Neurologist David Geldmacher, M.D., who leads the University of Alabama at Birmingham Division of Memory Disorders, sees many older patients with memory loss, dementia or Alzheimer’s disease. He also sees their caregivers, who often are spouses or adult children.
“I recognized the need for a dementia risk-assessment clinic because a lot of my time in the care of people with memory loss is spent advising people without memory loss how to protect themselves,” Geldmacher said.
Building on international studies that examined risk factors for dementia, Geldmacher created the UAB Alzheimer’s Risk Assessment and Intervention Clinic, the first such clinical service in the nation. Patients receive a detailed, personalized risk assessment, which includes family history, a detailed memory history for the patient, cognitive testing and a baseline MRI scan. That information is incorporated into existing risk-predictor models, which have been validated by research studies that followed thousands of patients for as many as 20 years to produce an accurate risk assessment.
“It’s about an hour-and-a-half process of collecting a detailed risk-factor history, and we focus on the reversible risk factors,” Geldmacher said. “So many people facing dementia focus on the irreversible risk factors, such as ‘I’m getting older’ or ‘my dad or mom had dementia.’ We can’t change those things, but we can change things like levels of physical activity and cholesterol counts and blood-pressure numbers.”
Geldmacher says the studies have shown that reducing one or more risk factors can have a significant effect on reducing one’s overall chances of developing Alzheimer’s disease.
“For most people, Alzheimer’s disease is an illness you live with, not an illness from which you die,” Geldmacher said. “With a better understanding of individual risk, there are steps that people can take to minimize the risk for serious memory loss. One of the common themes for both short-term and long-term risk is cardiovascular health, which is something that is more or less under our control through lifestyle changes or medications.”
He presents a hypothetical patient — a woman in her 50s with a family history of dementia who is mildly obese and has cardiovascular issues.
“If she reverses one of three things — loses weight, brings her cholesterol under control or brings her blood pressure into the normal range — she can cut her risk in half,” Geldmacher said. “And if she manages all three of those reversible risk factors and brings them all into the desirable range, she can cut her dementia risk in half again.”
Jon Kling is a nonhypothetical patient. His mother had dementia, as did all four of her sisters. The 72-year-old, semiretired financial planner is reasonably healthy, but worries about his risk of dementia. He was one of the first patients to see Geldmacher at the new clinic.
“I really wanted to be able to establish a baseline of where I am today,” Kling said. “I didn’t feel like I was at particular risk right now, but down the road I didn’t know. I just wanted to see where I stood.”
Kling got good news: His dementia risk is relatively low. Geldmacher’s assessment included recommendations on how to keep that risk low, including increased physical activity and proper diet. Kling was already practicing some of those recommendations.
“The physical activity of walking and working with light weights — those were things I’ve been doing for years,” Kling said. “The assessment was really a reinforcement that I was doing the right things and that I need to continue to do so.”
Geldmacher says the research models offer a long-term risk assessment of 20 years for people in their late 40s and 50s and a six-year assessment for older patients. Kling believes the assessment also helps with awareness and education.
“If I asked you what your ideal weight was, you could probably tell me exactly what that weight should be,” he said. “If I asked you to name three or four risk factors for dementia or Alzheimer’s, could you do it? Most people really don’t know, and this will provide a great deal of needed awareness.”
For Geldmacher, preventing or slowing the progression of dementia is key.
“At this point in 2014 and for the foreseeable future, we don’t have any medications that meaningfully attack the processes in the brain that lead to Alzheimer’s disease,” he said. “We still don’t understand the cause of Alzheimer’s disease, so prevention by medication is a distant goal for us. It’s something we work on every day in our research labs and our clinical testing, but it’s not something that will emerge tomorrow or next week.”
For Kling, having the assessment and a baseline of where he stands today is comforting.
“There’s peace of mind with knowing my risk,” he said. “And knowing that we have this type of help in our own backyard right here in Birmingham, Alabama, is fantastic. It’s great to have the type of professional risk assessment that Dr. Geldmacher and his program provide. I think it’s invaluable.”
Patients will have two clinical visits with Geldmacher and his staff. The first will be to compile histories and conduct testing. The second will be to review the personalized treatment plan, including how to access resources to help achieve lifestyle changes, and where to find supportive and educational materials. The clinic will also suggest coping strategies that can be employed to ease the burden of dementia on the individual and his or her family. The two-visit assessment is fee-for-service and will cost about $1,000, which includes the MRI scan.
Geldmacher anticipates that the risk-assessment clinic will ultimately serve as a gateway to research projects aimed at finding medications or other treatments designed to lower risk of memory disorders.
Call 205-975-7575 for more information or to make an appointment for a personalized dementia risk assessment.