Alzheimer's disease and dementia with Dr. Alvarez

Thank you. Thank you. Thank you. Thank you. wide-ranging topic. The numbers of people with Alzheimer's disease is increasing. I pulled up some facts from the Alzheimer's Association, and they state that 5.3 million Americans are living with Alzheimer's disease, including an estimated 200,000 under the age of 65. And by 2050, up to 16 million will have the disease. That's correct. Yes, they're amazing numbers, and they are increasing. That is true. So what would you attest this to? What are some of the causes that you found with your research? You know, I think there are many reasons for the disease and the prevalence of the disease, and part of it is due to our diagnostic tools. So we certainly have much better diagnostics than we did several years ago. We're better able to make these diagnoses earlier. We're better equipped to differentiate the different types. And, you know, there's other factors that we really don't understand that might be related to lifestyle or diet or other environmental factors that may also be contributing factors, such as, you know, the risk of Alzheimer's disease. So, you know, I think that's a good way to start. Yeah. So, you know, I think that's a good way to start. Yeah. So, you know, I think hypertension, such as, well, one can only speculate, but, you know, unfortunately, we just aren't in a place that we really understand all the causes, and we don't have a cure yet. Yeah, that's the problem, right, is that it seems like research is just at the forefront of trying to figure out Alzheimer's. Yeah. So, you know, we have some exciting developments happening. That's, you know, we're in a position where we're trying to figure out what's happening in the brain. We're seeing some markers that might indicate causes or certainly the processes of what's happening neurologically, but why they happen in some people and not others. We don't have all of those answers yet. We know a little bit. We know, you know, we know about vascular dementia, that there's a link between vascular events, hypertension, the brain. We know that there's a relationship with diabetes. We know there's a genetic link with Alzheimer's, but that actually accounts for a very small portion of patients. The genetic type is really only about 3% of all Alzheimer's cases, so it's very small compared to the other 5.3 million people that are affected, but we're learning more, and so that's certainly good news. That is good news, especially about the genetics. Yeah. So, you know, we're in a position where we're trying to figure out what's happening in the brain. We're seeing some markers that might indicate causes or something like that. We know that there's a genetic connection. My grandmother had Alzheimer's, and it was frightening to watch the process that she was going through, and towards the end of her life, she didn't recognize anybody, and she was put into a nursing home before she deceased. So, it's a very sad and long process sometimes. Absolutely, and I think, you know, a lot of families do worry about the genetics. I think it's a very sad and long process sometimes. It does look different from the other types. Unfortunately, the onset does tend to be much earlier in life. I've seen it as early as the 40s, 40s and 50s, and commonly, patients that I see who have onset at that time had one or both parents that were also affected by it. So, there's a little bit more of a clear genetic marker, but, you know, for patients in their, 70s and 80s, those may not be genetic cases. They may be other types of dementia. So, is that a normal process of aging is losing memories and, you know, the, it's not quite connecting for, you know, what you're trying to think of and what you're trying to state? So, memory loss is really not a normal part of aging. Forgetfulness, is a common complaint, and especially in patients over 50. So, normal loss, things like forgetting your keys, forgetting an appointment, forgetting the name of an acquaintance, those are normal experiences that we all experience. There might be some slowing. So, things take a little bit longer to learn or to process new steps of learning something new. But, other indicators like forgetting, how to do something that you've always known how to do, like reading a clock, when that occurs, that's a little bit more concerning. I would also say that severity and frequency are also important to look at. So, if you forget your car keys, and we've all experienced this, right? So, or you lose your car keys. If that happens once or twice, you know, in a year, I might not be real concerned about that. But, if it's actually a normal thing, if it's actually interfering with your life, and interfering with your ability to function, and to get to your appointments, or to participate in activities, that really might be something different and something that you need to look into. So, that would be one of the neurological markers that you were talking about, correct? It would be. So, memory loss that actually interferes with your functioning. And then, you know, loss of skills, again, things that you've always known how to do. So, that's a little bit more concerning. But, if you forget your car keys, you know, you're not going to be able to do anything. So, if something that you're accustomed to doing is no longer familiar to you, that would certainly be an indicator. And one of, for Alzheimer's disease specifically, getting disoriented in familiar places is another indicator. So, having an experience of, you know, perhaps in a neighborhood that you've lived in, or a place that you go to frequently and becoming disoriented or lost, you know, that's a little bit more concerning. So, if you forget your car keys, you know, you're not going to be able