Understanding Alzheimer’s and Dementia Part 1: Early Signs and How to Support Brain Health

Understanding Alzheimer’s and Dementia Part 1: Early Signs and How to Support Brain Health

Part 1 of our two-part series on Alzheimer's and dementia: the difference between the two, normal memory changes vs. early warning signs, and practical ways to support brain health and cognitive decline prevention. Continue with Part 2: Dementia Caregiver Support: Navigating an Alzheimer's Diagnosis, Caregiver Survival and Finding Hope (Part 2).

Welcome to the first episode of a special two-part series on Senior PrimeTime, where real people and real conversations come together. In this insightful discussion, host Bonnie Keith is joined by featured specialists Sivana Lavine Waller from the Alzheimer's Association and Geriatric Care Manager Ronda Wilkin to provide clear answers, practical guidance, and empowering hope for families navigating memory changes, brain health, and cognitive decline.

This episode breaks down the core concepts every family needs to know about aging and cognitive vitality. Listeners will gain a clear understanding of the difference between dementia and Alzheimer's disease, learning that dementia serves as an umbrella term for a range of cognitive symptoms, while Alzheimer's is a specific progressive brain disease. The experts explore the physical reality of brain atrophy, using relatable visual concepts like the Swiss cheese analogy to explain how brain tissue loss impacts memory, reasoning, behavior, and daily independent function.

Beyond medical definitions, the episode focuses heavily on proactive prevention, brain longevity, and lifestyle risk reduction. Drawing from clinical research and landmark studies like US POINTER, the specialists share actionable ways to build cognitive resilience up to twenty years before symptoms appear. Key topics include the critical heart-brain connection, the cognitive benefits of physical exercise, adopting a Mediterranean diet, and keeping the mind active through social engagement. The conversation also highlights overlooked health factors, explaining how untreated hearing loss places extra strain on the brain and accelerates social isolation.

Listeners will also learn practical steps for establishing baseline cognitive health, including how to request free annual cognitive screenings during Medicare Annual Wellness Visits starting at age sixty-five. Finally, the guests guide families through distinguishing normal age-related forgetfulness, such as occasionally misplacing car keys, from early warning signs of dementia, such as forgetting how keys work or becoming disoriented in familiar surroundings. By recognizing mild cognitive impairment early, older adults and caregivers can access timely support and take proactive control of their health journey.

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Guest Contact Information:

Sivana Lavine Waller, MPH Senior Program Manager, Alzheimer's Association California Southland Chapter Direct Phone: 818-446-1573 Email: sclavine@alz.org Alzheimer's Association Helpline: 1-800-272-3900 Website: alz.org

Ronda Wilkin Geriatric Care Manager and Senior Advocate, Dementia and Alzheimer's Specialist Direct Phone: 818-667-9133 Email: ronda@dementiapartner.com

Presented by The Foundation for Senior Services:

Senior PrimeTime is proudly brought to you by The Foundation for Senior Services, connecting seniors and families with trusted education, valuable resources, and vetted specialists. Special thanks to CEO and Co-Founder Joyce Robertson and the Foundation's AgeWell Academy for providing essential community education to help older adults and families better understand the issues that affect aging.

The Foundation for Senior Services Toll-Free Phone: 855-836-0807  

Email: info@TheFSS.org

Website: FoundationForSeniorServices.org 

Senior PrimeTime is brought to you by the Foundation for Senior Services and hosted by Bonnie Keith.
Each episode features conversations that help seniors and their families live with purpose, vitality, and confidence in Act Three.

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Transcript

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SPEAKER_02 0:05

Welcome to Senior Prime Time. Presented by the Foundation for Senior Services. I'm your host, Bonnie Keith. Today's episode is Brain Health, Memory Changes, and Alzheimer's, clear answers, practical guidance, and new hope. I want to acknowledge Joyce Robertson, CEO and co-founder of the Foundation for Senior Services, because Joyce, who normally is with us, is unable to join us today. But the Foundation's mission is an important part of this conversation through their Age Well Academy. The Foundation provides education to help older adults and families better understand the issues that affect aging. And what we're going to be talking about is one of those huge issues. And as we honor the Foundation's mission in this special two-part series, I am joined today by two experienced specialists, Savannah Waller and Rhonda Wilken. I would like each of you to briefly introduce yourself, share your professional background, and tell our listeners about the work you do. Savannah, let us begin with you and then Rhonda.

