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Dr. Thomas Krefft, a neurologist at St. Tammany Parish Hospital (1202 S. Tyler St., Covington, 985-895-4000; www.stph.org; www.sthfoundation.org) who also has a private practice, discusses Alzheimer's disease, its symptoms, treatments and how if affects lives.



Q: How does a doctor diagnose Alzheimer's disease?

A:
Alzheimer's is a clinical diagnosis. There are neuropathological criteria, but it is a brain disease and you can't do biopsies on the brain to see if a patient has it. Diagnosis is partly based on the patient's history, so we usually require someone familiar with the patient's problems to come in with them. Because of the nature of the illness, it's difficult for [the patient] to recount all the details or to understand their importance. We also do a thorough neurological examination to rule out conditions that can mimic Alzheimer's (but require a different treatment).



Q: Aside from memory problems, what are the main symptoms?

A:
Memory problems is the initial symptom in approximately 90 percent of the patients with Alzheimer's. Eventually it will affect all areas of cognition, including language, attention, visuospatial, multi-tasking, judgment, insight. It also affects behavior. Short-term memory will be more affected, because some of the long-term memories have been reinforced over and over over the years. We don't know exactly where in the brain (the trigger for Alzheimer's is located). Long-term memory is diffusely located in the brain.



Q: Who are the mostly likely candidates for developing Alzheimer's?

A:
There's no specific profile. There is definitely a genetic component in some people. How big a component is debatable. In Familial Alzheimer's Disease, usually the onset is at a much earlier age, in the 40s and 50s Š and it's caused by a particular gene.



Q: I understand there is no cure for Alzheimer's disease, but what can one do to alleviate the symptoms or improve a patient's ability to function?

A:
First off, you want to try to maximize general health Š by treating any other medical problems. There are certain medications that are available on the market today: Aricept, Reminyl, Exelon, Cognex and Namenda, which works on a different receptor. The primary focus is to improve memory. There's nothing to suggest that any of those medications slow down the neurological process of Alzheimer's. You want to treat other situations, such as safety issues. If there's a balance problem, for instance, that should be investigated to see if there is another situation going on; it doesn't normally affect balance until the later stages.



Q: Physiologically, what happens to an Alzheimer's patient and what causes the condition to develop?

A:
It's really a multi-factorial list. There are a number of things that can go wrong in the brain to bring on Alzheimer's, and it's usually a combination of factors. That's why we have a variety of medicines to attack it at different points in the brain. It almost certainly will be a combination therapy.



Q: Are there preventative measures a person can take, such as certain types of exercise or diet restraints?

A:
There's nothing that's been proven at this point. There are things that have been suggested, but there is nothing at this point that you can actively do to decrease your risk. We hope there will be soon.



Q: What kind of care is advised for Alzheimer's patients in the moderate and latter stages of the disease?

A: In the latter stages, they're going to need daily care for such everyday things as dressing, bathing, hygiene. In the moderate stages, they may have problems with things such as using a microwave or stove. You have to evaluate each patient individually and figure out what each needs. It's not like a muumuu, where one size fits all.



Q: Do they become a danger to themselves or others?

A:
Certainly you can become a danger to yourself if you don't understand the consequences of your own actions. You can become disoriented about the situation. I had a patient once who threw a towel on top of a gas burner because he wanted to dry it out, not realizing it was not a good idea. They just can't function like they normally would; the disease impairs them.



Q: What are the most serious problems or difficulties one encounters with these patients and their families?

A:
It does affect interpersonal relationships; there's definitely a social component to the diagnosis of Alzheimer's. It has to affect what people do in their day-to-day living. It's also a lot of work (for the caregiver), which is one of the biggest difficulties. You're talking about someone who at some point can't perform activities. It's a constant adapting that the caregiver has to do and a constant evaluation of what they are able to do. The stress it puts on the caregivers, who are often in their 70s and 80s and have health problems themselves, is not good and can be overwhelming.



Q: If you could get one message across what would it be?

A: Being a neurologist, I would emphasize that it is crucial that we get an accurate diagnosis that we're dealing with Alzheimer's and not some other condition that mimics it. That is going to get more crucial as we develop new medications -- and they are being developed.

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