to do anything. So, if you forget your car keys, you know, you're not going to be able to do anything. So, having an experience of having an experience of being disoriented or lost in a place like that, those would be incidents of more concern. But normal forgetting, not remembering people's names or forgetting appointments, that's really a more normal part of the experience. And approximately what age does the memory problems start kicking in, typically? You know, it's really different for everyone. And that's not to say that, you know, anyone without a real memory problem, you know, you're not going to have a real diagnosis, whatever, have a memory problem. People may not be affected at all at their time in life. But it really depends on the type of dementia. And Julian, I can talk a little more about the difference between Alzheimer's and other types. It's a common misconception that they are two different things, that Alzheimer's is one thing and dementia is another. But the fact is, is that Alzheimer's is a type of dementia. So, you can think of dementia sort of being an umbrella term. And under that umbrella includes Alzheimer's disease as a type of dementia. Vascular dementia is another type. Lewy body dementia is another type. There's another type called posterior cortical atrophy, which is a little more rare of a type. There's dementia that's brought on by other diseases like Parkinson's disease or multiple sclerosis. And those are a little bit different as well. So, I should also mention frontotemporal, which is another type. And so, they all look a little bit different and they have a slightly different course of their illness. But depending on the type of dementia, the onset could be, you know, with a genetic case of Alzheimer's disease could be in the 40s or 50s, which is relatively rare. And more commonly, I would say my average, patient is about 82. Okay. And if a family member is concerned about a person's potential memory loss, that they're not remembering things that used to come easily to them, what would you recommend that a family member does or even the potential patient? You know, I think that family members often are next to the patient, of course, and they're not going to be able to remember things that they used to remember. And so, I think that family members often are next to the patient, of course, the first ones to notice that something might be changing a little bit. And I think that it can be going on for a while before people really are ready to talk about it. Part of the reason for that is because oftentimes patients who have some awareness that they might be struggling with some memory loss or some disorientation oftentimes are very fearful. It's a very frightening experience. And so, you know, when you're at home, you can probably function really well at home, right? You remember where everything is and, you know, you can probably function really well at home, right? You remember where everything is and, you know, can really do pretty well in that environment. So oftentimes the times that I hear from families sometimes are like after holidays where kids and family members and grandkids have gotten together and realized maybe that something is changing. Or someone who's going to a new environment might be struggling a little bit more with learning the layout of that environment and finding their way. So, you know, for families, for community members or for individuals who are noticing changes, I really can't stress enough that the earliest possible intervention is the best course. So, you know, my recommendation would be, you know, to certainly start with your primary care physician. And if possible, get a referral for a neurologist. See a neurologist, go through testing, there's cognitive assessments and simple neurology. Turn to a أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ أ family in the past who really thought that their loved one was experiencing signs and symptoms of cognitive impairment. But this person was actually going through quite a serious depressive episode. And once that was effectively treated, the cognitive issues resolved as well. So, you know, we don't want to jump to any conclusions. But certainly if there's a family history or if there's indicators in place that might point to that, the sooner that they can be assessed and begin a treatment protocol, the better long-term outcomes there are. Right. So it's just making that first step to the physician's office and stating, you know, my mother, father, grandparents or whatever. They look like they're having more issues lately. And I'm concerned about that. So maybe going with them to that appointment so that the conversation can start between the family and the doctor and really get a good history of exactly what's going on in the home environment. Absolutely. Julianne, I think that's such an important piece because if we really don't want to believe something, we might be under-reporting. That's happening. Right. And under-reporting to your physician is something that's really never helpful. Because even though it's difficult and a difficult time, the most accurate reporting and the family being involved can play such an important role in getting treatment started sooner than later. So, you know, I see cases where the family or patient or both, you know, had a difficult time with. So I think it's really important to do a good job of getting a diagnosis, which is understandable and engaged in what we call doctor shopping. And when to try and get multiple opinions. And I think certainly getting a second opinion is absolutely valid. But when it delays actually receiving treatment and puts off taking steps to try and slow the progression or try and increase quality of life, it becomes, you know, a costly time