say that it’s a cause, but definitely it’s a risk factor.Remember that sleep is the time when we recharge and our brain recharges. This is the time that the brain gets rid of any harmful metabolic products or things like that. So it is very important that patients have good sleep hygiene, and this is one of the things that I always screen for when I evaluate patients.

What time do you go to bed? What time do you wake up? Do you take any naps refreshed in the morning? And there are certain questions related to our history when we talk about dementia, maybe it’s a caregiver question or a bed partner. I ask them, does the patient snore. This could be a risk factor for developing cognitive decline, if obstructive sleep apnea is untreated. This is something that we definitely screen for.

Macie Jepson
I don’t have anything that dramatic. But the older I get I just want a good night’s sleep. So I will occasionally take one of those, something with a PPM added to it. And you burst my bubble while we were preparing for this because you said that could be an issue. Tell us about that.

Mohamed Elkasaby, MD
Yeah, that’s correct. One of the things I see very commonly in patients medication list is that they are using a relaxing tool or maybe something that helps them fall asleep. And the problem with all these preparations or most of them, they have what we call antihistamines. Antihistamines can cause potential side effects, brain fog, confusion. They can affect patients attention. There are certain medications like zolpidem and similar medications. They are considered central nervous system depressant agents, and these kinds of agents have potential side effects. Patients in older age become more sensitive to that, so they can cause inattention. They can cause confusion. They can cause brain fog. They can affect cognitive abilities if they are used for the long term.

Macie Jepson
If I’m understanding you correctly, it’s the side effects that you’re more concerned about, not necessarily those drugs doing damage to the brain.

Mohamed Elkasaby, MD
Yes.

Macie Jepson
Okay, that makes me feel a little better.

Matt Eaves
There’s been a lot in the news recently about genetic tests that people have taken and you have the marker for dementia or Alzheimer’s. I think about often for myself, what I want to know. Would you take the test?

Macie Jepson
I have not taken it. And I think that I would if I were convinced that having that knowledge would change my outcome or change my quality of life. I’m not convinced yet that that’s the case, so what I don’t want is to learn that I have this and that. That’s just going to go down that road and there’s nothing I can do about it. Who wants to live that way? And if it came back negative, that certainly wouldn’t mean that I would be spared. So I have given it a lot of thought, Matt. And at this time I. I have not done it. Doctor, I am open for to a conversation if you would like to change my mind. I love being informed.

Mohamed Elkasaby, MD
So yeah, actually I agree with you. I think the basic thing starts with understanding what does it mean? And it is really important that we do that. First of all, we have to differentiate between two types of genes. We have what we call the risk genes that mean when we have them our risk to develop Alzheimer’s is increased, but it’s not guaranteed. And not having them does not mean that we will not get Alzheimer’s. So this is part of it.

The other type of genes is what we call the deterministic genes. They are rare to begin with, and they tend to happen more in familial Alzheimer’s disease. The likelihood of developing Alzheimer’s disease with these genes is pretty high. This is something that happens rarely and that’s seen more in early onset Alzheimer’s disease, which means that people who develop symptoms before the age of 65 and who are having multiple family members affected by Alzheimer’s disease.

Macie Jepson
Let’s talk about the worst case scenario, that one where you said there’s a pretty good chance that you could end up with Alzheimer’s. If you have this, what can we do for those patients? What can they do with that information that can change the quality of their life?

Mohamed Elkasaby, MD
I think we have different aspects. First of all, of course patients are concerned when they have multiple family members and they develop this at an early age. So it’s very understandable that they need to know, do I have this or not? So if they turn out to have this kind of gene, what should we do if they are younger? And probably most of them don’t have any symptoms?

I would say they start with following a healthy lifestyle trying to follow a regular exercise routine. Have a healthy diet, try to avoid any of the modifiable risk factors like stop smoking, no excessive alcohol, avoid any kind of risk for brain injury or head, trauma, things like that. And this is very important to follow.

The other thing I would say, since they know that they are at increased risk, I probably would encourage them to participate in research if they are interested. This is something that can help other people and help the field to develop new treatments or maybe more understanding of the underlying etiology.

Macie Jepson
We’re talking about medications that could prolong the onset of the disease or the progression of the disease. Is that what you mean by research? Or maybe that doesn’t even happen until you have a diagnosis?

Mohamed Elkasaby, MD
There are different clinical trials and some of them are looking at what you are talking about. There are certain what we call disease-modifying therapies. And we have two medications are approved by the FDA to be used in early Alzheimer’s disease. And when I say early Alzheimer’s disease, it’s people who have mild cognitive impairment or have a mild stage of dementia, but it has to be due to Alzheimer’s disease to be qualified to receive these medications. This is on the treatment level.

There are trials going on to see if starting these medications for people who have pathological changes in the brain but don’t have symptoms, can help delay the onset of the disease or not. I don’t think that we have to date any positive study in that regard. I think there were some studies, they were negative, but I think there is a lot of studies going on for this kind of early treatment.

And also, what we know about the medications that are approved. There are other medications in the pipeline to help slow down the disease progression so patients can enjoy their independence for a longer time.

Matt Eaves
My guess would be for those that are non-pharmaceutical type studies, you’re trying to isolate environmental variables or at the very least document them. So you have some sort of baseline. Because right now if I have the gene, but I’m engaging in unhealthy behavior, or if I don’t have the gene and engage in that behavior, it’s going to have an impact on what the percentage likelihood is, right? And so just the gene itself, that’s sort of the nature nurture conversation.

