Making a difference in the treatment and prevention of Alzheimers Disease – WJBF-TV

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 Alzheimers 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 thesepatients.

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

Brad Means: Sowhat does it take for them to come to your program? Is that the place where theinitial assessment happens? Or is this where someone with established dementiaor Alzheimers can come for help?

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

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

Dr. John Morgan: Iusually dont give them a pill. I usually reassure them after doing appropriatetests

Brad Means: Yeah.

Dr. John Morgan: Justto make sure. So your neurologist may, or your primary doctor may blow this offand say its not big deal. But sometimes it can be significant and that its anearly sign of youre starting to get forgetful. But, if it comes back to youwhy your keys are in the refrigerator by the milk, or it comes back, PaulinePrimroses name comes back to you later that night when youre lying in bed,that helps me say its much more benign that ominous.

Brad Means: Doyou look for plaque, and that tells you yay or nay if they have something,otherwise what is the determining factor to know if its not just somethingbenign.

Dr. John Morgan: Yeah,so the main things that we do is rule out other causes of memory trouble. Soyou look at thyroid function to make sure their thyroid is not low. You makesure they dont have an infectious disease called syphilis. Syphilis can causememory troubles, too. You want to make sure that theyre being

Brad Means: Syphilisis still a thing?

Dr. John Morgan: Ivehad three patients that test positive for syphilis that probably hadneurosyphilis causing dementia.

Brad Means: Wow.

Dr. John Morgan: Yeah,its really rare, but we do it just as a rule out. And the other thing we checkis B12 levels. Vitamin B12, if thats low, that can lead to memory troubles aswell. 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 theres nomajor 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. Andthen, in rare cases we do amyloid imaging, like we were discussing. We can testsomeone with amyloid, with a PET scan that lights it up in the brain. Or youcan do a spinal tap that looks for amyloid in the spinal fluid.

Brad Means: Andcan you get rid of that plaque?

Dr. John Morgan: Well,actually, there is some data with research thats ongoing right now. Thatantibodies that attack beta-amyloid are clearing the plaque in the brains ofAlzheimers patients. The problem is, is that how much that correlates withcognitive change is in question.

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

Dr. John Morgan: Yeah,we have one trial thats open right now, with more coming. But its mostlyfocused on folks with whats called mild cognitive impairment. Mild cognitiveimpairment is viewed as a early Alzheimers manifestation in patients. Whereyou have memory troubles, I can test for it, and see it on the testing that Ido with you memory, and you wind up with findings that are consistent withearly Alzheimers, but you can still take care of your daily living tasks.

Brad Means: Whatsthat assessment look like? Is it just remembering words?

Dr. John Morgan: Lotsof things. So drawing figures, like boxes or squares or pentagons, things likethat. 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.Whats called executive function. Attention and concentration, other tests ofmemory as well.

Brad Means: Dowomen do better on those things than men?

Dr. John Morgan: Wellactually, women more often develop Alzheimers than men a little bit.

Brad Means: Really?

Dr. John Morgan: Yeah.

Brad Means: Why,do we know?

Dr. John Morgan: Wedont know why thats the case. It may be that theyre living longer. Women maylive seven to eight years longer than men and Alzheimers is a disease ofaging. So folks up to age 85, up to half of patients up to age 85 havedementia. So its very common, as we age.

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

Dr. John Morgan: Ihavent. I dont know if theres really data that reflects that men or women dobetter. 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: Thatspossible, certainly men are more visual than women I would say.

Brad Means: Whenyou help a patient, can you help them extend, I dont want to say normal. Canyou help them stave off dementia or Alzheimers if they get in early enough.

Dr. John Morgan: Wedont have a definite disease modifying therapy yet. So there was some newsthat was just released, you may have seen from a company called Biogen, whichwas studying a monoclonal antibody, which attacks amyloid called acanthomatous.That antibody was shown to clear plaques, and improve cognition in very, veryearly Alzheimers patients by about 25% or so. So theres some data thats asignal there and the FDA wants them to continue research along those lines. Butwe dont have something that definitely slows it down. Things that you can doyourself include mental and physical exercise. Those are well correlated withpreserving cognition and brain size, and things like that. As well as aMediterranean diet may be helpful.