factor. So if families are able to be involved and to report things, then really you can get the most accurate diagnosis and get on the right track as soon as possible. So one of the lessons is to be honest with the process that's going on and the sooner the better. And I think that's easier said than done. Yeah. Understandable. Things are frightening and hard to understand. Yeah. Yeah. I think that's a really important point. And I think that's something that's really important to understand. It's, you know, just a difficult process. But, you know, again, early intervention, especially for patients who are in the early stages or the mild stages, there's, you know, so many things that you can do that are effective and can really increase quality of life and essentially try and buy some time to live out, you know, not just the highest number of years, but the highest quality of life. Exactly. Exactly. So, Dr. Alvarez, we're going to take a quick break and let's talk about some of the testing and some of the assessments that you do at your center when we come back. Sounds good. The Chicago School of Professional Psychology offers numerous psychology, behavioral and health-related science graduate degrees at three campuses, Los Angeles, California, including branches in Westwood and Irvine. Chicago, California, and San Francisco. Illinois and Washington, D.C. and online. The Chicago School prepares students to meet the ever-changing mental health needs of society through classroom experience and real-world training. The Chicago School Counseling Centers in Irvine and Westwood provide caring, confidential, and affordable psychological services to individuals and their families. For more information, visit thechicagoschool.edu. Thank you to the Chicago School of Professional Psychology for sponsoring Psych One-on-One. This is Julianne Good with Dr. Cheryl Alvarez. And we are talking about Alzheimer's disease and dementia this evening. Now, Dr. Alvarez, what is some of the testing, processing, and assessments that you do at the Alzheimer's Family Service Center in Huntington Beach? Well, Julianne, one of the things that the center does is they do monitoring. They do a lot of testing. They do a lot of testing. They do a lot of testing. They do a lot of testing. They do a lot of testing. And we monitor how the patients are doing over time. And we use a couple of different assessments for that. We use a very basic neuro-screening that just sort of allows us to see the level of impairment, if it's changing, if it's plateaued, if there's any increases, which we do occasionally see and I'll talk about why that happens, or if there's any bigger drops that better consist not consistent with what's observed. We also do a depression screening there. So all of our patients who attend the day center, so we're in adult day health care, and so our patients all come for the day. Their families receive respite and our participants engage in a number of different activities and socialization during the day. And so, you know, the relationship between depression and dementia is a tricky one. And so it's one that the facility puts a lot of emphasis on monitoring and then treating or managing as appropriate or indicated. So we engage, we have some specialized assessments that measure depression in dementia patients, both for people who are in the mild stages and those who are a little bit more moderate or severe. But I would just mention that the research really tells us that people who have depression may have a greater risk of developing dementia. And people who have dementia in the early part, at least, may have a higher risk of depression. And as I mentioned a little bit earlier, that depression can, can really look like cognitive impairment. So when patients are depressed, they're actually more likely to score lower on these assessments and have more difficulty with cognitive functioning. So at what point do you start looking at it, whether it's depression or dementia? What is, what are some of the key factors that are different between the two? Well, symptoms of depression in dementia patients can look a little bit different. So it might look like irritability. It might be difficulty sleeping. It might be anger. It might be just departures from, from the way that the person is normally experienced in the family. So treating the depression really becomes a priority. Once the depression is treated, we occasionally see some returns to baseline in their cognitive functioning. So at that point, do you just give a diagnosis of depression and then don't go further with, with the cognitive assessments? Because it's just, it looks like a kind of a cut and dry case then. No, you know, because dementia is a progressive disease. We always want to be monitoring, we want to be monitoring that. So we want to see, you know, are they progressing faster or slower or is there anything unusual that might be happening? So sometimes when we see clients who've had a big decrease in their cognitive functioning as measured by a neuro-screening, I'm actually looking for other things. So I'm looking for, is there a physical ailment here? Could there be a urinary tract infection? Could there be pain? Could there be some other aspects of the brain that are not as good as the other things? So I'm looking for, is there a physical aspect that might be contributing to a cognitive decline that's not actually a progression of the disease? And oftentimes there is. So as people with cognitive impairment tend to lose their ability to articulate some of those discomforts or pain, their cognitive functioning is actually affected by pain, just like yours and mine would be. If we were, if we were in pain, our attention is really diverted towards that and not towards others. So I'm