“This collaborative effort continues to elevate Norton Neuroscience Institute to a national stage,” said Gregory E. Cooper, M.D., Ph.D., neurologist and director of Norton Neuroscience Institute Memory Center. “It’s an affirmation of what we’ve already done, while also incentivizing us to continue pushing the limits of dementia and Alzheimer’s care in our community.”

The program funds a dedicated nurse navigator, Deborah Lockridge, R.N., BSN, CCRC, at Norton Community Medical Associates – Preston, whose job is to collaborate with primary care providers at the practice to identify patients who are at high risk and may be experiencing early symptoms of cognitive decline. The goal is to more quickly connect those patients with treatment at Norton Neuroscience Institute Memory Center and provide personalized education and support services along the way. The hope is to more efficiently diagnose and treat Alzheimer’s disease and other forms of dementia in their earliest stages. If the pilot proves successful, this clinical pathway may be used as a worldwide model for future Alzheimer’s care.

“This grant enhances the comprehensive care services we offer here at Norton Healthcare,” Lockridge said. “We all agree having a point of contact who can answer questions, encourage patients and caregivers and point them in the right direction is going to be a tremendous benefit to our community. We will use this opportunity to develop a collaborative, easy-to-navigate care model that can be scaled not just throughout Norton Healthcare, but across the country.”

Alzheimer’s disease is growing into a worldwide epidemic. According to the National Institute on Aging, more than 6 million Americans currently are living with Alzheimer’s, and more than 13 million will be living with the disease by 2060. The current care model requires multiple medical providers to coordinate to ensure patients who are eligible for disease-modifying therapies receive them during the early window of opportunity, when they will most benefit.

Yet, there are pathways for prevention, early detection and accurate diagnosis that could change the course of the disease forever. For example, in August 2023, Norton Neuroscience Institute became the first site in Kentucky to administer disease-modifying therapies to patients with mild cognitive decline and mild Alzheimer’s disease. In addition to early treatment, Norton Neuroscience Institute is actively pursuing brain health and prevention strategies.

“We’re very proud of our memory program and what we’ve created so far, but we know there is still much work to be done,” Dr. Cooper said. “We won’t rest until we’ve tried to perfect our system to quickly identify, diagnosis and treat people at the earliest possible stages, when we believe we have the greatest chance to slow this disease in its path.”

The six pilot sites will serve as start-up incubators for the development of materials and best practices for the program’s long-term sustainability and expansion — without the need for external funding. The learnings and resources from the Brain Health Navigator program will be incorporated into Davos Alzheimer’s Collaborative’s Early Detection Blueprint.

The other sites included in the program are Dartmouth Health (New Hampshire), Memorial Healthcare (Owosso, Michigan), Sharp Rees-Stealy Medical Group (California), UC Health (Ohio) and Keck Medical Center of USC, part of Keck Medicine of USC (California). Patients can schedule an appointment by calling (502) 446-4664 or visiting NortonHealthcare.com/MemoryCenter.

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The 18-month study of people with and without Alzheimer’s disease focuses on whether an imbalance in good and bad bacteria plays a role in development of Alzheimer’s disease-related dementia.

“This an exciting new line of research into the potential cause of Alzheimer’s,” said Shirish S. Barve, Ph.D., chief research scientist for Norton Neuroscience Institute and Norton Research Institute.

“We’re hoping what we learn in this study will help us develop effective prevention and treatment therapies for Alzheimer’s disease-related dementia,” said Dr. Barve, who is known internationally for his research on the connection between gut health and brain health.

READ MORE: Here are seven ways to keep your brain healthy

Gut bacteria potentially could affect brain health, because gut bacteria regularly communicate with the brain. The digestive tract and brain have evolved a high level of communication to help us get the nutrients we need, signal when we’ve had enough to eat and prevent digestion of dangerous substances.

Normally, beneficial bacteria in the gut prevent the overgrowth of bad bacteria. But lifestyle and environmental factors such as age, diet, high blood pressure, obesity, sleep and pollution can result in an imbalance, which can lead to inflammation.

READ MORE: Eating well means eating for brain health

In what is known as the gut-brain axis, nerves send signals back and forth and work in tandem with the immune system.

