Dr. Reuben on “Is There a Cure for Alzheimer’s Disease?” and Other Pressing Questions
By 2025, a projected 7.1 million Americans will be diagnosed with some form of dementia, including Alzheimer’s disease. When a family member receives an Alzheimer’s diagnosis, so many questions arise from “Is there a cure for Alzheimer’s disease” to “Can I care for my loved one at home?”
As Chief of both UCLA’s Geriatrics Medicine division and the Alzheimer’s and Dementia Care Program, Dr. David B. Reuben is accustomed to answering these and many other questions.
The Alzheimer’s and Dementia Care Program provides ongoing care for patients with a Dementia diagnosis. It creates customized, effective treatment plans for patients with dementia and also offers extensive resources including 24/7 access to specialists, holistic evaluations, and caregiver training. The team at UCLA also trains caregivers and staff at other institutions nationwide.
At Racing to End Alzheimer’s, this program is currently one of two beneficiaries that your donations help support. As of September 1, 2022, the program had seen 3,520 persons living with dementia and their caregivers, and 758 are being currently being followed.
We were lucky enough to speak with Dr. Reuben and ask him some frequent questions that come up when it comes to treating Alzheimer’s and managing the disease.
The number one question we get is, “How close are we to finding a cure for Alzheimer’s?” How would you respond to this inquiry since we know Alzheimer’s thus far isn’t curable?
We are not sure how far away a cure for Alzheimer’s is, but a good analogy for this scenario is heart disease. The condition starts with an abnormality in the blood and high cholesterol, then the blood vessels build up plaque. When the blood vessel is completely blocked, then the person has a heart attack and part of the heart muscle is destroyed,. This process doesn’t occur all at once, it happens in stages.
With Alzheimer’s disease, researchers have also been able to identify a pathway by finding the protein (amyloid) that is not disposed of appropriately, and which tends to accumulate. Then the plaque causes tangles in cells of the brain and the brain cells die, leading to dementia.
The whole scientific approach to disease-modifying agents is to interrupt the cycle, but unfortunately lowering amyloid in the brain has not shown the same kind of benefit as you’d imagine, like lowering cholesterol for heart attacks. Billions of dollars have been spent on 243 different compounds, and almost all of them have failed. It means that there are other contributors, so just lowering the protein level isn’t enough. It’s a very wily disease.
Is there hope for a cure for Alzheimer’s?
I’m a great believer in science. If you think about some of history’s most impossible battles, you realize there are some amazing things that can be done. We just have a tough opponent to work with here. The action for now is with prevention because once the cells are dead it’s impossible to get them to regenerate.
When someone gets diagnosed with Alzheimer’s what’s the first thing you like to say to patients and their families?
At this point, it’s going to be a journey. Our team will be with you through that journey, and you’re not going to be on your own. I like to remind them that we are here to answer their questions. We try to minimize the complications, so caregivers can provide the care, and the patients needs are met and their preferences are respected. It’s not just at the time of diagnosis: things change over the course of that journey; there are twists and turns.
What does it mean to “manage the patient”?
People always ask what the producer’s role is in Hollywood: they do whatever needs to be done. Managing the patient is doing whatever needs to be done on their behalf, like a Hollywood producer.
But then, how do you explain what you are doing to someone who might not understand? That depends on where they are in their dementia course. If it is an early stage, then I always give that person a brief explanation. If they don’t have the cognitive capacity to be part of the decision-making process, then we work directly with the family. You have to provide a lot of reassurance with your tone of voice, working with caregivers, and even a simple touch of the shoulder.
Can someone care for an Alzheimer’s patient at home?
It depends on resources. When people come to us we take a thorough inventory of their needs. If they have enough money, then they can essentially set up a nursing home in the house. Alternatively, sometimes family members will take time off of work and spend time with their loved one. Sometimes there are no resources, so they will rely on insurance, most commonly Medi-Cal or Medicaid, and other means. In any case, everyone starts on the track of trying to keep people at home as long as possible.
What makes a caregiver the most important resource a person with dementia has?
The patient will spend the most of their time with that person, and they are likely to be the person who loves them the most, and who is willing to do the most for them. For example, the caregiver will talk to their physicians and dementia care specialist on their behalf.
How common are caregiver stress and depression? How does your program help with that?
It’s very common: published literature says 30 to 40 percent of caregivers become depressed. In another survey, one third of people regularly felt completely overwhelmed. It’s a lot of work caring for a person who has late-stage dementia. It’s like being a parent, but the person is bigger, heavier, and stronger. They don’t grow out of it either, so they are moving in the wrong direction. Their caregivers are tired and don’t have time for themselves. Fortunately, we offer training and support groups that help people get connected to therapy in addition to adult day health care, so caregivers can get some reprieve.
For more information on Dr. Reuben or UCLA’s Alzheimer’s and Dementia Care Program, visit the organization’s website.
ADC has demonstrated a significant impact on patient and caregiver well-being. Before joining the program, many caregivers were uninformed and fighting this battle alone. Only 38% knew where to turn to get answers about dementia problems and only 24% felt that they had a healthcare professional to help them work through dementia issues. At baseline, 13% of caregivers were depressed and 33% had high stress.
After entering the program, 94% of caregivers felt that their role was supported and 92% would recommend the program to others. At 1 year, their confidence in handling problems and complications of Alzheimer’s disease and dementia improved by 79%. We look forward to making your donations go the distance in Alzheimer’s care together.