SPEAKER_00 1:10

Hi everyone. I really got into this industry and into public health because I was very close to my grandparents. And unfortunately, they both ended up with dementia. And I went on to work with older adults as a case manager for low-income older adults and saw how this disease sort of devastated those individuals and their families. And I wanted to figure out how I could help. And oftentimes they were coming to me when it was too late and the planning couldn't be made. And so when I went back to get my master's in public health, I decided to combine my love of public health and older adults. And working with the Alzheimer's Association really allows me to help older adults and their families while also promoting brain health. So I'm really glad that I ended up where I am.

SPEAKER_02 2:16

Awesome. Thank you so much for being here, Savannah. I really appreciate it. And Rhonda.

SPEAKER_01 2:21

Well, hi, good morning. My name is Rhonda Wilken. I'm a geriatric care manager and a dimension Alzheimer's specialist. I've been in the senior field more than a quarter of a century helping seniors. I began my career as a senior living administrator. I actually still teach administrative classes through the decades, really honed in on my expertise and my love for dementia care and dementia training. Again, like so many people for me, there is a personal as well as a professional backstory. My family is multi-generational with early-ish onset with behaviors, including a great-grandmother, a grandfather. He has three daughters, one being my mother's older sister, my mother, and now my mother's younger sister. But through this journey, I've had the blessing to also lean on my friends at the Alzheimer's Association and I'm thrilled to tell you that I believe this is my 26th walk to end Alzheimer's coming up this year. So it is a personal and a professional passion for me. Honestly, I've been blessed to help more than 500 families in Southern California through this journey with care and compassion and decision making. And so I'm I'm just honored that you asked and thank you for allowing me to join you this morning.

SPEAKER_02 3:52

And you know, it's really interesting that the two of you have experienced with family members this horrible disease and and what it can do to the person and their families and friends. I, for one, had never in my entire life, up until four or five years ago, had any family member or friend in my whole entire circle of family and friends had any cognitive issues. I just thought that was not going to be part of my world, part of my reality. And then my husband, Paul, started to develop symptoms. And so this topic is very, very deeply personal to me because I lived through what many of the experiences that we're going to be sharing today. Now, every family's journey is different. I know, and I was always told that when I was going through it, and I discovered that because I started to meet people through support groups that were having the same issues but different.

SPEAKER_01 4:47

We often say, Bonnie, if you've met one person with Alzheimer's, you've only met one person because every journey is so different. And if you ask almost every professional, I often do when I when I teach, I'm like, okay, what what's your why? Like the hands all go up. We all have that story that brings us to the table and why we're so passionate about what we do for a living and why we want to help so many people.

SPEAKER_02 5:19

The interesting thing is though they're so different, but yet so much the same that everyone that I met, though they were going through totally different things, there would be one thing that they were experiencing. And I went, that's what's happening to me. Maybe a different way. It's a different person, but the same. So it's different and yet the same. So there are so many commonalities. And again, that's what I want to talk about today. One thing before before we start what is the difference between Alzheimer's and dementia? Please let our listeners and viewers finally understand this.

SPEAKER_00 5:58

Yeah, this is a really common question. So dementia is an umbrella term, right, for a set of symptoms that has to do with memory loss, judgment, reasoning, behavior, thinking. It's not a disease, right? So it's that umbrella term. And Alzheimer's is the most common form of dementia, making up about 60 to 80% of all cases. But there's over a hundred different types of dementia, like gluey bodies and vascular dementia and frontotemporal. So many people often use them interchangeably, but dementia is actually not a disease, it's not a diagnosis. And that's really important for people to understand is that they need to seek out an accurate diagnosis.

SPEAKER_02 6:44

When my husband Paul was diagnosed, he was diagnosed with profound dementia. So in my mind, I was thinking Alzheimer's was the umbrella, dementia was the disease, and now thank you for clarifying that.

SPEAKER_01 6:57

Dementia's the umbrella. If the audience remembers that this is a brain disease about atrophy of the brain. And of course, the symptoms and the type of dementia often relate to the part of the brain that's affected. But the commonality here is that most of us with a healthy brain, our brains weigh about three pounds. And at the end of a journey, somebody who's passed from dementia has a brain that weighs about one pound. So it truly is the commonality here is brain atrophy and shrinkage. And then the challenges that we face, and that's why we say everybody's journey is so different, depends on the lobe and the area of the brain affected and age of onset. The commonality is its atrophy, it's brain damage. But that for me is always where people go, just like you are, Bonnie, going, Oh, now I get it.