Researchers now want to learn if chronic inflammation may increase an individual’s chance of getting Alzheimer’s disease.

Inflammation is an important immune response that helps the body fight infection, injury and disease, but chronic inflammation can be unhealthy. Chronic inflammation can damage healthy cells, tissues and organs and has been linked to such chronic and life-threatening diseases as Type 2 diabetes and cancer.

Microglia are immune cells in the brain. These cells help maintain a healthy brain environment, looking for invaders and clearing away cellular debris. When they find something, they release inflammatory signals. In the aging brain, they are more likely to stay activated for longer than normal, an exaggerated response associated with Alzheimer’s and other neurodegenerative diseases.

Some research suggests that gut microbes may contribute to development of amyloid deposits in the brain. Amyloids are proteins that can collect into clumps or amyloid plaques that can interrupt brain cell activity and contribute to cognitive impairment.

Whether or not someone gets Alzheimer’s is linked to factors we don’t control and those we do. In addition to aging, genetics and a family history of the disease are the biggest risk factors for Alzheimer’s. Other factors, which may account for 40% of all cases, include physical activity, diet, smoking, education, staying socially and mentally active, and blood pressure.

Alzheimer’s has a devastating impact on millions of families. Some 6.9 million Americans have Alzheimer’s, affecting an estimated 1 in 9 people over 65 and 1 in 3 people over 85 in the United States. Symptoms, which worsen over time, include memory loss and cognitive symptoms such as difficulty thinking and confusion.

Currently, most patients are treated with cognitive enhancing medications that treat the symptoms of memory loss, but not potential inflammation. One type prevents the breakdown of an important chemical messenger for learning and memory. The other helps with chemical signaling in the brain. More recently, medications have been approved that remove abnormal protein from the brain, and slow the progression of Alzheimer’s disease.

Current clinical trials and studies led by Dr. Barve

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Researchers are working to determine the causes of progressive memory disorders such as Alzheimer’s disease. Certain genetic risk factors have been identified. For example, if you have a parent or sibling diagnosed with Alzheimer’s disease, your risk for dementia may be double that of a person without a first-degree relative with dementia.

Although we cannot change our genes, fortunately, there are risk factors you can control. Addressing these risk factors can improve cognitive function and brain health while reducing a person’s risk for dementia and serious cognitive decline.

• Increase physical activity and exercise regularly
• Quit smoking
• Reduce alcohol consumption
• Avoid social isolation
• Continue learning new knowledge and skills
• Avoid air pollution

READ MORE: Here are seven ways to keep your brain healthy

Several conditions, if left untreated, can lead to impaired brain function and increase the risk of dementia.

• High blood pressure (hypertension)
• Diabetes
• Hearing impairment
• Poor mental health and depression
• Head injury
• Obesity

“There’s an increasing body of evidence that addressing multiple factors under our control can meaningfully reduce a person’s risk of developing dementia,” said Kenneth Gregory Pugh, M.D., a geriatrician who specializes in dementia and cognitive disorders at Norton Neuroscience Institute Memory Center.

READ MORE: Eating well means eating for brain health

Research opportunities are available to help you understand your risk. Participation varies, from online surveys to clinical trials of innovative medications. Learn more about research opportunities at NortonResearchInstitute.com.

Types of memory loss

There are various types of memory loss in addition to dementia and Alzheimer’s disease. While dementia disproportionately affects older adults, it is not a normal part of aging. Healthy aging can mean it takes you longer to process thoughts, and doing multiple things at the same time (multitasking) may become more difficult. But even with aging, routine memory, skills and knowledge should not deteriorate — and sometimes actually improve with age. Forgetting names or where you left your phone is normal. Storing your phone in the freezer would be cause for concern.

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• Subjective cognitive impairment is when an individual noticesworsening of thinking abilities, including memory, but the decline cannot be verified by standard memory and cognitive tests.
• Mild cognitive impairment (MCI) describes memory or thinking issues greater than what would be typical for your age. With MCI, however, you remain independent, able to take care of yourself and carry out normal daily activities.
• Dementia is characterized by progressive or persistent loss of intellectual functioning, especially impairment of memory, abstract thinking and language. It often is accompanied by changes in mood or personality. This is due to pathologic changes occurring within the brain. The most common forms of dementia include Alzheimer’s disease and vascular dementia, among others. Dementia results in the inability to perform normal daily activities required to remain independent.