looking for a way to do that. So you work very closely with patients, physicians. Absolutely. So this facility is actually a really unique and wonderful place. I sound biased here, but I may be a little bit. But it really is because it provides a place where people who have these impairments can be monitored and can really receive care. So I'm looking for a way to do that. And interventions that can help slow progression, they can help increase quality of life, and anything that the facility and the staff are seeing that the change in that person is communicated to their physician and to their family. And so that really helps intervene with little things and keeping them from becoming big things, as with Alzheimer's disease, it can really fast. So it's one of the ways that the facility really takes care of the patients. And it's really helpful. takes care of this special and specific population. That's wonderful. It's wonderful you have all of those services. That's great. Now, what about medications? Aren't there only like one or two on the market that they think may slow down the process? So there's a few. There's a few medications. And depending on the type of dementia sort of depends on which medications might be effective. And, of course, like every medication, they're not necessarily appropriate for every single person or for every single situation. But there are several. Right now the big players, I would actually say that one of the big player combos is a combination of medication. It's a combination of two different medications. And they work in different ways. They do different things. So there's a couple of theories about how dementia forms, if you will, neurologically. And so using these two different medications is one of the ways that we could address both possible potential neurological events happening. So one of them is an acetylcholine esterase inhibitor. And that's essentially just saying that it interferes with acetylcholine reuptake. And then another one is commonly known to many, and that's Exelon, which comes in a patch form. So Exelon and Amenda, the combination of those two, are showing a lot of efficacy in helping maintain cognition and slow down. So that's one of the things that we're looking at. And then the other one is a combination of two different medications. So if you possibly can, the progression. Those two are commonly put together. There's also Aricept, which has been around for some time. And I think is commonly used. And most patients respond pretty well to it. And it does have a relatively tolerable side effect profile for most as well. So, you know, I think that new medications are coming. We are expecting to see some new ones not too far out here. But for the time being, the ones that are offered are showing some good results. That's wonderful. That's good. And I know Aricept has been around for quite a while. So I used to be in the medical profession. So they came up quite a bit for senior citizens, that they would be. And they put on that when they were starting to show cognitive impairments. So... Yeah. And there are a number of clinical trials that are going on right now, and some of them in the later phases that have some hopefuls with it. So, of course, what we're ultimately looking for is, you know, the cure and what's going to intervene with the disease progression and forming and understanding why it's forming in the first place. So we're not there yet. But... Yeah. In the meantime, the combination of meds as well as some other things, which I'll talk about, certainly can help along. Is there anything that we can do to prevent this from happening or at least slowing down the aging process? You know, I don't know that there's any definitive thing that we can do to prevent dementia. And, of course, it depends on the type because different types have different causes, some of them known and some of them unknown. You know, and certainly diet and exercise are going to play a role, particularly with vascular dementia. So physical health, exercise, low blood pressure, low cholesterol, diabetes management, all of those things. There's great, you know, wealth in body research that points to as much as 20 minutes of walking a day having a significant impact on reducing the risk. There's, you know, of course, a link between diabetes and Alzheimer's that's not fully understood yet. And so managing that successfully. But, you know, two of the big, big players. And both prevention and in treatment are probably some of the simplest things that we could do. One of them, of course, is exercise. So exercise has a very positive effect, essentially, globally in the body. Every part of the body is benefiting from that in some way. And the other component is socialization. So the role of socialization, both pre-diagnosis and post. And it's along with exercise, probably the most profound treatment that's really available. And so what I mean by that is interacting, being with other people, having conversations, participating in those conversations. Sometimes patients with dementia will struggle with words, with word finding. I struggle with it sometimes. But it's not the same. It's different. It's different. but we all become a little bit more aware of it, right, when we're talking about it. But there can be different types of what's called an aphasia, so difficulty with words or word finding or naming skills. And so really participating in those conversations and being sort of forced into recalling those words or attempting to recall those words and to use them and to be listening is really one of the most profound and powerful things that anyone can do, both for prevention and for treatment. Yes, and just keeping connected with people is really important for all of us. Hugely important. Also, you