Senior Living on the Suncoast

Alzheimer's and Associated Behaviors w/ Dr. Domingo

May 07, 2021 Steve Bennet-Martin, Angelo Domingo Season 2 Episode 6
Senior Living on the Suncoast
Alzheimer's and Associated Behaviors w/ Dr. Domingo
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Senior Living on the Suncoast
Alzheimer's and Associated Behaviors w/ Dr. Domingo
May 07, 2021 Season 2 Episode 6
Steve Bennet-Martin, Angelo Domingo

Steve discusses Alzheimer's and it's relateded behaviors with guest expert, Dr. Angelo Domingo

E-mail [email protected] today with your feedback and questions!

Support the show (http://www.patreon.com/happylifepod)

Show Notes Transcript

Steve discusses Alzheimer's and it's relateded behaviors with guest expert, Dr. Angelo Domingo

E-mail [email protected] today with your feedback and questions!

Support the show (http://www.patreon.com/happylifepod)

Steve:

Hello there. Welcome to senior living on the Suncoast. I'm your host, Steve Bennett, Martin. And I'm happier being the only senior centered podcast to us to solve as we navigate the complex systems of aging together. Up and down the Suncoast to Florida. My mission with this podcast is to help make sure that the rest of your life is the best of your life, which means today we'll be talking about Alzheimer's disease with the Suncoast best doctor as voted by all of you, Dr. Angela Domingo. But first I wanted to give you an update. Many of you have. Recently enjoyed the encompass series that I've partnered with. And that in conjunction with this interview with Dr. Domingo are the last recorded interviews I have to release for the near future. As we are getting into may, we are almost at the point where my day job at hardest Venice we are going to be opening our doors and welcoming new residents to move in. With that it does take my time away from side hobbies as such as this. So make sure you stay tuned and subscribe to it because we will be back one day. And in the meantime, if you ever need any assistance, the best way to reach me will always be happy. Life [email protected] That's H a P P Y L I F E P O [email protected] And until I talked to you guys again, enjoy this episode and stay happy. our guest expert for today. Dr. Angela Domingo is a returning guest for the podcast. He is a Yale university school of medicine, fellowship trained neuropsychologist in pursuit of his goal of being one of those professionals who helps improve the quality of life for the chronically medically ill and their caregivers. He's provided not only some amazing care up and down the Suncoast, but also education and awareness. Welcome back to the show Dr. Domingo.

Dr. Domingo:

Oh, it's a pleasure to be here. Thank you for having

Steve:

me back. Yes. And so for those of you who might have missed it, or need a refresher, you were on previously talking about Parkinson's disease and its associated behaviors, correct? Yes, that's right. Yes. And so moving on, though, I originally met you before you were with Parkinson placing. You were doing talks on Alzheimer's throughout the area. So I, I also thought because it's another great topic that it would be great to have you back. So thank you for agreeing.

Dr. Domingo:

Oh, you're so

Steve:

welcome. And so what is the definition of Alzheimer's disease? How do you define that?

Dr. Domingo:

So Alzheimer's disease is marked by the buildup of what we call plaques and tangles within the brain. So these plaques are essentially clumps of protein. Specifically data amyloid protein. There won't be a quiz after this, so it doesn't matter if people remember that

Steve:

term or not. I was gonna say, I'm just, I'm just looking forward to transcribing this and writing it all down.

Dr. Domingo:

If you need help spelling that I'd be happy to help you. So these clumps of protein starts to build up in key areas of the brain and they're toxic to the nearby brain cells and ends up killing those brain cells. There's also what we call tangles. So tangles are made of another protein called tau. Now our brain is essentially just a gelatinous mass, so we need scaffolding to hold the whole thing up. And that's, that is sort of the role of tau protein. It helps with the scaffolding of the brain and transport for the brain cells. So if you can imagine what would happen if you had a rope ladder and you cut that rope ladder in half as it was hanging, what it's going to do is it's going to twist in on itself. Yeah,

Steve:

I, I was making the visual and I was I'm going along with you.

Dr. Domingo:

Yeah. So those, those twists are the tangles. It's essentially like the scaffolding of the brain is starting to collapse in on itself. And so you have these plaques in these tangles that, that often occur first in a area of the brain called the hippocampus. Which is just a fancy Latin word for sea horse, because it looks like a sea horse on, on scam. Yeah. And that the hippocampus is where new memories are packaged to be stored in the network of our brain. And because that area is attacked typically first in Alzheimer's disease, we noticed that people with Alzheimer's disease have profound memory loss.