SPEAKER_02 8:01

That's why they kept telling me in the support group, think of his brain as Swiss cheese, and the holes are getting larger. So soon they'll just be one big hole. And I and just just that image just so clarified it because uh I looked at him, especially in the beginning, and he he still looked like Paul and he acted like Paul, and he kind of almost talked like Paul, though he was saying words that didn't make sense and not finishing his sentences. But it was so frustrating. And I had to be reminded all the time this wasn't Paul's uh talking to me anymore, this wasn't Paul's reacting to me anymore, this wasn't Paul's behavior, it was the disease causing him to do and speak and say this way. And when you start thinking that it's the disease, it helps you be a little bit more patient, which is very difficult for me.

SPEAKER_00 8:50

Uh I want our listeners to know that they can think about it a little like this, which has really been eye-opening for some people. You would never just say, I have a cancer diagnosis without understanding what type of cancer, right? So you'd want to know if it was breast cancer or lung cancer or prostate cancer. Well, we want to know what type of dementia it is, right? So we're at the point where we can accurately diagnose. Um, there was a point where we couldn't. I didn't know what type of dementia my grandparents had, but we knew it was dementia. But now we can. And so I think that that's the important part is you can see cancer as that umbrella turn and then those different types of cancers under it. Same thing with dementia. It's just that people have been confused over time because of the way that it's been used out in popular culture, mostly incorrectly. So thank you for that question because I think it's really important.

SPEAKER_02 9:47

Caring for our brains shouldn't begin only after something seems wrong. Just as we take steps to protect our heart and our muscles and bones as we age, we can also support our brain health throughout our lives before any of this happens, even if we think we're going to be immune to it. So before we talk about cognitive changes and what families may face, let's start with the bigger picture, what all of us can do right now to help keep our brains as healthy and resilient as possible. So when we talk about brain health, what does that actually mean beyond simply having a good memory?

SPEAKER_01 10:16

So we know there's enough research, uh, the pointer study that the Alzheimer's Association um did for a few years, but we specifically know that uh staying healthy, exercising, eating well, staying educated, learning, but truly exercise and eating well make a huge difference long term in your cognitive health. It actually is a disease where if we do things right and do them early, we can push off some of the uh complications that we see, the memory issues that we see. So again, it's a disease where right now we're all looking just to buy time. So my family history generally starts in mid to late 60s. We start to see symptoms. I am proud to be 62, and I have been a tennis player, and I try and eat healthy, and I watch the sugars, and I try and keep all of that at bay so that maybe I can get another 20 years. It's about what we do now to make a difference later.

SPEAKER_00 11:28

Yeah, that's a really good answer, Rhonda. Um, I just think brain health, like you said, Bonnie, is so important from a public health perspective. No one was talking about brain health 20 years ago, right? Um, they talked about heart health. I remember jump rope for heart, but that's where the Alzheimer's Association wants to go, is we want to be, like Rhonda said, many years ahead of time, focusing on our brain health, right? So that we can do things, lifestyle risk reduction efforts like eating well, um, exercising, cognitive stimulation, social interaction, health monitoring, sleep habits, things of that nature that are really important now and that form the basis of yeah, how this may develop, right? We're we're looking at risk factors. And so these habits are cumulative. So the more you do altogether, the better, right? Because if you think about it, if someone uh eats horribly and they never exercise but they're super outgoing, well, you know, it may not be as good, right? So we're trying to look at this holistically. There's not one silver bullet, but it brain health impacts everything we do thinking, memory, behavior, your emotional health. So I just really want to emphasize to the listeners how important this is because we know that changes start up to 20 years in advance in the brain, those cognitive changes. There's no symptoms, but those changes, the plaque and tangles, are happening. And so I think that that's really critical.

SPEAKER_02 13:03

You mentioned the heart. So we often hear what's good for the heart is good for the brain. What does that mean? What's that connection?

SPEAKER_00 13:12

That is the tagline, right? What's what's good for the heart is good for the brain. Um so your heart is pumping blood to the brain, right? And the blood is carrying oxygen and nutrients to the brain. So if you think about it, what's good for the heart is good for the brain, you want to make sure that the brain is getting the oxygen and nutrients that it needs. So, you know, your blood pressure, diabetes, weight management, smoking, all those factors can really play into your brain health as well. And so we need to stop looking at, you know, the heart as a separate organ, the brain is right, they are separate, but we're in a body together. And so how we treat our whole body is very important and interacts with each other.

SPEAKER_02 13:57

Are there less obvious factors that people may overlook, such as hearing loss? My husband had horrible hearing loss. Uh, untreated sleep apnea, uh, chronic stress and depression medications, high blood pressure. Tell us about some of those.

