Bret S. Stetka, MD; Gary W. Small, MD


July 03, 2014

In This Article

Advice for Alzheimer's Care

Medscape: What is your advice to our audience of not only neurologists, but also primary care providers, who treat patients with Alzheimer disease? How would you counsel them to incorporate all the new data on imaging and lifestyle?

Dr. Small: The approach that I use is broad. We do the standard medical procedures and use the assessment tools that make sense. I always ask myself if I'm ordering a test, how does this change the patient's management or outcome? If it doesn't, I'm reluctant to order it.

I try to engage the patients and family members in the conversations, and talk about the pros and cons of each approach. What if you were to get a PET scan? What would be the positives and negatives for you? Some people want to see what their brain looks like, and that could be helpful. For others, it's going to be a waste of their money, and they don't really want to know or it's not going to be helpful.

And I always ask about diet and exercise, and try to help people develop a lifestyle program that improves their brain and heart health. If you just exercise and diet, you will lower your risk for diabetes. The most recent epidemiologic studies show that if you develop diabetes, it doubles your risk for Alzheimer disease.[8]

Finally, at UCLA, we have programs that help people compensate for their memory loss. We enroll them in Brain Boot Camp and a memory maintenance program or memory training classes so that we can teach them methods to improve their memory performance, and they are not as frustrated by it. Those methods are not as effective in people who have dementia already, but certainly, for the so-called "worried well," we and others have shown that cognitive training is very effective, and if people use the techniques, they can enjoy the benefits for many years.

Medscape: These are the approaches that you mentioned last year, in which you use image associations to facilitate remember certain information?

Dr. Small: Yes, we use visual imagery to give the information meaning. If something is meaningful, it's going to be memorable.

Medscape: Those are very practical tools. Are they available for clinicians outside of UCLA to use with their patients?

Dr. Small: The UCLA Longevity Center licenses these programs around the country. We are in 17 states and about 70 sites right now. If people want more direct access, I have written several books on this. The most recent is Alzheimer's Prevention Program (Workman Publishing Co., 2012) That might make it easier for people to access the information.

People can also go to Lumosity, and pay a fee each month to exercise their brains. Whether that is effective in improving memory, I don't know.

In the programs that we have developed, we have a curriculum, and we train local volunteers or staff to teach the classes. For older adults -- who are most of the people who are complaining about memory -- they like coming to a small class, and it's a great way for them to learn the techniques and to destigmatize the memory loss. We have found them to be very effective. If anyone is interested in that, they can go to and find out about the programs and see whether that works for their institution. The licensing fee is not huge.

Medscape: Do you have any parting thoughts for the clinicians out there treating patients with Alzheimer disease?

Dr. Small: There are disincentives to even finding out about the diagnosis, because it takes time. It's worth it, however, if you want to deliver the best care for your patients. It will save time: Many studies have found that inadequately diagnosed and treated dementia leads to more emergency department visits, less cooperation with medical treatments, and more phone calls. So I encourage any physician dealing with this age group to work out a system in their practice, so that they can effectively help millions of people who need their help.


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