Steve:

Yeah. Yes. And I know my memory loss has one of those, those first symptoms that, that people talk about with Alzheimer's, but in terms of getting an Alzheimer's diagnosis, I mean, the hippocampus sounds like a plan. Place where you can't exactly. Ch check it out with just looking at it. So how does someone get the diagnosis of Alzheimer's disease?

Dr. Domingo:

So the only way to, with 100% accuracy diagnose Alzheimer's disease is through autopsy. And, you know, we can't do that. So the way that it's typically diagnosed is through, for at first MRI. So if we see unusual accuracy or, or degeneration in the hippocampus then we, we have a really good clue in green that this is Alzheimer's disease. And then people can use a pet scan to measure glucose uptake because our brain essentially runs on sugar. And so if the hippocampus isn't taking up sugar, like it's supposed to be, then we know that there's something wrong. There's also Cerebro, spinal fluid analyses that can happen where. They'll measure the amount of tau and beta amyloid in the cerebral spinal fluid to give an indication if Alzheimer's is, is a, an accurate diagnosis or not. There's also pet scans that can be used at I'm sorry, not that I already said

Steve:

that. Okay. Yeah. And so if it's not Alzheimer's what are some of the other common forms of dementia that people might run into?

Dr. Domingo:

Oh, did you want me to talk about specs? I can mention spec. Okay. There's also SPECT scans that can be used that can be used to identify Alzheimer's disease.

Steve:

Okay. Yes. And so, in addition to Alzheimer's disease, what are some other common forms of dementia?

Dr. Domingo:

So Alzheimer's disease is by far the most common form, but all other forms of dementia include frontotemporal dementia. So whereas Alzheimer's disease typically starts in the temporal lobe where they hit the campuses. And worked its way up. Frontotemporal dementia starts in the frontal lobe and works its way back. Okay. There's vascular dementia, which is related to blood flow issues in the brain. So one of the main issues in vascular dementia. Is small strokes, you know, Tia is they're called transient ischemic. So if people have enough transient ischemic attacks, it's already tiny, tiny strokes and small blockages that occur that often we don't even feel. But as they build up. It can result in gradual cognitive decline.

Steve:

And so with all of those, or just in general, what are some of the more common forms of treatment for dementia and Alzheimer's?

Dr. Domingo:

So the, usually the first line treatment for dementia is or aerosept. And that is a colon Estrace inhibitor. So what that means is it blocks the re uptake of acetylcholine. Okay. So acetylcholine is a chemical in the brain that helps us think.

Steve:

Yeah, I remember that at one point in psychology class, but refresh my memory. Perfect.

Dr. Domingo:

So acetylcholine is a neurotransmitter that's involved in cognitive functions and in Alzheimer's disease, there is a reduction of acetylcholine in the brain. So Amy thing that ends in eighth ASC is usually an enzyme that degrades degrades, the chemical that comes before. So colon Estrace, degrades, acetylcholine. So if you inhibit colon, EStories. Then you are allowing the acetylcholine to be present in the brain for longer periods of time and active. Excellent.

Steve:

Well, yes. And that is what you're looking for at that stage.

Dr. Domingo:

Yes, that's exactly what you're looking for at that, at that stage. And then as the condition progresses, they The Dr. May prescribe an N N N and the a inhibitor. So the N N a inhibitors they're, they're considered antagonist. So they modularly. The chemical in the brain, and that is thought to help with memory function. Whereas, you know, the colon Estrace inhibitor increases the CDOT Coleen in the brain and, and MDA antagonist decreases the end, MDA chemical. Allowing for more regulation of cognitive function.

Steve:

Yes. And so with those medications, one thing that I w I always thought the clarification was helpful was that you know, there is no cure for Alzheimer's or dementia that it is, you know, a degenerative disease. And so it does, it kind of just helps those slow, the decline cracked.

Dr. Domingo:

Not really, no, it doesn't particularly slow to the, the decline as much as it provides a bump in cognitive function. So I wish we had visual here. You know, people often think that by adding these medications, They will decrease the slope of the decline. In other words, the, as opposed to a black diamond ski run, it'll be more like a bunny Hill. Okay. But what really happens is within a month, usually of taking these medications, people experience. A small improvement function, but the decline remains the same.

Steve:

And so what are some early signs of Alzheimer's or memory loss that you would recommend would be a good reason to start scheduling an appointment with your doctor?

