by Mell P
For Alzheimer’s Awareness & Brain Month, Carib News sat down with Dr. Tanveer Mir, currently the Chair of Medicine at South Brooklyn Health in Coney Island. She is a clinician-educator with experience in IM, Geriatrics Medicine, Memory Disorders, Bio-Ethics, Hospice and Palliative Medicine. In a nutshell, her special focus is helping to improve chronic conditions and disease, which she describes as both a passion and a commitment.
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Very early in her career, Dr. Mir became interested in geriatrics, and care of the elderly. As she explains it “as our age span extends, chronic conditions are being seen more frequently in individuals”. Conditions like heart failure, COPD, cancers, and arthritis.
Chronic conditions and their co-existence complicate medical illnesses even more with memory disorders and dementia being one of them, is also a very important issue as age progresses.
Given my personal confusion around my grandmother’s situation, as I raised questions about how her condition could have gone unnoticed for so long, she mentioned that my grandmother’s story wasn’t unique and that it happens more often than not. We simply miss the signs or quite frankly do not know what to look for.
Dr. Mir explained that in patients who show signs of Alzheimer’s, the oldest part of the memory is retained the most, and high-functioning people who have a college education, or those who work throughout their lives, they tend to function at a high level.
However, people with a lower levels of education and who live a mostly sedentary lifestyle, dementia in them may occur earlier.
Dementia or Alzheimer’s? Same or Different?
To clarify the difference, dementia is loss of memory over the years. It’s a chronic condition in which brain cells are lost. Different types of dementia can be stroke-related or head injury; it could be related to small strokes in the brain, it could be related to a brain tumor.
“Many other condition that leads to dementia, but Alzheimer’s remains the commonest one. About 85% of all dementia is still considered to be Alzheimer’s,” she said.
It is not uncommon in primary care because patients are not screened routinely for dementia.
What to Pay Attention To As a Care Giver
People living with memory changes from Alzheimer’s or other dementia often find it hard to complete daily tasks. Sometimes they may have trouble driving to a familiar location, organizing a grocery list or remembering the rules of a favorite game.
If the person you are caring for needs help to do simple tasks like microwave settings or to record a TV show, something else might be happening with them.
They can lose track of dates, seasons and the passage of time, difficulty with balance or trouble reading. They may also have problems judging distance and determining color or contrast, causing issues with driving.
They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have trouble naming a familiar object or use the wrong name.
I asked about aggression in Alzheimer’s patients because I’ve seen this. Dr. Mir explained that what often happens with the loss of brian cells is some of those frontal responses are gone and have trouble expressing themselves and are unable to convey their feelings, loss of faculties, which can lead to aggressive behavior.
I was curious to know how the treatment and care for Alzheimer’s disease has changed over the years. Luckily, Dr. Mir shared that it has.
Alzheimer’s disease was discovered by a clinical psychiatrist and neuroanatomist, Alois Alzheimer on November 3, 1906, who reported “a peculiar severe disease process of the cerebral cortex” hen treating a 50-year-old woman whom he had followed from her admission for paranoia, progressive sleep and memory disturbance, aggression, and confusion, until her death 5 years later. His report noted distinctive plaques and neurofibrillary tangles in the brain histology. Put simply, her brain had degenerated over time.
In the past 20 years, different types of stages have been identified, like minimal cognitive impairment (MCI). We can screen for MCI in family members we deem
There are currently 7 million patients expected to increase to 20 million by 2060.
Patients are now treated based on three stages – early, mid, and late stage.
Dr. Mir emphasized that Alzheimer’s doesn’t directly kill, and it’s important to get vaccinated against flu, pneumonia, hepatitis, and to screen for cancer.
If they are well cared for, have social interaction, have a schedule and can maintain a good lifestyle, they can do well. However, lack of care and support can lead a patient in mid-stage to be hospitalized.
What About Predisposition to Alzheimer’s?
As a person whose close family member had Alzheimer’s, I was worried about my predisposition to the disease.
Dr. Mir explained that the apolipoprotein E (APOE4) gene is a significant genetic risk factor for Alzheimer’s disease. Having at least one copy of the APOE4 gene doubles or triples the risk of developing Alzheimer’s, while having two copies increases the risk eight to twelvefold. However, not everyone who has one or two copies of the APOE4 gene will develop Alzheimer’s, and many people who don’t have the gene will get the disease. This suggests that the APOE4 gene increases the risk but it is important to note that other factors like lifestyle, race, ethnicity, and environment also play a role.
As far as screening is concerned, Dr. Mir suggested a basic mental health screening called the Mini Mental State Examination (MMSE) is a tool that can be used to systematically and thoroughly assess mental status. It is a simple questionnaire that your primary care doctor can complete for patients over the age of 65 years, and is effective as a screening tool for cognitive impairment with older, community dwelling, hospitalized and institutionalized adults.
Dr. Mir also mentioned paying attention to hypo- or hyper-thyroidism, which can cause dementia by slowing down your brain or by causing depression.
Cognitive impairment is no longer considered a normal and inevitable change of aging. Although
older adults are at higher risk than the rest of the population, changes in cognitive function often call for
prompt and aggressive action.
When we know better, we can do better….and we will.
Dr. Mir has contributed to several peer-reviewed publications, book-chapters and clinical guidelines. She has been a physician leader in Organized Medicine and is dedicated to improving chronic
conditions and community health in the larger Brooklyn area.