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Dementia refers to any loss of mental functioning that is not part of normal aging. This includes not only losing your memory, but issues with thinking, learning and reasoning.

“There are many facets to dementia. People with dementia could start having issues communicating or paying attention, or having issues with their judgment, or becoming disoriented,” said Rachel N. Hart, D.O., geriatric medicine specialist with Norton Neuroscience Institute.

Together, these changes can affect someone’s ability to function and could mean losing the basic skills necessary for daily living.

Dementia with Lewy bodies is one example of dementia that initially presents without memory loss. It is progressive, like Alzheimer’s disease. Initial symptoms include difficulty paying attention and remaining alert, and recurrent visual hallucinations.

Hallucinations and misinterpreting visual signals are common issues in people with dementia. For example, someone who has dementia with Lewy bodies might see a shadow on the ground and think it’s a hole.

In addition to changes in the ability to process information and think, dementia also can result in changes in mood and behavior.

Frontotemporal dementia, or FTD, is a type of dementia typically occurring in people under the age of 65. Initially it causes changes in behavior, rather than memory loss.

FTD can result in obsessive or socially inappropriate behaviors, swearing, a lack of personal hygiene, and an increased interest in sex. People with FTD also can show a lack of empathy, indifference, decreased self-awareness and a lack of judgment.

Like FTD, frontal variant Alzheimer’s disease, or fvAD, is an atypical dementia and shows early symptoms that are behavioral, rather than related to memory. This includes socially inappropriate behaviors, loss of motivation to do things they used to enjoy, lack of empathy, and repetitive or obsessive behaviors.

People with fvAD, which affects about 1 in 50 people with Alzheimer’s, also may struggle to follow a series of simple steps, become easily distracted and have other symptoms related to “executive function.” They also may become fixated on a single thought or object, or have difficulty holding more than one piece of information at a time.

Vascular dementia, which is also called vascular cognitive impairment, often occurs as a result of strokes, which can block major blood vessels in the brain. Depending on which part of the brain is affected, vascular dementia can cause changes in mental abilities other than memory. This can include difficulty following directions, disorientation, and trouble speaking or understanding speech.

Like other forms of dementia, vascular dementia can begin as a mild condition and worsen over time. It also can occur at the same time as Alzheimer’s and dementia with Lewy bodies.

Vascular dementia is diagnosed with a brain scan along with other medical information, such as a history of uncontrolled diabetes or smoking. FTD and other atypical dementias can be diagnosed using brain imaging, such as MRI or positron emission tomography scan, and more comprehensive cognitive testing called neuropsychology testing.

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The drug from Eisai Co. Ltd. and Biogen has been especially effective in the early stages of buildup and is now available for mild cognitive impairment due to Alzheimer’s disease.

How effective is lecanemab for treating Alzheimer’s disease?

Lecanemab had been accepted for accelerated approval by the FDA. Results from the Clarity AD phase 3 clinical study showed disease progression slowed by 26% after 18 months in those who received lecanemab infusions every other week.

“This is a very significant step forward for our field. Lecanemab is the first medication with solid evidence that it is really modifying the course of this disease and, at least as many of us think, treating the underlying causes of this disease” said Gregory E. Cooper, M.D., Ph.D., neurologist and director of the Norton Neuroscience Institute Memory Center.

Scientists believe buildup of beta-amyloid plaque in the brain could be responsible for damaging and killing nerve cells. Most researchers believe plaques somehow play a critical role in blocking communication among nerve cells and disrupting processes cells need to survive.

According to the Alzheimer’s Association, more than 6 million Americans are living with the disease. It’s one of the top 10 leading causes of death in the U.S., and the fifth leading cause of death among adults ages 65 or older. While lecanemab is not a cure for people with Alzheimer’s disease, research shows it slows the progression of the disease significantly. For a disease that has been untreatable in the past, the new drug is especially promising.