Dr. Domingo:

So one of the classic early signs of Alzheimer's disease is a profound, inability to create new memories. So they'll remember old stuff, you know, I remember aunt Betty 30 years ago. You know, what, whatever, when she wore that prom dress. Fine. Great. Do you remember what we just talked about five minutes ago and then you get a blank stare. So if you're noticing that your loved one is having profound memory loss, if you notice that there is behavioral change. So You know, having lapses in reasoning or hoarding things, getting somewhat paranoid that people are stealing, you know, so they'll misplace items and then blame other people for it. That's a, that's a big clue.

Steve:

Isn't hygiene as well.

Dr. Domingo:

Usually later on, later on in the transition they'll, they'll be hydrophobic. They'll, they'll be terrified of water. I remember I had a client lovely woman. She had a PhD in physics and. At a certain stage of Alzheimer's. She said to me that she would negotiate with the staff at the memory care facility. Can you only wash from the top of my head to my neck and leave the rest alone? And of course they said, no, no deal with that. But they get extremely hydrophobic. So there's that issue later on in the, in the disease? One of the hallmarks of Alzheimer's disease that can be particularly frustrating for caregivers is a lack of insight. You know, a lot of times. What happened? I

Steve:

don't know either, but w w w we're back. So I lost a lot of times.

Dr. Domingo:

Okay. A lot of times, one of the more frustrating issues for caregivers is the lack of insight that people with Alzheimer's disease exhibit. And Oh, I remember now I said a lot of times caregivers will say to me, you heard that

Steve:

part.

Dr. Domingo:

So I'm going to pause for a couple seconds and then start again. Okay. A lot of times caregivers will say to me that their loved one is in denial. You know my spouse doesn't want to accept this, or my mother, you know, is in total denial of her condition. She keeps making excuses. Well, the reality is. It's not denial. Denial implies that there is this complex psychological process going on, where the person is on some level, actively avoiding awareness of a subject or dealing with it with Alzheimer's disease. What you're looking at is a neurological. Process where their brain tells them they are a okay. Their brain says you're fine. Everyone else is not. People are stealing from you. They're lying to you

Steve:

once a day in my memory care from at least like one or two people. Like I'm the only person that's normal in here. Everyone around me is crazy. I'm the only normal one.

Dr. Domingo:

So, yeah. There's also this interesting paradox there where they can tell that other people are in quite right. They think they're perfectly fine because their brain tells them. Yeah, they're perfectly fine. And so no amount of convincing or debating or arguing or rationalizing is going to help you. No one has reached that point. Then you need to let that go. That expectation that they're going to understand.

Steve:

Yeah. And I also, one thing, especially for new families with a diagnosis, it's always hard when you see the family, like almost testing their loved one. Like, do you remember this? Do you remember that? Do you remember this? And I always can kind of see how that would do anything other than, you know, agitate, both individuals.

Dr. Domingo:

Exactly. Exactly. I tell people stop, stop testing, because I can tell you now that your answer is always going to be no, or they're going to make stuff up. And I, I want to also spend some time talking about that symptom because a lot of, a lot of caregivers will say to me, you know, why, why is my husband or my mother aligning all the time or making excuses? Well, they're doing what we all do, except on a more massive scale. It's called confabulation. Yeah, confabulation, right? It's it's a $12 word. Definitely. So when we have a memory, a distant memory, our brain fills in the gaps of that memory with things that make sense. So there've been a whole host of studies done on college students because they need class credit. Right? So you get class credit from doing these studies. Where Phil show them I'm a scene of an accident or a rescue or something like that, and have them write about it, score it. Yeah. In terms of accuracy. And then over time, have them write about it again and again and again, and you know, a year out. There accounts are not particularly that accurate, but they will make their accounts, like they'll rate their confidence in their accounts as very confident. Yeah. So that's confabulation now, when you're doing that for small details. People don't really

Steve:

notice when you're telling a story when you were, you know, six months old because you heard it so much, you know, it doesn't really affect your day to day behaviors. It's just confabulation. But I can imagine if you're confabulating 75 to 80% of your day, that could become problematic.

Dr. Domingo:

Exactly exactly when there's these massive gaps in people's memory, those gaps need to be filled with whatever garbage makes sense. You know, whatever seems to make sense at the time, which is why. Often for people that have Alzheimer's disease, when they're upset with their loved ones, then their loved one has never been, they've always been honorable. And when they're happy with their loved one, well then their loved one has always been a marvelous person because it's all context. There's no actual facts.

Steve:

Yeah. It's just what you most recently remembered.

Dr. Domingo:

Yeah. Yes, pretty much. So understand that your loved one is not in denial and your loved one is not a filthy

Steve:

liar. Yes. And I mean, so far a lot of these symptoms you're describing while certainly frustrating and life-changing don't necessarily seem like they would be a cause for concern for safety. So, I mean, how do some really problematic behaviors manifest that might cause safety concerns?