know, a great way to treat depressive symptoms. And if depressive symptoms are being successfully treated, cognition is going to be more intact as well. So it's keeping... Keeping on top of your moods, basically. And again, being honest with where you're at. It sounds like the day program that you have at the center would be really good for helping patients who are diagnosed with Alzheimer's and dementia to connect with other people who understand what they're going through and so that they don't isolate. Absolutely. It's a huge component of the program. And so, you know, Alzheimer's Family Services Center actually offers a couple of different programs. And one of them is for people who are in the very early stages. So some of our group in the very, very early stages may have been recently diagnosed or they may have been diagnosed years ago, but they're still in the early stages, which is, of course, what we want, right, is to maintain the skills that you do have for as long as possible. So that group is called our New Connections Club. And it's a very tight social circle of individuals who get together a couple times a week. They share their coffee and juice and have a discussion about things that are going on in the world. They participate in pretty challenging cognitive exercises. They go on outings. They get exercise. They go through physical therapy and occupational therapy every day. They're there. And really, they're just provided with a place that they receive support and they have socialization and they have an opportunity to be out of the house and be exercising and connecting with others. And so that's our early stage program. And, of course, the earlier that people get involved with it, the better. So people tend to want to wait until they really, you know, have a reason that they need to participate. Or there's been a decline. But in reality, it's the sooner the better. So the more aggressive intervention at the beginning, the better longer-term outcome. Yeah, that makes sense. And then in the Friendship Club, which is our moderate, mild-moderate and potentially more severe, also socialization just a huge component. So small groups being engaged in activities, being present, interacting, talking, doing art, getting exercise, physical therapy, occupational therapy, and of course, you know, monitoring the other health conditions. So if we're seeing changes or we're seeing things that just are kind of out of character for that participant or something that's different, we're really in a position that we can notice that. We can bring it to the attention of the family and of the physician. We work so closely with the physician. And again, keep those things, you know, the little things from becoming big things. And it sounds like it's really comprehensive monitoring of the patient to see where they're going. And that's what they need. They need to have, you know, 24-7 care in some cases. And it's great that the center provides that and teaching the family how to provide it. And the physician. And the person is involved in the therapist. And it sounds like a big team of people. It is, yes. It's unprecedented. It's the only one of its kind in Orange County. Wow. And it's an amazing team. And, you know, I would also just add to it that you mentioned caregivers. And, you know, for caregivers to get involved in support groups, for caregivers to, you know, find that time for them to receive some support is such a, you know, very important piece. And well researched and, you know, strong outcomes with that that show that caregivers who are involved actually fare much better over the long run. And so does the person that they're caring for. You know, there's some very scary statistics out there about caregivers who pass before the person that they're taking care of. And the reason for that is, you know, is because they of course stop taking care of themselves. They start missing their own appointments and are dealing with the stress of a changing condition in which, you know, one day something works and the next day it doesn't. And so there's a lot of adapting. But there are a number of support groups available both at the Alzheimer's Family Services Center and in several other places and through the Alzheimer's Association in Orange County. And that would absolutely be a recommendation. And so the recommendation from any clinician in our facility is for a caregiver to attend a support group and get involved and really get the benefits of having their own socialization and their own cohort in which to receive support. Yes. And when we come back from the break, let's talk a little bit more about, as a family of an Alzheimer's patient, what they can do to strengthen up their support system. And you do have a lot of support. And you did mention the support groups and some of the elements that they go through. And to really have a good understanding of how rough this disease can be on the patient and the family. So we'll come back to that after we take a break. Are you searching for answers and insight to life issues? Is the behavior of family or friends questionable or concerning? Find tips and possible solutions from the convenience of your own PC, cell phone or tablet at therapycable.com. Therapy Cable has the most comprehensive library of contemporary therapy videos online. Help may be as easy as a few clicks away. Therapy Cable offers comprehensive therapy videos ranging from addiction to self-care and contact information for qualified providers. Find the answers to your life challenges at therapycable.com. Turn on Turn on Turn on Thank you. Thank you. Thank you. Thank you. And welcome back to Psych One-on-One with Julianne Good and Dr. Cheryl Alvarez. And we are discussing... ...Alzheimer's disease and dementia. And the