Access to the new Alzheimer’s drug and next steps

Lecanemab is indicated for those with very early or mild Alzheimer’s disease. An assessment of medical history, MRI and minor blood work are required to determine whether a patient is eligible. Additional testing such as a spinal fluid examination, through a positron emission tomography (PET) scan, and a genetic test can determine the risk of amyloid-related abnormalities appearing in diagnostic imaging tests such as MRIs.

Lecanemab is given by IV infusion every two weeks in an infusion center. The infusion is administered in less than an hour, with extended careful monitoring afterward. Home infusions may be an option after an initial series of center-based infusions. Repeat MRI scans can be completed three to four times during the first year to monitor for any side effects.

Is lecanemab safe?

There are some potential risks to the drug. A quarter of patients will experience a mild reaction to the infusion. Symptoms might include fever, headache, rash, nausea or abdominal discomfort. These symptoms usually can be controlled with over-the-counter medications such as acetaminophen or antihistamines, if necessary.

If you think you may be a candidate for lecanemab, contact your neurologist to discuss eligibility.

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“As caregivers, we want to know what is normal and if there’s anything we can do,” said Rachel N. Hart, D.O., a geriatric medicine specialist with Norton Neuroscience Institute Memory Center.

Here are the causes of changing behavior with dementia, strategies for managing symptoms without medication and considerations for medication if that is deemed necessary.

What causes behavioral changes in dementia patients?

“About 97% of people at some point may experience neuropsychiatric symptoms,” Dr. Hart said. Neuropsychiatric symptoms (NPS) describe a set of behavioral or psychological symptoms. These symptoms can range from delusional to physical (pacing or restless wandering) to verbal (incoherent speech or negativism). It can vary in level of aggression, and can include yelling, hitting or biting.

“Every person is different, and the way the disease presents itself in these symptoms depends on so many factors,” Dr. Hart said.

Behavior changes are affected by the stage of dementia. Early stage dementia can appear with depression or anxiety. In moderate stage, delusions, hallucinations, or paranoia are more common. The type of dementia also plays a role. NPS appear differently in patients with Alzheimer’s disease, Lewy body dementia or frontotemporal dementia.

How can caretakers handle behavioral changes?

Here are five ways to help loved ones if you are a caregiver:

1. Clear and simple communication: Use short sentences and simple words. Long, complicated sentences are confusing and frustrating for someone who is losing their language capabilities.
2. Approach with care: Give the person time to recognize who is coming toward them. Walk slowly and speak softly.
3. Keep questions simple: Avoid open-ended questions and narrow down choices: A question that is better than asking, “What do you want to wear today?” would be: “Do you want to wear the blue dress or the green dress?”
4. Practice patience: Try not to point out mistakes or lose your temper. This can worsen anxiety and agitation in individuals with dementia.
5. Maintain a routine: Doing the same things at the same time is comforting and can help decrease anxiety.

“Most often it comes down to impaired communication,” Dr. Hart said. “We all have needs and desires we want to be addressed. We want companionship and safety. Individuals with dementia are gradually losing the ability to have those needs met and those desires satisfied.”

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When should I stop driving?

There is no set age for stopping driving, but there are many issues to consider. People over 70 are more likely to have automobile accidents than other age groups. “As we age, our bodies change. We lose muscle flexibility and tone, hearing and vision aren’t as sharp, and reaction time slows,” said Rachel N. Hart, D.O., geriatric medicine and memory specialist with Norton Neuroscience Institute. “It’s important to keep yourself and other people safe.”

Driving and aging

• Anticipate the changes: “You should keep going to your doctors for regular checkups. Ask questions and be honest about your symptoms and experiences,” Dr. Hart said.
• Family conversations: If a family member approaches you about your driving, try to keep an open mind. There are ways to keep you safely behind the wheel longer.
• Screenings: Your doctor can help you find a driving fitness evaluation. This sets a baseline for your driving skills and can identify weaknesses.
• Interventions: You might be eligible for equipment or training to help you feel more confident and comfortable behind the wheel, such as hand controls or low-effort steering wheels.
• Staying engaged: It’s easy to feel disconnected from your community if you no longer can drive. Look for ways to get out and about safely such as ride-hailing or ride-sharing programs.

