Alzheimer’s Disease

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Studies suggest that many Hispanics may have more risk factors for developing dementia than other groups, and a significant number appear to be getting Alzheimer’s earlier. Dr. Victor Salazar-Calderon, neurologist and chairman of the Arizona Latino Medical Association, talks about the medical treatment and diagnosis of Alzheimer’s. Yvette Alvarez-Rooney talks about her family’s experience dealing with a loved one who has the disease.

José Cárdenas: The Hispanic population continues to be the country's fastest and largest growing minority. As this happens, the number of elderly Hispanics will increase as well. Some studies suggest that many Latinos have more risk factors for developing Alzheimer's disease and a significant number appear to be getting it earlier. Recently, I had the opportunity to talk to the chairman of Alma, the Arizona Latino Medical Association, about the disease. I also talked to a family member who shared her experience in dealing with a relative who has Alzheimer's. First, we would like to hear from you.

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José Cárdenas: Thank you both so much for joining us on "Horizonte." Dr. Salazar, I'd like to start with you, give us a little bit of your background.
Victor Salazar-Calderon: My name is Victor Salazar Calderon, I am the chairman of the Arizona Latino Medical Association - Alma. And I came to this country in 1984 and did my residency in neurology from 1985 to 1989. And have a private practice here in Phoenix, since July 1989.

José Cárdenas: And while you're a neurologist, you don't necessarily specialize with Alzheimer's but you end up treating Alzheimer's patients?

Victor Salazar-Calderon: That is correct, I see a lot of Alzheimer's, epilepsy, migraines, neck and lower back pains and nerve disease.

José Cárdenas: And as I understand it, there are higher incidents of Alzheimer's in Hispanics than in non-Hispanic populations, why is that?

Victor Salazar-Calderon: We don't know, and that is the reason why we would like Hispanics to participate in research, but we know for sure that the low-level of education doesn't help us, we need to educate ourselves a little bit more. We know that risk factors such as diabetes, hypertension, that predispose us to cardiovascular disease including hypercholesterolemia for example, and all of these things can cause a stroke and these you know can be the beginning of Alzheimer's disease.

José Cárdenas: I want to come back to some of that, because you've indicated in the discussions we had, brain exercises. Yvette, you had a personal experience with Alzheimer's and you're also involved in treatment or therapy that's related to that. But let's talk about the experiences you had with your mom.

Yvette Alvarez-Rooney: Well it started probably about 19 years ago when my father approached me and asked me to do some informal cognitive evaluations with my mom. And at the time I was doing that for a school district, and he was concerned about her memory loss back then. It was somewhat of a joke between the family members off and on about my mom and her memory loss, she would tell us to get something over there, and she really couldn't remember the vocabulary.

José Cárdenas: You mean she would have trouble finding the right words for what she wanted to say?

Yvette Alvarez-Rooney: Always. She would say something in Spanish. [Speaking Spanish] And it was like what cosa-- on top of where? And we would joke about that. But my dad approached me about 19 years ago and said I'm concerned about your mom.

José Cárdenas: How old was she at the time?

Yvette Alvarez-Rooney: She's 73 now, so that's…

José Cárdenas: About 54?

Yvette Alvarez-Rooney: 54, uh-huh. So I got on the phone, and I called the Alzheimer's Association because I shared it with the rest of the family and at the time, they were a little reluctant, I guess, you could say, to tell me whether or not that it was that. They couldn't do it over the phone anyway. But they asked me a series of questions and they said it sounded a lot like depression and she could be possibly be in a state of depression and the only way they could tell at the time is if there was an autopsy that was gonna be done. So that wasn't an option. So it will be three years if November after my dad died. My mom was reading an article in AARP and my sister came to pick her up and she handed her the article, my mom handed my sister the article, and said I have this, and it was an entire article on Alzheimer's, and my sister said, why do you think that? Because I have everything in there. And mom was sure that she had it. So my sister called all of us and said mom thinks she has this, what do we do?

José Cárdenas: So there's a gap of 16 years between when your father expressed his concerns and when your mom read the article. What was happening in between, was she getting worse, having more difficulty in identifying things?

Yvette Alvarez-Rooney: No, actually she wasn't. I think in retrospect, we all sit back and try to evaluate what's changed. But like I was telling Dr. Salazar earlier, my mom really right now is doing well, in the sense that she can communicate.

José Cárdenas: Has she been diagnosed as having Alzheimer's?

Yvette Alvarez-Rooney: She has. We took her to the Banner Institute and that was the place we researched would be the best place for her to be able get the help and screening and they were able to weed out the difference between depression and Alzheimer's.

José Cárdenas: And what was it in the article that made your mom think she had Alzheimer's?

Yvette Alvarez-Rooney: Well in particular, her inability to express herself with vocabulary. That was one of the biggest, her short term memory. Her inability to keep track of the days of the week and she was transposing numbers quite often and those were the main things that she found.

José Cárdenas: I want to come back and talk about the treatments she's receiving. As Yvette's comments indicate, it looks like there's advances made in terms of a diagnosis for Alzheimer's. We don't have to wait until you're dead to tell you you have it.

Victor Salazar-Calderon: Exactly, diagnosis of Alzheimer's disease is made basically by clinical history. Just by clinical history, we're more than 90% accurate.

José Cárdenas: And what would those clinical clues be?