caregiver's situation with the families for the patients. It can be really, really stressful. Nearly 60% of Alzheimer's and dementia caregivers rate the emotional stress of caregiving as high or very high. And about 40% suffer from depression. And three-quarters of Alzheimer's and dementia caregivers report... ...that they are somewhat... ...to very concerned about maintaining their own health since becoming a caregiver. And they are more likely than caregivers of other older people to say that caregiving made their health worse. Absolutely. The role of the caregiver is incredibly stressful and incredibly taxing. And as I indicated earlier, the statistic for caregivers who become a victim of the disease... ...before the... ...before the... ...before the... ...before the... ...before the... ...before the placement of a patient themselves is astounding. I want to say it's 65%. I might even be underestimating that a little bit. And so, you know, we absolutely encourage caregivers to really think about the role that they're playing... ...and how that role can actually be helpful to the patient over time. And obviously, if the caregiver's not in a position that they're taking care of themselves, they're not going to be in a good position to support their loved ones. one that they're working really hard to take care of. And how about hiring outside help, like, you know, nurses coming in or some kind of caregiver that is hired? How often is that instituted? You know, I think that there's many things that a caregiver can do to become well-equipped. And some of them might include hiring help. And for some people, that's not a reality or something that's feasible. But, you know, I think that starting with education is a really good place for a caregiver because understanding the disease, understanding what's happening and what the experience of their loved one is or might be at some point is sort of a good place. It's a good place to get yourself into thinking and planning for how to deal with situations. I think caregiver frustration sometimes comes out of feeling that the patient is doing something on purpose or is being difficult on purpose. And, of course, they're not. They're really, you know, things that can come along with dementia, like repetition or agitation or sometimes uncooperating. Those types of things can be very frustrating and challenging for caregivers. And so one of the things that we do is really try and help caregivers anticipate what is, you know, what does the disease look like in the place that they are right now? What might it look like? How do we plan for it? What types of caregiving techniques work? There's a common technique that I'll educate. I'll educate families on something called therapeutic sitting. And so what this is is really making a decision about, you know, working to orient someone to reality or going along with them. And the example that I like to use here is I have a patient who's very dear and will sometimes approach me and be upset. Because he believes he's at the airport and that his flight has not departed yet. And so I say, oh, you know. And so you have a choice at that moment, right, to say, well, you're not at an airport. You're here at the center. And really therapeutic sitting is based on the idea that that's not helpful because his perception at that time is his reality. So therapeutic sitting would say, I would say, you know, your flight's going to be leaving shortly. Can I get you a glass of water while you're waiting? So it's a technique that helps caregivers really pick the battles and find that we don't have to upset the loved one. And it's not necessary. They're not going to benefit from our effort to try and say, that's not right. You're not at an airport. You're somewhere else. And so over time, I think caregivers really can embrace that, that they get a positive response from their loved one. And they're engaging in more quality time and less disputing or arguing. Yeah, that does get wary. My grandfather had to take care of my grandmother for quite a while before she was placed in a nursing home. And it just wore him out. He became very thin and emaciated. And it's shortly after she passed, he passed away within a year. So is that kind of a typical scenario that you found? You know, I think it depends. It depends on how well educated the caregiver is, what kind of plan they have in place, what kind of support that they have, what the state of their health is. You know, there's so many factors, I think, that play into it. But certainly, you know, helping caregivers make decisions about how much support they need is absolutely a part of, you know, treating this disease. So looking at what resources are available for that person or for that family. Are there other family members involved who might play a role in supervision or in care or treatment or transportation? Are there other possible resources? And one of them that we talk about is the Caregiver Resource Center, which has a wonderful amount of, and you can Google that and find them. And they do a lot of different education classes, classes like Powerful Tools, where caregivers really are learning about the disease. They're learning about interventions that work really well, that minimize stress, that minimize agitation, that really, you know, improve the interactions between them. And they're loved one. And help the caregiver manage, manage things more successfully. So, you know, I think education is a really good place to start. And ultimately being better educated about the disease and what it looks like and what the behaviors are can certainly go a long way towards a successful caregiving experience. But, you know, planning is another component. So, you know, planning for this is where we are now, but what do we