Making a difference in the treatment and prevention of Alzheimer’s Disease


Making a difference in the treatment and prevention of Alzheimer’s Disease

AUGUSTA, Ga. (WJBF) – Dr. John Morgan is the director of the Movement and Memory Disorder Program at the Medical College of Georgia at Augusta University. He sees how Alzheimer’s Disease changes patients, and he is one of the dedicated doctors working to improve the outcome for his patients before and after the diagnosis.

Brad Means: Dr. Morgan, thanks for loaning your time to us and thanks for what you do for these patients.

Dr. John Morgan: Thanks, Brad, glad to be here.

Brad Means: So what does it take for them to come to your program? Is that the place where the initial assessment happens? Or is this where someone with established dementia or Alzheimer’s can come for help?

Dr. John Morgan: So we do a lot, a variety of things, at our practice at MCG. We evaluate folks who are the worried well, I call them, who are like I misplaced my keys the other day, and I forgot so-and-so’s name, and I know him for years. I evaluate folks that are doing okay, all the way to folks who have advanced dementia. So we care for the whole range of folks that are doing quite well in life all the way to those with advanced dementia.

Brad Means: If you are forgetting names, or some of those things that the worried well do. Can you give them a pill, or do something to make those names go back in their head, and for them to stop having those episodes?

Dr. John Morgan: I usually don’t give them a pill. I usually reassure them after doing appropriate tests

Brad Means: Yeah.

Dr. John Morgan: Just to make sure. So your neurologist may, or your primary doctor may blow this off and say it’s not big deal. But sometimes it can be significant and that it’s an early sign of you’re starting to get forgetful. But, if it comes back to you why your keys are in the refrigerator by the milk, or it comes back, Pauline Primrose’s name comes back to you later that night when you’re lying in bed, that helps me say it’s much more benign that ominous.

Brad Means: Do you look for plaque, and that tells you yay or nay if they have something, otherwise what is the determining factor to know if it’s not just something benign.

Dr. John Morgan: Yeah, so the main things that we do is rule out other causes of memory trouble. So you look at thyroid function to make sure their thyroid is not low. You make sure they don’t have an infectious disease called syphilis. Syphilis can cause memory troubles, too. You want to make sure that they’re being–

Brad Means: Syphilis is still a thing?

Dr. John Morgan: I’ve had three patients that test positive for syphilis that probably had neurosyphilis causing dementia.

Brad Means: Wow.

Dr. John Morgan: Yeah, it’s really rare, but we do it just as a rule out. And the other thing we check is B12 levels. Vitamin B12, if that’s low, that can lead to memory troubles as well. We image everybody looking for any signs of thing you might not expect. Like a stroke, or tumors, or other things like that to make sure there’s no major structural legions. We can also look for signs of shrinking of the brain, called atrophy, in certain areas like the temporal lobes, things like that. And then, in rare cases we do amyloid imaging, like we were discussing. We can test someone with amyloid, with a PET scan that lights it up in the brain. Or you can do a spinal tap that looks for amyloid in the spinal fluid.

Brad Means: And can you get rid of that plaque?

Dr. John Morgan: Well, actually, there is some data with research that’s ongoing right now. That antibodies that attack beta-amyloid are clearing the plaque in the brains of Alzheimer’s patients. The problem is, is that how much that correlates with cognitive change is in question.

Brad Means: Are we doing anything here at home, any trials that people can take part in. Or at least we can await the outcome?

Dr. John Morgan: Yeah, we have one trial that’s open right now, with more coming. But it’s mostly focused on folks with what’s called mild cognitive impairment. Mild cognitive impairment is viewed as a early Alzheimer’s manifestation in patients. Where you have memory troubles, I can test for it, and see it on the testing that I do with you memory, and you wind up with findings that are consistent with early Alzheimer’s, but you can still take care of your daily living tasks.

Brad Means: What’s that assessment look like? Is it just remembering words?

Dr. John Morgan: Lots of things. So drawing figures, like boxes or squares or pentagons, things like that. Remembering lists of words and recalling as many as you can over time. Also, connecting things together, and planning things out, from A to B to C. What’s called executive function. Attention and concentration, other tests of memory as well.

Brad Means: Do women do better on those things than men?

Dr. John Morgan: Well actually, women more often develop Alzheimer’s than men a little bit.

Brad Means: Really?

Dr. John Morgan: Yeah.

Brad Means: Why, do we know?

Dr. John Morgan: We don’t know why that’s the case. It may be that they’re living longer. Women may live seven to eight years longer than men and Alzheimer’s is a disease of aging. So folks up to age 85, up to half of patients up to age 85 have dementia. So it’s very common, as we age.

Brad Means: But have you noticed whether men or women preform better on this task?

Dr. John Morgan: I haven’t. I don’t know if there’s really data that reflects that men or women do better. Education status, and pre-morbid function is also important as well.

Brad Means: Yeah, Google told me that women remember words better, men remember images better, and so that sort of affect the outcome of those tests.

Dr. John Morgan: That’s possible, certainly men are more visual than women I would say.

Brad Means: When you help a patient, can you help them extend, I don’t want to say normal. Can you help them stave off dementia or Alzheimer’s if they get in early enough.

