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(light music) - Hi, I'm Susan Taylor with Scripps Health in San Diego, California. More than 6.7 million people in the United States are living with Alzheimer's disease and while most people develop it after the age of 65, early onset Alzheimer's disease can affect folks in their forties and their fifties. Joining us to talk about diagnosis and treatment is Dr. Leonard Sokol. He is a neurologist with the Scripps Clinic Medical Group. Doctor, thanks so much for being with us. - It's an honor to be here, Susan. Thanks so much for having me. - So, is early onset Alzheimer's disease different from Alzheimer's disease folks who would develop it after the age of 65? - Yes, that's a great question. And we know from the literature that people under the age of 65 often tend to have less memory related complaints as the primary symptoms. We know that they can have issues behaviorally, so they can act very irritable, they can have difficulties in their judgment, they can act very aggressive. Oftentimes, there can be issues with finding the right words so language can be a prominent symptom as well. We often know that there can be troubles navigating, troubles processing faces, troubles with doing calculations. And the kind of main take home is that for people who are under age 65, oftentimes the primary symptoms that are most bothersome really actually tend to be those that are non memory in nature. - So, who is at risk for early onset Alzheimer's disease? - We know that if there is a strong family history, then you will also be at risk as well. So that means that if your mother or father had early onset in the forties or fifties, and your grandparents also had it in their forties or fifties, then you as well may be at an elevated risk. We know that roughly about 10 to 11% of early onset cases have this type of pattern of inheritance in which there is some type of familial or genetic component. - So what causes it? - So we know that there is a laying down of amyloid and tau, so plaques and tangles within the brain, and ultimately that causes disruption in the ability of the brain to communicate and to really translate to problems functioning in the day to day. - And so what are the symptoms because I mean, a lot of folks as they age, they have memory issues like remembering somebody's name or remembering where you left the car keys and that doesn't necessarily translate into you having early onset Alzheimer's. - So I think when we really think about the symptoms, we often kind of want to know how pervasive is it? How bothersome is this going on or is this impairing your abilities to really function in your day-to-day environment? And that other people are also starting to notice, or your spouse may start to notice or your children, grandchildren, things of that nature oftentimes are signifying a need for additional evaluation. - So how is it diagnosed? - So the diagnosis tends to be a very comprehensive process and the diagnosis entails a visit with a healthcare professional who will go through and take a history to really get a sense of what are the presenting signs and symptoms that they're seeing both on the exam when they examine you, but also what are you noticing and oftentimes what are other people noticing because you may not notice those things or you may be a bit oblivious or blind to some of the symptoms that you're having. And so it oftentimes spans about 60 to 90 minutes of a visit with a physician. You'll get your past medical history and everything else that's gone on, a good strong family history of not only things of Alzheimer's, but other brain and psychiatric related diseases. We really go through to begin a kind of cognitive evaluation by looking at things like your attention, by looking at your language, by looking at your memory function, by looking at things that are considered your executive function. So your abilities for judgment, your abilities to plan, your abilities to sequence, your abilities to toggle between various different tasks. We look at how well you process your visual spatial features. So how are you being able to draw certain things, how are you able to conceptualize where things are in space and interpret and to make inferences about certain things as well and then really also getting a good sense of behaviors, that becomes really important too. And so it's really important that another loved one or another trusted person is there to also kind of weigh in. And so we do that evaluation. We work transdisciplinary. So in addition to a neurological evaluation that oftentimes is supplemented with other imaging to look at the brain, so looking at how the brain itself looks, but also looking, there are also additional tests to sample fluids from the brain and the spinal cord as well. So there's often, sometimes a spinal tap, especially for young onset Alzheimer's is something that comes to the fore and is often recommended along with additional tests, like an amyloid PET scan would be something that we would consider, additional neuropsychological testing to have a more quantified and numeric stance. And so these are some of the things that we do. It's often a bit of an odyssey, so it's not something that we will know immediately the moment that we leave, but we'll have a reasonable hunch and a reasonable educated diagnostic thought in terms of what we have and then we kinda work to further explore that and the intervening subsequent visits that we have on hand. - So how is it treated? - We have medications that really allow for parts of the brain to continue to communicate with each other, even if certain parts of the brain are not functioning as well. - Are there things that you can do to help prevent it or to slow down the progression of early onset Alzheimer's disease? - Yes, so I think the answer there is it depends, and I think a lot of that is dependent on what is causing it, I think, and a minority of cases. And again, there's about 10 to 11%. There is a strong familial component with a very, very high chance. But in the bulk majority, there are other causes that are contributing to early onset. And we know that environment plays a very strong role. And there have been several studies that have come out that have really looked at the prevention of dementia in general, in particular Alzheimer's. And we know that around 40% roughly is environmental in nature, so this is lifestyle. So really taking up and having the adoption of a very healthy lifestyle, knowing that there is not a silver bullet, but really the culmination of good physical, mental, social and spiritual health for the optimization of brain health at large. - And once you've been diagnosed, how do you live with it? - Yeah, so in addition to medications, it's really important to think about the adoption of a really healthy lifestyle. So staying very physically active and socially and spiritually active and really staying socially connected as well and really thinking about how we are enacting as many meaningful activities throughout the day. So making sure that there's enough structure and enough tasks that you're doing that are still finding and bringing joy to your life. And in addition to that, this is a progressive disease. It's important to also think about how to plan for the future as well. - And what about alcohol or other substances that actually might affect your thinking ability? - Yeah, so I mean, if you're using a significant amount of alcohol, you should drastically be reducing the intake and you should be avoiding any non-prescribed medications that alter your thinking. - If you are having memory issues, when should you go see a doctor? - I think that it's okay to be bringing it up with your primary care physician, with a neurologist. There's certainly many different studies and medications and support. So I don't think it's something to delay upon. I think if you're of the personality that having more information is better, we have that information available to us, and help prepare for the future as well. Whether it's something that's age related or something that may be the harbinger of something else down the line, we can help track that over time. - Any final thoughts, Doctor? - Thanks so much, Susan, for this question. I think the final thought here that I would weigh in on is that if you are experiencing cognitive changes, so changes with your memory and your attention and your processing speed and other people are noticing things, go in, see your primary care doctor and consider additional testing. We're always more than happy to evaluate and to start that process and start that conversation with you sooner. - Doctor, thanks so much for being with us. We appreciate you taking the time. - Thanks so much, Susan. It was a real honor to be here. Thanks so much for asking me to join. - Sure, if you want more information on early onset Alzheimer's disease, just click on the link or go to scripps.org/videos. Want more critical information about your health? Please subscribe to our Scripps Health YouTube channel and follow us on social media at Scripps Health. At Scripps, we are here for good. I'm Susan Taylor, thanks for joining us.