need to be looking at? What's coming next? And in every case, you know, we don't know. A patient might be in the mild stage, you know, hopefully for a long period of time and do very well, which is wonderful. And they may progress more quickly than expected. So because the course of disease is unknown, planning is such a critical part of, I think, managing stress. And that might include things like, you know, what will happen when, you know, one person like your grandfather is no longer able to be her sole provider of care. So resources like absolutely in-home care assistance, hiring someone. And, you know, many families do have hired help that allows them to get some respite. And sometimes those caregivers, especially if they have training in this population, can be very successful with things like showering or bathing or dressing or some of the things that can be kind of frightening for patients. So that's a possibility. And then, you know, looking just at the bigger family. Picture things like planning for the future. So getting documents in place that are important. Legal documents like power of attorney and advanced health care directives. Those are things that really need to occur at the time of diagnosis. So if it's still appropriate to do at that time, then that would be something you would consult an attorney about. But, you know, I certainly spend a fair amount of time helping. Educate families about, you know, having things like power of attorney in place really, you know, protects your loved one and protects you as a family member to help make some of those decisions later on when they're no longer able to do that themselves. Right. That's really important to institute at the beginning of this process. What does the patient want? It's, you know, while they can still make the decisions for themselves, you know, lay out the course. Say these are what your possible options can be and what would you like? What would you like right now? How can you foresee this if it's possible so that they feel that they're more in control once, you know, their cognitive abilities start dwindling? Of course. Of course. It's, you know, it's a, it's a, I think a difficult thing to initiate and to start in a difficult, certainly, you know, conversation. It's a difficult conversation to have, but it ultimately gives that patient power to say this is how I would want things to be handled. And if, you know, my cognitive abilities are such that someone else takes over my affairs, it also makes treatment and participation in treatment much easier. Yes. So patients who do not have a durable power of attorney in place may not be able to participate in certain clinical trials. Yes. Other activities that, that really would require someone to consent for them. And also I think it creates, you know, a number of potential other challenges with, you know, real estate and other sort of financial arrangements that I sometimes see when families really need to access funds for care and for long-term care. Yes, it's expensive. If it's not because of their plans. Yes. So, you know, having that plan in place and consulting and, and, you know, having that plan in place. Yes. And having an elder law attorney is, is a really good step to sort of just protect. So, you know, you do everything you can do to protect both, you know, the, you know, the family and the patients and for, for everyone to be a part of that decision-making process. Mm-hmm. That is important. And as we're wrapping up, Dr. Alvarez, what can you recommend to families and patients to ease this difficult process? Sometimes instituting something. Yeah. That's reconnecting the family in joy and love and fun and, you know, getting something positive out of this experience. You know, I, I think that it's, it's a disease that really asks you to live in the present. And it says, you know, enjoy right now because the best you have is right now. And, and to be present with your loved ones. And to be present with your loved ones and your family. Put a plan in place and enjoy your life. You know, do, do what you need to do. Get your paperwork done. Get your support systems together. Have your wishes made. And enjoy your life. You don't, you're not going to have control over a lot of things. But, you know, engage in socialization. Engage in exercise. Pleasure is such an important piece. Do things that are enjoyable and pleasurable. It's both really good for the caregiver and for the patient. And, and enjoy the right now. Live in the now. Exactly. Great advice. And how can listeners contact you at the center? Or contact the center in general? Listeners can contact the center. We're at Alzheimer's Family Services Center. And certainly can Google that and find us there. And they can call the main line and speak with myself or any of our social work team or clinical team there. And we're happy to provide any resources and support. Wonderful. And thank you so much, Dr. Alvarez. That was great information on Alzheimer's and dementia. My pleasure. Thank you, Julianne. Thank you. And thank you to my listeners. I really thank you for your support. If you would like to contact me, you can do so at 562-234-4650. My office is in Irvine, California. I'm open for consultation. If you have any questions or concerns, please email me at jgoode8 at verizon.net. Friend me on Facebook at Psych1on1, P-S-Y-C-H, 1-on-1. And contact me anytime. I'd love to hear from you. Thank you so much to Cheyenne Hayes for doing a great job at the board tonight. Thank you, Jeremy Hansen, for being our executive producer. And this has been Julianne Good for Psych1on1. Take care of yourself. Take care of each other. Bye now. Bye now.! Bye now. Bye now. Bye now. Bye now. Bye now. Bye now. Bye now. Bye now. Bye now. We'll see you next time.