Brad Means: Whatsa Mediterranean diet consist of mainly, for those who dont know. Were talkingabout lots of oils and chicken?

Dr. John Morgan: Yeah.

Brad Means: Andolives.

Dr. John Morgan: Yeaholives, 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 haveanything, right?

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

Brad Means: Whatsthe difference between dementia and Alzheimers? And I ask you this every timeyou come here, and do you have to have dementia first?

Dr. John Morgan: Sothats a great question. A lot of patients will come in and say, Mydoctor told me I have dementia, but thank God I dont have thatAlzheimers.

Brad Means: Right!

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

Brad Means: Right.

Dr. John Morgan: Youhave different types of cancer. Alex Trebek has pancreatic cancer, others havecolon cancer, et cetera. Dementia is an overarching head. Below that is themost common cause, Alzheimers disease and thats at least half the cases. Buttheres also mixed dementia, which has vascular changes in the brain due tohigh blood pressure, diabetes, smoking. Those are things you can modifyyourself as well, controlling those. Or theres temporal dementia, theresalcoholic dementia if you drink too much. Theres all kinds of dementias thatare underneath that head.

Brad Means: Dr.Morgan, whats the time table once a diagnosis is made. And if its not greatnews. So when a family leaves your office, how much time do the have beforethings really start to deteriorate. And I know thats probably too general.

Dr. John Morgan: ButI get your gist. So folks usually live with Alzheimers, once its diagnosed,10 to 12 years or so, that kind of time frame. Luckily its diagnosed late inlife, 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 theperson. So some things that are helpful include doing those exercise typethings, physical and mental. But also if you start out a sharper knife in thedrawer, thats better for you.

Brad Means: Yeah.

Dr. John Morgan: Sofolks who have a lot higher cognitive reserve, theyll do better over a longerperiod of time, than those who werent the sharpest.

Brad Means: Whatdo you do about the stress part of it, or the panic part of it. Because if Iwas in that chair across that table from you you know, I would be extremelyuneasy going forward, and maybe that anxiety would take over my ability to dosome of the treatments that youre recommending. Can you help them cope withthat?

Dr. John Morgan: Yeah,a lot times and anxiety or depression can be a part of any condition that isdegenerative, you know, like Alzheimers or Parkinsons. But treating theanxiety and depression is important. Medication can be helpful, but also ittakes a mindset adjustment. You know, Ive got Alzheimers, but it doesnt haveme. Same thing with Parkinsons, you fight back against it, and you just try todo your best on a daily basis. And if you worry about five years from now, yourejust gonna shorten your life come worrying.

Brad Means: Whatsort of recommendations, probably my last question, can you give to familiesout there. Maybe if they have a primary care physician who sort of just blowsit off and says oh, youll 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: Sowe have a whats called a memory assessment center. Its funded by the state ofGeorgia, its a line out of budget, in the budget each year. From about $4million plus that funds five different centers around the state. Emory, is thequarterback of the program, and we were the first memory assessment center inthat program. So we have a social worker that helps us deal with issues thatfamilies are going through. We have referral bases that help get them to thearea agency on aging, the Alzheimers association and other things like that tohelp establish things. And we also have a conference of clinic that if youcontact us at 706-721-2798, we can get you in, in a reasonable, timely fashionand evaluate your loved one.

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

Dr. John Morgan: Iwould say for sure.

Brad Means: Good.

Dr. John Morgan: Numberone because resources, mega resources from pharma, NIH, other folks are goingin to solving this issue. Because if we dont solve, slowing down Alzheimersand Parkinsons were gonna have a dementia and Parkinsons tsunami as babyboomers age, and we may not be able to afford it as a country, taking care ofthese folks.

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

Dr. John Morgan: Thankyou very much.

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Making a difference in the treatment and prevention of Alzheimers Disease - WJBF-TV