Dr. John Morgan: We don’t have a definite disease modifying therapy yet. So there was some news that was just released, you may have seen from a company called Biogen, which was studying a monoclonal antibody, which attacks amyloid called acanthomatous. That antibody was shown to clear plaques, and improve cognition in very, very early Alzheimer’s patients by about 25% or so. So there’s some data that’s a signal there and the FDA wants them to continue research along those lines. But we don’t have something that definitely slows it down. Things that you can do yourself include mental and physical exercise. Those are well correlated with preserving cognition and brain size, and things like that. As well as a Mediterranean diet may be helpful.

Brad Means: What’s a Mediterranean diet consist of mainly, for those who don’t know. We’re talking about lots of oils and chicken?

Dr. John Morgan: Yeah.

Brad Means: And olives.

Dr. John Morgan: Yeah olives, and olive oil, chick peas, probably things like that.

Brad Means: Yeah, and, better to do, especially the puzzles and the brain games, before you have anything, right?

Dr. John Morgan: Yeah, so keeping your mind active has been shown to keep it juicier and larger compared to how it shrinks later with Alzheimer’s disease. So even if folks with cognitive issues, if they exercise their minds and exercise their body, their size of their cortex is bigger.

Brad Means: What’s the difference between dementia and Alzheimer’s? And I ask you this every time you come here, and do you have to have dementia first?

Dr. John Morgan: So that’s a great question. A lot of patients will come in and say, “My doctor told me I have dementia, “but thank God I don’t have that Alzheimer’s.”

Brad Means: Right!

Dr. John Morgan: Well, they’re the same. So if you can think of this. Let’s put it in an analogy. Cancer, you have cancer. Cancer is not a good thing to have, right?

Brad Means: Right.

Dr. John Morgan: You have different types of cancer. Alex Trebek has pancreatic cancer, others have colon cancer, et cetera. Dementia is an overarching head. Below that is the most common cause, Alzheimer’s disease and that’s at least half the cases. But there’s also mixed dementia, which has vascular changes in the brain due to high blood pressure, diabetes, smoking. Those are things you can modify yourself as well, controlling those. Or there’s temporal dementia, there’s alcoholic dementia if you drink too much. There’s all kinds of dementias that are underneath that head.

Brad Means: Dr. Morgan, what’s the time table once a diagnosis is made. And if it’s not great news. So when a family leaves your office, how much time do the have before things really start to deteriorate. And I know that’s probably too general.

Dr. John Morgan: But I get your gist. So folks usually live with Alzheimer’s, once it’s diagnosed, 10 to 12 years or so, that kind of time frame. Luckily it’s diagnosed late in life, and folks often die of other things that take us out of this world. Cancer, stroke, heart attack, you pick your poison. But, it all depends on the person. So some things that are helpful include doing those exercise type things, physical and mental. But also if you start out a sharper knife in the drawer, that’s better for you.

Brad Means: Yeah.

Dr. John Morgan: So folks who have a lot higher cognitive reserve, they’ll do better over a longer period of time, than those who weren’t the sharpest.

Brad Means: What do you do about the stress part of it, or the panic part of it. Because if I was in that chair across that table from you you know, I would be extremely uneasy going forward, and maybe that anxiety would take over my ability to do some of the treatments that you’re recommending. Can you help them cope with that?

Dr. John Morgan: Yeah, a lot times and anxiety or depression can be a part of any condition that is degenerative, you know, like Alzheimer’s or Parkinson’s. But treating the anxiety and depression is important. Medication can be helpful, but also it takes a mindset adjustment. You know, I’ve got Alzheimer’s, but it doesn’t have me. Same thing with Parkinson’s, you fight back against it, and you just try to do your best on a daily basis. And if you worry about five years from now, you’re just gonna shorten your life come worrying.

Brad Means: What sort of recommendations, probably my last question, can you give to families out there. Maybe if they have a primary care physician who sort of just blows it off and says oh, you’ll be fine. But the person who lives with the patient, or potential patient knows that something is wrong. How do we get them to you?

Dr. John Morgan: So we have a what’s called a memory assessment center. It’s funded by the state of Georgia, it’s a line out of budget, in the budget each year. From about $4 million plus that funds five different centers around the state. Emory, is the quarterback of the program, and we were the first memory assessment center in that program. So we have a social worker that helps us deal with issues that families are going through. We have referral bases that help get them to the area agency on aging, the Alzheimer’s association and other things like that to help establish things. And we also have a conference of clinic that if you contact us at 706-721-2798, we can get you in, in a reasonable, timely fashion and evaluate your loved one.

Brad Means: One last question. I was told to wrap as quickly as possible. But this is almost a yes or no, Are you more hopeful now that we are making a dent in this thing than you were when you started your practice?

Dr. John Morgan: I would say for sure.

Brad Means: Good.

Dr. John Morgan: Number one because resources, mega resources from pharma, NIH, other folks are going in to solving this issue. Because if we don’t solve, slowing down Alzheimer’s and Parkinson’s we’re gonna have a dementia and Parkinson’s tsunami as baby boomers age, and we may not be able to afford it as a country, taking care of these folks.

Brad Means: Well said. Dr. John Morgan, thanks for the work that you do.

Dr. John Morgan: Thank you very much.

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