Resources

There are local resources to help you with all of these strategies. For people who have been unable to drive a vehicle due to neurological condition or for those who have experienced age-related changes in function, the loss of independence can be devastating. The Norton Hospital Driving Assessment Program, a service of Norton Neurosciences & Spine Rehabilitation Center, assists in returning individuals to safe, independent driving. Driving assessments are given by a licensed occupational therapist certified as a driving rehabilitation specialist, stroke rehabilitation specialist and low vision specialist. The therapist assesses vision, visual-perceptual skills, physical ability (reaction time, strength and mobility) and cognitive skills (attention, decision-making, memory). You can visit our website to learn more about this program.

Driving and Dementia

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1. Think smaller: People with dementia often have trouble making decisions, recognizing faces of people they don’t see often, and moving around in large spaces.
   “This can look like offering fewer dishes at a meal, inviting fewer people and staying in one or two rooms of a home,” said Teepa, Teepa “Also, smaller plates and smaller portions,” so the person doesn’t feel overwhelmed or pressured to eat.
2. Simplify: Find ways to reduce the demands on the person physically and emotionally. An example would be instead of having a marathon meal, just get together for coffee and dessert.
   “Instead of doing many big events, think of ways to make it easier on yourself as the planner and the person as the participant,” Teepa said.
3. Shorten the duration: It’s important to understand the potential to overwhelm a person who has dementia. Shortening the length of time they are asked to participate can make for a smoother event for everyone.
4. Support for sensory issues: “Ask where the person is sensory-wise,” Teepa said. “What can they handle visually and aurally?”
   Will the person find background noise or small children overwhelming or irritating? If you’re in a place where people need to wear masks, will that create stress as the person tries to understand conversations that might be hard to hear? Scents — including perfumes, body washes/soaps and fragranced candles — also may pose an issue for people with dementia.
5. Social support: Have someone assigned to hang out with the person throughout the event. It should be someone the person knows, but not a host or hostess who would be very busy with the rest of the event. The support person would help with hydration, bathroom breaks and other tasks.
6. Spatial support: This means helping the person transition from space to space, such as inside to outside, room to room or home to home. The person may feel confused or overwhelmed, so it is important to communicate the transitions to the person with dementia.
7. Circadian sensitivity: Ask yourself when the person will be at their best. What time of day are they usually the most alert and awake? When do they struggle? If you can’t change the timing of an event, can you shorten the length of time the person is present?
8. Be flexible: If it’s not working out for some reason, it’s OK to leave the event. By the same token, if it is going well, don’t try to push for more.

Teepa’s overall message is to focus on the celebration, be willing to pivot when needed and support those people in our lives with dementia.

Teepa recently was featured on “Good Morning America,” highlighting her popular TikTok videos about how to care for someone with dementia.

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Misplacing a pen or forgetting someone’s name is a normal loss of memory for someone who is older. Symptoms of dementia in older adults reflect changes in how their brain works — they may struggle to use a telephone or a television remote control they had mastered long ago.

“It really comes down to having evidence of cognitive decline from a previous level of ability,” said Rachel N. Hart, D.O., geriatric medicine physician with Norton Neuroscience Institute Memory Center.

Dementia affects about 1% of people in their 60s and the percentage doubles every five years or so. Among people in their 90s, 40% have dementia. About half of people with dementia go undiagnosed.

Symptoms of dementia in older adults can include difficulty finding the right word, trouble with common tools like the remote control, inability to recognize formerly familiar items or people, and loss of “executive function,” or ability to plan, which affects things like the ability to balance a checkbook.

Day-to-day activities that could be affected by dementia include working, shopping, driving a car, cooking, doing finances, dispensing medications and maintaining a home. Dementia symptoms also can include difficulty with basic activities like dressing, bathing, eating and toileting.

Diagnosing and treating dementia

Dementia is diagnosed using tests like the Montreal Cognitive Assessment, which gives a score out of 30 and can indicate whether someone has mild, moderate or severe impairment.

To be diagnosed with dementia, mental difficulties also can’t be the result of some reversible medical condition like major depression. To rule out other potential causes of cognitive troubles, a number of tests may need to be performed.

