The head of the Division of Memory Disorders of the University of Alabama at Birmingham (UAB), neurologist David Geldmacher, M.D. recently created the UAB Alzheimer’s Risk Assessment and Intervention Clinic, which is the first of its kind in the country. With the main purpose of helping not only patients suffering from dementia and Alzheimer’s disease, but also their caregivers – often their spouses or adult children – the facility was born out of Dr. Geldmacher’s observation of patients and caregivers’ need for more effective teaching and guidance.
The creation of the Intervention Clinic is based on international studies that demonstrate the risk factors for dementia. Within the facility, patients will be offered a detailed, personalized risk assessment, including family history, a memory assessment, cognitive testing, and a baseline MRI scan. The data from those exams are then factored into existing risk-predictor models.
“I recognized the need for a dementia risk-assessment clinic because a lot of my time in the care of people with memory loss is spent advising people without memory loss how to protect themselves,” explained Dr. Geldmacher. “It’s about an hour-and-a-half process of collecting a detailed risk-factor history, and we focus on the reversible risk factors. So many people facing dementia focus on the irreversible risk factors, such as ‘I’m getting older’ or ‘my dad or mom had dementia.’ We can’t change those things, but we can change things like levels of physical activity and cholesterol counts and blood-pressure numbers.”
He explained that in previous trials that have demonstrated a decrease in one or more risk factors, the patient’s overall propensity to develop Alzheimer’s is significantly reduced. “For most people, Alzheimer’s disease is an illness you live with, not an illness from which you die,” the physician stated. “With a better understanding of individual risk, there are steps that people can take to minimize the risk for serious memory loss. One of the common themes for both short-term and long-term risk is cardiovascular health, which is something that is more or less under our control through lifestyle changes or medications.”
Dr. Geldmacher presented a hypothetical case of a 50-year-old woman, with a family history of dementia, and is suffering from mild obesity and cardiovascular issues. In this case, she would be deemed at risk of developing the disease. However, “if she reverses one of three things — loses weight, brings her cholesterol under control or brings her blood pressure into the normal range — she can cut her risk in half,” Geldmacher said. “And if she manages all three of those reversible risk factors and brings them all into the desirable range, she can cut her dementia risk in half again.”
One of the first patients to visit the new clinical was Jon Kling, 72 years old, a reasonably healthy semi-retired financial planner, whose mother and all four sisters had dementia. He was worried about developing the disease. “I really wanted to be able to establish a baseline of where I am today. I didn’t feel like I was at particular risk right now, but down the road I didn’t know. I just wanted to see where I stood,” Kling said.
Geldmacher assessed Kling to be low-risk, and gave him recommendations on how to keep it that way, such as increasing physical activity and sticking to a healthy diet. “The physical activity of walking and working with light weights — those were things I’ve been doing for years. The assessment was really a reinforcement that I was doing the right things and that I need to continue to do so,” said Kling.
“There’s peace of mind with knowing my risk,” he added. “And knowing that we have this type of help in our own backyard right here in Birmingham, Alabama, is fantastic. It’s great to have the type of professional risk assessment that Dr. Geldmacher and his program provide. I think it’s invaluable.”
The physician believes that research models provide a reliable long-term risk assessment across 20 years, which is especially useful for patients in their late 40s and 50s. There are also six-year assessments for much older patients. “At this point in 2014 and for the foreseeable future, we don’t have any medications that meaningfully attack the processes in the brain that lead to Alzheimer’s disease,” said Geldmacher.
“We still don’t understand the cause of Alzheimer’s disease, so prevention by medication is a distant goal for us. It’s something we work on every day in our research labs and our clinical testing, but it’s not something that will emerge tomorrow or next week,” he added. Patients have two appointments with Geldmacher and his team: The first one is meant to gather pertinent histories and perform tests, while the second is to review the personalized treatment plan.
The physicians will provide patients resources that can help them implement lifestyle changes, as well as where to find supportive and educational materials and recommendations on coping strategies that can reduce the burden of dementia on the individual and on the family. The two-visit assessment is fee-for-service and will cost about $1,000. Geldmacher expects it to become a gateway to research projects with the purpose of finding new drugs or other treatments for lowering the risk of memory disorders.
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