SPEAKER_00 14:12

Well, my understanding, um, though very general, is that you know, untreated hearing loss increases your cognitive load, right? Which makes it harder for you to process. So if you're always straining, you're always having a hard time hearing, your brain is working much, much harder to interact and to hear what's going on around you. So over time, that's the key thing, that that brain is working so hard that it may be impacting right your brain health. And also, this happened to a lot of individuals that I worked with in my past job as a case manager. People will withdraw when their hearing is bad. They won't go to that meeting or that engagement. And we know that social isolation also can lead to cognitive decline. And so, with the hearing loss element, it's just such an important piece and very treatable. So, we are trying to look at all these treatable factors as a way to say, hey, these are things that we can do and test for to make sure that we are staying as cognitively healthy as possible.

SPEAKER_01 15:20

So there are things that we can do to directly affect certain types of dementia. For example, vascular dementia is directly related to not getting enough oxygen in from the heart to the head. That's exercise, that's eating right, right? That's not smoking, that's lowering your stress levels. So if we could fix that, think of the actual impact we would have on one major type of dementia that we actually can control, right? Vascular dementia. If there's a alcohol-induced dementia, drinking one or two glasses of wine is fine. But if you wake up every morning and you have a case of wine for breakfast, you will end up with WK dementia. Never heard of that. Yeah. There are lifestyle choices, obviously, that we can all make, which is what Savannah and I have been discussing with the audience today that are just so important for health later on.

SPEAKER_02 16:26

So is there a certain age like with start getting your mammograms at age 40? And is there a certain age when people should start thinking about this and discussing it with their health care provider, even if they don't have symptoms?

SPEAKER_00 16:37

Uh so there's no set age right now where you have to get cognitive screening from the Alzheimer's Association perspective, anytime there are potential signs, meaning you don't know for sure, but even potential signs of the disease, you want to go talk to your doctor because unfortunately, as Ronna mentioned, there is early onset Alzheimer's. So people can get Alzheimer's in their 40s and 50s. So we want to encourage people to get tested that early if there are signs. But there is the Medicare annual wellness visit for those who are 65 and up. And so at that point, we encourage individuals to get their cognitive screening yearly uh for free with that Medicare visit. And that way they'll have a baseline for understanding where they're at every year. Um a lot of people don't get it, and that way, similar to a mammogram, similar to, you know, heart screenings, et cetera, you have your baseline, you understand where you're at because that unfortunately, until people are bringing it up with their doctor, a lot of primary care doctors are not taking the proactive approach to screen, and that is what should be happening every year. So it's a yes and no, right? Yes, uh, you know, you should of course get screened, but I I don't want that to put an age on it because we encourage anyone who who is having any kind of potential signs to get tested. And then with the genetic component, um, you know, there's mostly risk factor genes uh for this disease. So ApoE4 uh genes. That yes, if your parent or your sibling has this disease, your likelihood of getting it is higher. And if you have multiple family members, immediate family members who have it, it's even higher. But it does not mean it's deterministic, which means that you will definitively get it. It's important to know that for the audience that the the high, high majority of individuals just have those risk factor genes. But there is a very, very small, minute uh group of people who have deterministic genes. But it's so small that it really isn't considered a widely spread genetic testing kind of component. So it is like Rhonda, she'll speak to this, but when you have multiple family members who have it, you are at a higher risk, unfortunately.

SPEAKER_02 18:57

So if you could give our listeners a realistic brain health starting plan, which is difficult. Perhaps three things that they could begin doing like this week or even today. Uh Rhonda, what would you what would you recommend?

SPEAKER_01 19:14

Walk. If you're not already an athlete, just go walk 30 minutes a day, take a brisk walk, increase your exercise and eat well, choose a different diet, everything in moderation, just stay healthy. That's the best that you can do. And we know that exercise makes a significant difference, as does uh diet. We know that we see an increase in some of our ethnic populations for the disease, and a lot of it can be attributed directly based to socioeconomics and diet and lack of resources and health. It plays an instrumental part in this disease. So a lot of it we can do ourselves.

SPEAKER_00 20:03

It's definitely what Rhana said exercising more, eating a healthy Mediterranean-based diet is good, right? Um, I think it's important for our listeners to know we're not saying go run a half marathon. I think people don't realize that building in physical activity is all baby steps over time. Can I park further in the parking lot and walk over? You know, can I garden? Can I play with my grandchildren? Little changes that don't have to be these monumental steps and incorporating walking and these moderate exercise elements are very, very important. So I want to encourage that and then I want to encourage socialization. People are not getting out the way they used to. There's so much that could keep us inside, but you know, pick one outing, you know, call a friend. It really does make a huge difference over time.