Dr. Domingo:

Oh, well a one on that list is wandering,

Steve:

you know, people quite

Dr. Domingo:

well because people get confused as to where they are. So I've often had caregivers say to me, you know, we're at home. And my husband looks at me and says, I want to go home. Well, right, because your husband is in recognizing that he's already at home. He doesn't recognize the environment. So that's often why wandering occurs other times wandering might occur because people are agitated. And so they're moving around aimlessly. I sort of go from one thing to the next and that may lead them to go outside. They may be disoriented and living in the past where, you know, they feel like they need to go to the store for something. Because that happens in recent memory. So they wander out thinking that they're going to go to the store or they're going to go to the bus stop, or they're going to wait for a train, or they need to go to the airport because they're angry that they're being held quote unquote, against their will. So there can be a lot of reasons why people would wander So there's that there's a lack of judgment. So people will do dangerous things. Not realizing that they're they're dangerous because they have no insight into their own limitations where, Oh, I'm sorry. Go

Steve:

ahead.

Dr. Domingo:

So where someone with Parkinson's who has insight may say, you know, I need help with this. I don't have the skills to cut this tomato. Somebody with Alzheimer's disease may just go ahead and grab a hatchet that's used for cutting through bone. To cut, to cut a piece of fruit and possibly their hand because to them, a knife is a knife is a nicest, the knife.

Steve:

Look at me when I cook, because I sometimes do that same thing where someone will look and say, that's not the right knife for the job, but if it cuts, it works for me.

Dr. Domingo:

I will schedule your evaluation as soon as possible.

Steve:

I always tell people where I work. I'm like I'm working for my future discounts.

Dr. Domingo:

So there's also danger in taking a shower by themselves because they may not be aware of adjusting the water temperature properly. So they'll turn the nozzle all the way to the, to the hot side and possibly scald themselves. And then, you know, as soon as they get the slightest bit agitated, their brain function can completely shut down and then they will know that they won't know what to do. They may just stand in there and scream. And so, so those are, those are some real safety

Steve:

issues. Yeah. And so how do you suggest a loved one might manage these behaviors or do their best until it's, you know, when would it be time to consider a move to a community?

Dr. Domingo:

So the best way to manage these behaviors are first and foremost, don't get into an argument with your loved one. Don't say, you know, we already talked about this. You're not supposed to go out the front. Well, they don't, they have no concept of that. Even if they do in the moment, it goes in one ear and out the other. So you really have to set up the environment. For them, they can't adjust to the environment. The environment has to adjust to their needs. So you want to set your your thermostats on automatic controls, so they can't adjust the temperature too much one way or the other, your water heater can be set on an economy setting. So the temperature doesn't get above 102 20 degrees. So even if they turn it off all the way. It's not going to scald them.

Steve:

That is good to know. I didn't know. You could do

Dr. Domingo:

that. Oh, yeah. You can get wander guards, you know, like GPS, bracelets, or pendants that are really, really helpful. Not only for tracking, but in case somebody falls most of the newer pendants. Now you don't even need to push a button. They have like failed

Steve:

detection technology.

Dr. Domingo:

Right? Exactly. And they, they are amazing. I had a client whose clip had broken. So about five times during the session, the pendant literally fell from the lanyard into her lap and each they would call and say, are you okay? We detected a fall. So they, they work. They work incredibly well. You want to alarm your doors to make sure that, you know, they're not getting out. You want to put a gate around anything dangerous, like a pool and you know, have help coming in like a companion if you need to leave. And your loved one is a wander risk, then they, they really should have somebody with them at all

Steve:

times. Yeah. And I mean, that brings me to, you know, what, when would be the time to move to a community then like a memory care?

Dr. Domingo:

Yeah. So if your loved one is confused about where they are a lot of the time, even when they're home. If they're becoming aggressive and easily agitated or argumentative easily overwhelmed. So sometimes, you know, caregivers will say to me, you know, my loved ones snaps at me all the time. Or, you know, can't watch TV. Doesn't want any visitors. You know, when I have help come in, he gets angry at the hell. He doesn't like anybody else there. Those are clear indications that the environment at home is not structured enough for them, you know, in a facility. Everything is geared towards the residents. They're insulated from the realities of life. There are no phone calls. There's no mail coming in. No unexpected visitors, no repairmen, no news on the TV, 24 hours a day. There's nothing.