Victor Salazar-Calderon: I should begin saying Alzheimer's is the most common type of dementia. It's just one type of dementia and then we have different types, Parkinson's, Huntington's, Jacobs and many others -- even HIV dementia. But the most common type is Alzheimer's. And similar to what your mother went through, short-term memory loss. They have difficulty finding words to express themselves. Pass me that, I need to write a letter. They forgot the name of a pain killer, pain. And they have these troubles just naming. They have trouble with orientation and trouble with judgment. They have trouble --

José Cárdenas: Judgment in what sense? Social interaction or making decisions?
Victor Salazar-Calderon: Making decisions. They have trouble balancing their checkbooks and the person with Alzheimer's may -- they may put, you know -- may misplace their car keys or put their glasses in the refrigerator. They do things like that, at the beginning…

José Cárdenas: As opposed to simply not remembering when they put them?
Victor Salazar-Calderon: Exactly. And they look for them and open the refrigerator and they find the glasses,

Yvette Alvarez-Rooney: It's interesting you say that because my mom, one of the symptoms you said, she had trouble with balancing some of the things she was doing, billing for my dad. But she told us, I think there's a ghost in the house. Why? Because I found an alarm clock in the middle of the washing machine. So there was there was an alarm clock sitting on the spinner of the washing machine and she was sure it was a ghost that put it there because she I don't remember doing that. And it was very typical, and forgetting she put something in the refrigerator that didn't belong there.

José Cárdenas: Dr. Salazar, how could you explain the fact that Yvette's mother was not getting worse over a long period of time?

Victor Salazar-Calderon: At the beginning, we have what is called mild cognitive impairment and 11-14% a year of these patients will develop Alzheimer's, they will turn into Alzheimer's up to 90%.

José Cárdenas: Going from mild to --

Victor Salazar-Calderon: Exactly, so if I was to have mild cognitive impairment in the next ten years, I have up to 90% that I will have Alzheimer's disease.

José Cárdenas: Now with respect to Hispanic, it's not that there's a higher incidence, but they develop it at an earlier age.

Victor Salazar-Calderon: That's correct. It's pretty much the same age, mid 50s, it begins 10 years earlier in Hispanic versus Caucasians. The prevalence of disease in us, Hispanics is almost twice as much than Caucasians. 9.8 versus 5.4.
José Cárdenas And I know the research is under way to try and help answer that question. But any preliminary thinking as to why this is the case?

Victor Salazar-Calderon: Well, we don't know. We know the level of education that we mentioned has to do with it.

José Cárdenas: And why is that, because the assumption is that if you're more educated, you're using your brain more?

Victor Salazar-Calderon: That's correct. There are more connections at the brain level. And that will help us, to deal with the beginning of the disease. To mask the symptoms of the disease before it shows up.

José Cárdenas: So Yvette, the treatment your mom has been receiving, describe that for us.

Yvette Alvarez-Rooney: Well the first thing they did were screenings to evaluate whether it was the Alzheimer's. And then after that…

José Cárdenas: And they confirmed it was?

Yvette Alvarez-Rooney: They did, and at that time they put her on the medication Aricept, and it was interesting I was telling Dr. Salazar, that she's not demonstrating the same symptoms that she was right after my dad died. She was doing things that were very uncharacteristic, I mean, that were that were that quickly after the diagnosis. She was doing shadowing, which is following someone around. She was repeating sentences that we would say. She was having a conversation, she would repeat those things. All of that stopped and we're not sure exactly why. It could be the Aricept, we're not sure, but all of us were in agreement when we talked to the member of the Alzheimer's Association, and said, this is what we're seeing, it's not like we're in denial, it's not like we don't want mom to have it, we don't. But at the same time why is this happening? She's not progressively getting worse. She's stabilized at that point.

José Cárdenas: It sounds also like she did improve…

Yvette Alvarez-Rooney: She did.

José Cárdenas: And my understanding is that once you begin treatment, the hope is to stabilize, but you can't reverse the effects?

Victor Salazar-Calderon: We cannot cure the disease, that is the reason why we want more and more patients to participate in research. But the treatment that we have available is good for activity, keeping the patient independent with activity so they are living, moving behavior and cognition, which is memory and as a matter of fact, the difference drugs that we have, improve memory for about nine months to 12 months and then after nine or 12 months, the patient's memory continues to decline at a slower pace than the patients not treated. As you know, the studies were up to six months without treatment before actually they were giving treatment to patients not treated for the first six months because it was not correct to keep them of the drug because we knew the medication was helping the other people. Therefore, we know that the medications we have work, but they don't cure the disease.

José Cárdenas: Tell us about the outreach you're involved with.
Victor Salazar-Calderon: We're trying through Alma to make people aware of, Hispanic patients aware of the need, we need their help. Just to find a cure for Alzheimer's and other conditions. Many of the medications we have to treat different medical conditions when approved by the FDA and we use them in Hispanics or any other racial group, sometimes they don't work as well and the reason, again, beings is because they are not really tested on Hispanics. Less than 1% of patients tested in research are Hispanic.

José Cárdenas: Yvette, last question. You had mentioned when we were off the set that your mom had gone to Scottsdale Art Museum and it had an impact. Tell us how that was.

Yvette Alvarez-Rooney: It was huge, we saw a change in her. She flourished. It was a side we hadn't seen. We knew she was artistic but when she had the opportunity to express herself and say how she was feeling because often times when you have Alzheimer's, you can't often verbalize what's going on inside of you, so the art that allowed her to do that to express herself and to be able to share with other family members and other people who had Alzheimer's what it was like to have it.

José Cárdenas: Thank you for sharing those experiences with our audience.

Yvette Alvarez-Rooney: You're welcome, thank you.

José Cárdenas: Thank you both for join joining us on "Horizonte."

Victor Salazar-Calderon: Thank you very much.

Dr. Victor Salazar-Calderon:Neurologist and chairman of the Arizona Latino Medical Association;Yvette Alvarez-Rooney;

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