SPEAKER_02 21:00

Yes, there are meaningful steps that we can take and baby steps everybody. You can't do it all at once, but doing something is better than doing nothing. But even people who do many of the right things may eventually notice changes in themselves or someone that they love. So that brings us to a very confusing question. How do we distinguish this is a biggie from normal changes? How do we know if it is normal, aging science, from something that needs medical attention and that may actually be the beginnings of dementia?

SPEAKER_01 21:31

So I often look at if the functional impact of somebody's life, for example, I myself will run upstairs and go, Darn, what did I want up here? And then I'll go down and five minutes later, it'll come to me. That's normal aging. I'm not too worried about it. But if somebody can no longer follow the steps to write a check, to balance a checkbook, what's their functional ability? If they can't find their way home to something that they've done. Every day for 30 years. Those are a little more concerning. Those are some of the earlier signs that we often see. One lovely person from the Alzheimer's Association always said, everybody forgets where they put their keys, but if you forget that you need keys to drive a car, that's a bit of a challenge. So that's where functional ability first starts and we see changes before most memory starts to fail. That we start saying. And then I always suggest take notes. If you're the loving spouse or adult child, start taking notes so that you can share with your provider some specific incidences that have happened that have caused concern.

SPEAKER_00 22:48

I think I just want to reiterate some of what Rhonda said is that it starts to disrupt your daily life. Things like you used to be able to do easily, you're not able to do anymore. Some of the examples she brought up of, you know, you go to the grocery store and you can't find your way back home from the grocery store you've been to over the past 20 years. You know, those types of things are usually the wake-up call for most individuals and families to say, hey, there this might be a warning sign. But there are other things that may be warning signs that people don't think of. You know, the social withdrawal personality changes of that anxious, suspicious types of behaviors. And those are the ones that often go under the radar for a lot of people because they're just thinking if there's some kind of behavior change or they just don't like you know that group they were going to anymore. But oftentimes those are the very subtle signs of early signs of memory loss. So and and some type of dementia.

SPEAKER_02 23:46

So interesting. It seems that the behavior change like that, more of an emotional change, is more easily dismissible by the family rather than uh, as you mentioned, Rhonda not knowing how to do your checkbook. Yes, it affects everything, relationships and driving. Why is it important not, though, to assume that every cognitive change is Alzheimer's? There's forgetfulness, there's mild cognitive impairment, there's dementia, there's Alzheimer's.

SPEAKER_00 24:15

So there is mild cognitive impairment due to Alzheimer's, and so that's an early stage of memory decline. You're you are able to do most things independently at that point, activities of daily living. But there are these small, noticeable changes that are happening with that individual. Now, not everyone who has mild cognitive impairment due to Alzheimer's actually progresses to the early stage of Alzheimer's and all the way through the progressive disease. So it's so it's right that some people, if they weren't able to say definitively, oh, he has early stage Alzheimer's Alzheimer's, that he has MCI, which a lot of people you don't even know that that is a term. So I think a lot of people would want to know though, if they had mild cognitive impairment due to Alzheimer's, because right now there's actually treatments that slow down the progression of the disease when you have mild cognitive impairment due to Alzheimer's as well as the early stage of Alzheimer's. So I think it's just important to be really clear with our listeners about this terminology because there is so much coming at us all the time in culture, on different websites, et cetera. And most people do say that their loved one presents really well in front of others, right? You're the one seeing them every day, in and out, right? You're seeing those times of day, they're not on top of it, right? We know how to present ourselves out in the world, but you can't do it all the time. So oftentimes family members and loved ones will say, Well, we need to tell the doctor what's really going on because we're taking those notes and saying, yeah, this is not normal for this individual, but they're gonna pretend that everything's okay.

SPEAKER_02 25:53

Well, we have covered crucial groundwork in part one, from distinguishing normal aging from warning signs to practical steps for keeping our brains resilient. But what happens when a loved one is in denial? Or how do you navigate diagnosis and care? Be sure to join us next time for part two, where Savannah Waller and Rhonda Wilkins share communication strategies, diagnosis depths, caregiver support, and reasons for real hope. Senior Prime Time is made possible by the Foundation for Senior Services and its commitment to helping older adults and their families find the support and trusted expertise they deserve. Please follow, subscribe, and share this episode with a family member or friend who may find it helpful. This is Senior Prime Time Real Simple Real Conversations. See you next time.