Mohamed Elkasaby, MD
That’s that’s basicallywhat we’re trying to explain to the patients. We have two main categories of risk factors. One, we cannot really change and one we can. So let’s start with the ones we can and then see how things go.

Macie Jepson
When my grandmother passed away there was no test that could have said it was Alzheimer’s until after she passed. And it wasn’t much better when my mom passed away not many years ago. But, doctor, from what you just described, there are ways to find out if we are in fact dealing with Alzheimer’s at an earlier stage now.

Mohamed Elkasaby, MD
Yes. That’s true.

Macie Jepson
That’s very helpful.

Mohamed Elkasaby, MD
Yes, definitely. And a lot of biomarkers are like being studied now. I think we are in the era of biomarkers. I think there is a lot of excitement around this. And the reason for that is not only to early detect Alzheimer’s disease, but the other thing to be really happy about and celebrate is that we have now treatments for early stages of Alzheimer’s disease.

So what you can do is detect early and treat early, so you can help patients enjoy their life for longer or have their independence by slowing down the disease progression. I think this is very important. And there are different biomarkers, it depends what we are looking at. There is different imaging that we can use. There are different biomarkers in cerebrospinal fluid, using a spinal tap, or there’s been more emerging blood-based biomarkers. So there are some blood tests that can test for Alzheimer’s disease.

Matt Eaves
You mentioned earlier about brain games or things that you could do to stay sharp. Do those really work? Is the brain like a muscle? And if you exercise it, it keeps it healthy. So is doing Sudoku or other puzzles or things like that, or just anything that’s mentally challenging. Is that is that helpful?

Mohamed Elkasaby, MD
Yes. For sure. You know, I think there are some studies looking at the opposite, like people who don’t use any kind of mental activity and people who are isolated. They are followed for a longer time, and they are found to have a higher risk compared to the people who are mentally active and socially engaged. So I think this definitely matters. It’s like if you don’t use it, you lose it. So this is something that you need to train all the time, at least to keep your cognitive abilities active and intact.

Matt Eaves
So a lot of times with Alzheimer’s or dementia, we’re thinking about the patient. But having lived it, as well as knowing other people who have done it, we hear a lot about the burden on the caregiver. Is there any advice you have for for caregivers who are dealing with this or how to, you know, work through this? Or if there are tips and ways of dealing with this more effectively?

Mohamed Elkasaby, MD
Yes, for sure. I really appreciate that point, Matt, because I see this many times in the clinic. I understand how burdensome their job is. It’s a 24/7 job. And this is a chronic disease that really slowly progresses. So they live this for who knows for how long and it’s something that really creates a lot of stress for them. And if they don’t understand how to deal with the symptoms, they might make things even worse.

We are very fortunate to have resources, which is very important. Patients say no one talks to them. They need to know what are the available resources that they can use, so that’s what I try to do. At initial visits when I talk to the caregiver, I always make sure that they have time for themselves. And if this is something that they can have, a home health aide comes for a few hours, maybe a couple of times a week so they can have some time for themselves. They can go meet with their friends, do something for themselves.

The other way we have been doing for over ten years, is a course called Savvy Caregiver. This is a very successful course. We do this at the Brain Health and Memory Center in Beechwood, and it’s done in person and virtually. So I try to give the patient and their caregiver the information for that. Of course, it’s mainly directed to the caregiver, and this helps them to deal with challenges, how they can redirect and try not to escalate and try to learn from other people who have experience with that.

I think it’s very helpful. I have a very positive feedback from caregivers who did the course, and they came back for a follow up, and they said, that has been very helpful to us. This is a very important part of the management to pay attention to the caregiver burden, for sure.

Macie Jepson
You’ve given us lots of reasons to be hopeful. You talked about the tools to diagnose earlier. You’ve talked about great strong resources and focus on on caregivers. So thank you for that. I feel like we’re getting toward the end on a very positive note. Doctor, is there anything else that you would want to add for our guests out there that would give them encouragement? And I and I would even say, help erase the fear because I had the fear and I will tell you that I will follow up and have a conversation with you, because that’s what probably needs to happen. So anything that you could do to alleviate the fear in people and give them a little encouragement as we wrap up.

Mohamed Elkasaby, MD
Yeah, the main message would be proactive management. So we need to really to be proactive on different levels. It starts with the patients educating themselves about what are the potential symptoms, and also for the caregiver to pay close attention. If they see something that doesn’t sound right, then they seek attention. Seek help from a medical professional and also for the primary care providers.

Then they start to screen patients, you know, even if they don’t have symptoms, but they are just presenting for a wellness visit. At age 65 or older, it would be very helpful to do that. Just a quick screening to see how things are. We need to encourage our colleagues to refer patients early.

I think what’s happening now in the dementia field is really a revelation. There are a lot of clinical trials going on. There’s a lot of hope, and you can imagine with the step that happened just two years ago, and even earlier than this, with the medication that we have for the first time ever. I would say after a long time of having many fail the clinical trials, we have now what we call disease-modifying therapy.

We have amyloid targeting therapy, which are the infusions that were recently approved to be used in patients with early stages of Alzheimer’s disease. I think is just the beginning, so I think I’m very hopeful. I think it just teamwork. So all of us have to work together to help improve patients care and also treat them with the appropriate tools.

Matt Eaves
Dr. Mohamed Elkasaby, neurologist at University Hospitals Cleveland, thank you for joining us.

Mohamed Elkasaby, MD
Thank you so much. Thanks for having me.