A Renowned Psychiatrist Offers Hope
My mother, Emily, was one of the world’s great beauties. More importantly, she was a Coty-Award winning fashion designer, a founder and Trustee of the renowned Fashion Institute of Technology, a syndicated columnist and best-selling author of beauty, health and wellness books. It was she, in fact, who encouraged me to fully embrace life and go confidently in the direction of my dreams, adding that it never hurt to wear a killer coral lipstick in the process.
Everyone who has a loved one who shows symptoms of deteriorating cognitive abilities suffers. When it is a mother of outstanding grace and intelligence who is diagnosed with dementia and, subsequently, Alzheimer’s, at a young age, it is particularly hard, as it was on me. To see her in a nursing home, even harder. But even in the throws of the disease, she still retained an innate sense of fashion. I recall visiting her one morning, coming directly from the gym. She looked me up and down, and in a moment of, sadly, increasingly rare lucidity declared: “Oh Lord, please tell me that’s not a hoodie you’re wearing.”
Understandably, the fear of my inheriting Alzheimer’s is never far from my mind. From the expected, “I can’t find my keys,” to the unfathomable, “why is there a dishwasher pod in the slot where I normally keep my Metro card?”
Thankfully, a neurologist set my mind at rest as far as the keys. “Everyone loses their keys from time to time,” he assured me. “It’s when you have them in your hand and you don’t know what they are for, that’s when it becomes problematic.” Same thing with our cellphones—although I am loathe to admit that once I was looking for it, at the same time I was actually talking on it. As far as the Cascade pod, that remains an unsolved mystery to this very day.
Needless to say, the more I know about Alzheimer’s and hear about promising updates, the better. To that end, I recently spoke with Dr. Brent Forester, Psychiatrist-in-Chief and Chair for the Department of Psychiatry at Tufts Medical Center, Director of Behavioral Health for Tufts Medicine and Professor of Psychiatry. Dr. Forester is an expert in geriatric psychiatry, specializing in the treatment of depression, bipolar disorder and behavioral complications of Alzheimer’s disease and related dementias.
Below, our enlightening interview:
JWM: To begin with doctor, it is a familiar name by now, but what exactly is Alzheimer’s disease?
Dr. Forester: Alzheimer’s is a progressive neurological disorder that leads to memory loss, cognitive decline, and eventually the inability to perform everyday activities.
JWM: What is the difference between Alzheimer’s disease and dementia?
Dr. Forester: Dementia is defined as a decline in cognition and daily functioning. It is a syndrome caused by many underlying biological processes or diseases, the most common of which is the Alzheimer’s type, accounting for about 2/3 of all dementias. I often use automobiles as an example: Dementia is similar to a car (there are many, many types of cars) and Alzheimer’s is a Subaru (a specific type of car). In medical terms, Alzheimer’s disease is the most common cause of dementia, characterized by the degeneration of brain cells and the formation of abnormal protein deposits in the brain.
JWM: Now for the question you must get very often: What are the early warning signs of Alzheimer’s disease? What should patients watch for and discuss with their doctors?
Dr. Forester: The hallmark of cognitive impairment is rapid forgetting of new information. The hippocampus, which plays a vital role in memory formation, organization, and storage, is the part of the brain that gets attacked early in disease progression. When a person has cognitive impairment, they often cannot store information. This is likely an early warning sign of Alzheimer’s, and it shows itself in the real world through everyday conversations when the individual cannot recall a recent conversation or a significant event that occurred in the last week, or retain new information. It’s important to bring this up with your physician right away as there may also be something else going on that needs further attention.
JWM: Are there different types of memory loss?
Dr. Forester: Yes, and that’s important. One of the early stages is called mild cognitive impairment (MCI). MCI is characterized by noticeable changes in cognitive abilities, such as memory and thinking skills, that are serious enough to be noticed by the person affected and by family members and friends, but they do not affect the individual’s ability to carry out everyday activities. Within the syndrome of dementia, there are three stages: mild, moderate and severe. As someone progresses through these, there is evidence for increasing deficits in cognition and daily functioning. About 10-15% of people with MCI progress to dementia each year.
JWM: What are some causes of dementia?
Dr. Forester: Underlying biological processes or diseases. Other causes include vascular, Lewy body, fronto-temporal, Parkinson’s, and many more.
JWM: Are there any new treatments available today?
Dr. Forester: There are ones that have proven effective for slowing the progression of Alzheimer’s in the early dementia stages. However, once an individual advances past these, new treatments are usually ineffective. So it’s important to talk to your doctor right away and ask what could be helpful. Don’t be afraid and run away. Many problems that are treatable; not all symptoms lead to Alzheimer’s Disease. Other health or lifestyle issues, stressors, or medical problems like diabetes or depression can cause short-term or long-term memory loss and affect thinking or behavior.
JWM: Given the prevalence of Alzheimer’s in general, are there any preventative measures one can take to delay its onset?
Dr. Forester: Every approach to prevention—just like every approach to treatment—must be individualized. In my experience, the most effective strategies for preventing or delaying the onset of dementia involve a combination of individualized interventions, lifestyle modifications, and addressing modifiable risk factors.
JWM: Is exercise important as well?
Dr. Forester: Yes! Regular aerobic exercise, for 30 minutes, three to four times per week, improves cardiovascular health and lowers dementia risk. Similarly, a balanced diet, such as the Mediterranean, DASH, or MIND diets, rich in omega-3s and vegetables while low in saturated fats, supports brain health. Social engagement is another vital, often overlooked, factor. Exercising with friends, for example, combines physical, social, and emotional benefits.
JWM: Any thoughts on maintaining overall health in general?
Dr. Forester: Just that it’s crucial. Regular checkups to monitor cholesterol, thyroid function, and mental health, along with managing depression and avoiding alcohol overuse, can further reduce risk.
JWM: Switching gears here, doctor. You talked about dementia, but what factors influence Alzheimer’s specifically?
Dr. Forester: While genetic factors and aging are beyond our control, many risk factors, such as high blood pressure, sedentary behavior, and smoking. Depression and loneliness significantly increase dementia risk so, as I mentioned, staying socially active and pursuing meaningful activities is essential.
JWM: Bringing it full circle, Dr. Forester, what are the latest updates you can share on both dementia and Alzheimer’s?
Dr. Forester: A holistic approach to dementia prevention is essential, as it addresses not only biological factors but also the mental, emotional, and social aspects that contribute to overall cognitive health. Know, too, that we are in an unprecedented time of advances in diagnostics and disease-modifying therapies for Alzheimer disease. For example, new treatments like lecanemab (Leqembi) and donanemab (Kisunla) have shown promise for early-stage Alzheimer’s, but they are most effective when administered before significant cognitive decline occurs.
JWM: Thank you, Dr. Forester. It is comforting to know that there is so much research being done by you and your colleagues to help find the cause. Hopefully a cure is in the not too distant horizon, which will make us all feel Better Than Before.
P.S. Needless to say, I haven’t worn that hoodie since.