Lifestyle modifications can help with dementia. These include exercise, adequate sleep, establishing and keeping consistent routines, and avoiding excessive stimuli. Keeping the brain active and continuing to socialize are also helpful.

There are two classes of drugs that have been approved for treating dementia, cholinesterase inhibitors and NMDA-receptor antagonists. Both types of medications are considered memory enhancing. They’ve been shown to slow the progression of dementia, but they aren’t a cure.

“They’ve not been shown to reverse the memory loss that’s already present for a patient with dementia,” Dr. Hart said.

Other medications can help with other symptoms of dementia in older adults. Antidepressants can be used to treat anxiety or agitation. Antipsychotics can be used to treat delusions or paranoia. Mood stabilizers can help in people with dementia who risk harming themselves or their caregivers.

Dementia should not be confused with delirium, an extreme, confused state caused by some sort of illness. Hyperactive delirium can result in agitation and restlessness, while hypoactive delirium can leave people drowsy and inactive. Some people will have both types of delirium during a single day.

Depression is common among older adults and it can be mistaken for dementia. Depression is defined as having five or more of the following for two weeks: poor concentration, loss of interest, sleep disturbance, low energy, sense of guilt, change in appetite, a change in behavior causing either a slowing down or agitation, and suicide or thoughts of death.

Dementia, delirium and depression are three separate, distinct syndromes, but all three can coexist in the same person. People with dementia have a higher risk for delirium, and many people with dementia also have depression, according to Dr. Hart.

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A study out of Australia found an association between coffee and dementia. Consuming more than six cups of coffee daily led to a 53% increased risk of developing dementia later in life. While the researchers are not sure exactly how too much coffee links with brain health issues, they noted that finding the right balance of consumption may help protect against future brain difficulties.

“Accounting for all possible permutations, we consistently found that higher coffee consumption was significantly associated with reduced brain volume — essentially, drinking six or more cups of coffee a day may be putting you at risk of brain diseases such as dementia and stroke,” said Kitty Pham, the lead researcher of the study.

READ MORE: Here are seven ways to keep your brain healthy

Dementia is a degenerative brain condition. Over time, the condition causes serious cognitive decline – it affects memory, thinking, behavior and the ability to perform everyday tasks. In Kentucky, more than 75,000 people 65 and older are living with the disease, which is the sixth-leading cause of death in the state.

READ MORE: Eating well means eating for brain health

You don’t have to quit all coffee intake. According to Gregory E. Cooper, M.D., Ph.D., chief of adult neurology and director of the Norton Neuroscience Institute Memory Center, while the findings are interesting, more research is needed to draw a final conclusion.

The dose of coffee and the amount of caffeine makes a difference.

“It looks like a solid study, but it would be hard to reach a strong conclusion yet,” Dr. Cooper said. “In fact, there is data suggesting that caffeine generally, and coffee more specifically, might even be protective to the brain. The difference is the quantity. Some small amount is good, and too much becomes bad.”

In fact, Dr. Cooper, who has worked with dementia and Alzheimer’s disease patients for more than 25 years, said up to 40% of dementia cases are preventable. Recommendations to lower dementia risk include prevention against:

• High blood pressure
• Hearing loss
• Air pollution (including secondhand smoke)
• Head injury
• Excess alcohol
• Smoking
• Obesity
• Physical inactivity
• Diabetes
• Sleep disorders

“If you address any of these issues, your chances for developing dementia are much lower,” Dr. Cooper said. “And as for the coffee, a cup or two isn’t likely to hurt, and could even be helpful, but don’t go too crazy on the caffeine.”

Health benefits of drinking coffee — in moderation

Moderate coffee consumption has some benefits:

• Reduced risk of prediabetes
• Reduced risk of liver disease
• May lower risk of developing some cancers
• May improve cognitive function, including mood, reaction time and general mental function

Some studies show the caffeine in coffee can protect against cognitive impairment and conditions such as Alzheimer’s disease. 

This study recommends adults have no more than 400 milligrams of caffeine in a day. That’s roughly five eight-ounce cups of regular coffee. 

While you don’t have to stop drinking coffee, more research is needed about:

• Coffee intake
• Caffeine consumption 
• How drinking coffee is linked to brain volume
• The long-term impact of high coffee intake on cognitive impairment

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