Steve:

Nope, it's this. They just keep the same schedule every day as consistently as possible for that reason.

Dr. Domingo:

Exactly because people with dementia, particularly Alzheimer's dementia, love consistency. And so it's important as a caregiver that people recognize it's better to place their loved ones. Earlier in the process than maybe they're comfortable with. You don't want to wait until the very last minute, because by that time, your loved one has no capacity to adapt to new situations. The ideal time to place someone is when they still have some awareness. Of where they are and have some ability to understand what's happening around them. And get to know and relate to people around them, so that as their condition declines, they've already established in their brain. Oh, these people take care of me. This is where I live. This is the routine. Yes.

Steve:

I mean, I can, I know from my time working in a memory care community for years and years though, the ones that moved in earlier on were always, you know, almost like comfortable and like, they were perfectly happy to the point where they take new residents in almost under their wings instinctively, even though they didn't know the difference between whether they were new or not. But, you know, they could tell that this person was a little bit more uncomfortable and like, they felt so comfortable there. They wanted to make the other person feel comfortable. So the sooner, the better I kind of gray.

Dr. Domingo:

Exactly. And I saw that in my work as, so when I was 17, I started my career as a recreational therapy assistant at Brookdale Brookdale hospital in Brooklyn, New York. Wow. They, yeah, they used to split my time between the high-functioning floor of the nursing home and the dementia unit, which was locked, obviously. So. So what, after one morning I go in and residents from the high-functioning floor, isn't there, which isn't such a big deal because they go on trips all the time. Their families come to pick them up, you know? But then afternoon, I went on to the dementia unit and she was there. She was now living in the dementia unit. And I got very upset, 17 year old me thought I knew everything. And so I went to my supervisor and I asked my supervisor, you know, why would you do this? I know that her memory is starting to flip, but she's not to the level that these people are. And my supervisor. Took me up to the dementia unit. And she pointed out to me, she said, Angelo, these people that you work with up here that participate and are happy and content, these people were placed. Usually in-house from other units early. In the process. As soon as we detected the person was demanding, they understand why they're here. They know the staff they know the routine. These other people that are agitated all the time and can't really participate in activities and are constantly confused and aggressive. They were placed usually from the outside. What is

Steve:

that like from the outside too late?

Dr. Domingo:

Yes. Too late. Exactly. You know, it's the last minute. And so every day is a new day for them. They don't know why they're here. They don't know the staff. They've got strangers taking care of them and they're agitated all the time. So the motto is please your loved one sooner in the process rather than later, because it'll do your loved ones. Good. That that would be your, your, one of your last acts of true love and sacrifice would be to place them earlier

Steve:

in that process. I couldn't agree more. And you know, if you're in the Venice area, help give me a call now. Any other advice you would give to a loved one? If their, you know, person just got recently diagnosed with Alzheimer's or dementia?

Dr. Domingo:

Well, I would say, educate yourself as best as you can. If you find yourself getting really frustrated or fantasizing about running away, which happens, you know, getting angry, irritable, depressed, or anxious, get yourself help as a caregiver. There are. Tons of support groups out there. I run a support group once a month through art and courts. It's completely free. Oh, you're going to make me try to remember this now. I believe it is on the third Tuesday of the month. Hold on, let me, let me give me one moment. This will only take me a second. For slightly longer because I have to pull up my okay. So it is yes, the third Tuesday of the month.

Steve:

Excellent. And so I will make sure I post how to co contact them to sign up for the support group in the show notes.

Dr. Domingo:

Yeah, you just send them your call art in court. Leave your email address with the receptionist or on the voicemail, and then they will email you a link to the zoom the zoom support group, cause it's done remotely.

Steve:

Yes. And so, yeah. Well, especially nowadays with that, yes. We're all doing our supports through zoom and the, like now, in addition to working with art and courts, you've previously spoke about your work with Parkinson's place for any other listeners though. What are some other specialties you have that you might want to share with the audience?

Dr. Domingo:

Sure. I specialize in grief and loss. I specialize in caregiver stress both for a family that's caregiving and also professional care caregivers doctors, lawyers, financial advisors Those are my main, those are my main areas. People with chronic, also people with chronic medical illness as well. All right.

Steve:

And what would be the best way for them to get in contact with you

Dr. Domingo:

through my website? I Angelo S domingo.com S as in Sam. Or contact me directly at (941) 822-6122.

Steve:

Okay. Well thank you for being back on the show, Dr. Domingo. We hope to have you on again real soon.

Dr. Domingo:

All right. Thank you for having me back. Bye. Bye bye. There we go.