UAMS Donald W. Reynolds Institute on Aging Holds Geriatric-Care Conference

By Chris Carmody

The conference combined two of the institute’s annual events: the Geriatrics Medicine Highlights and the Cognitive Impairment and Memory Disorders Update. The event was open to health professionals, patients, caregivers and members of the community, and many of the sessions sought to offer practical advice in addition to medical expertise.

One of those sessions was a forum on diabetes management that featured Donald Bodenner, M.D., Ph.D., director of the UAMS Thyroid Cancer Clinic and chief of endocrine oncology; Christopher Johnson, Pharm.D., M.Ed., assistant professor in the Department of Pharmacy Practice; and Jeanne Wei, M.D., Ph.D., executive director of the Institute on Aging.

Responding to a question about improving the diets of diabetic patients, Wei said she encourages those over the age of 75 to eat more protein and reduce their intake of carbohydrates. She noted that people have more difficulties absorbing and utilizing proteins and carbohydrates as they age.

“Yes, you can have some, but minimize it,” she said.

Bodenner said that if patients want to have carbohydrates, he encourages them to “stay with everything brown.” He highlighted foods such as brown rice and multigrain bread, which he said have little or no effect on the patients’ glycemic index. He also advises them to stay away from ultra-processed foods.

Johnson agreed with those recommendations and added that it’s important to spend time with the patients to understand what barriers they’re facing.

“With underserved or older patients, one challenge is what they can afford,” he said. “Unfortunately, it seems like the healthier the food is, the more expensive it is.”

For patients in their 50s and 60s, Wei also described the importance of lifestyle changes such as exercise. Bodenner added that aging adults don’t need to walk 10,000 steps a day to see an improvement in their health.

“Any exercise is going to reduce morbidity and mortality,” he said.

The conference sessions focused on a variety of topics, including the diagnosis, medical treatment, and prevention of illnesses; cancer; neurocognitive impairment; and support strategies for patients and caregivers.

Ronald Petersen, M.D., Ph.D., director of the Mayo Clinic’s Alzheimer’s Disease Research Center, gave a virtual presentation about biomarkers and therapies for Alzheimer’s. Petersen said that when he entered the field in 1984, clinicians identified dementia cases and then conducted tests to rule out causes such as brain cancer or strokes. If they couldn’t find another explanation, then they would determine that the patient had probable Alzheimer’s disease.

“We couldn’t definitely say it was Alzheimer’s disease until the person passed away and had an autopsy,” he said.

That system remained in place for decades, until advocacy organizations in 2011 convened three committees to search for ways to accurately diagnose the disease. They focused particularly on biomarkers that provide clues about the underlying cause of a patient’s symptoms.

In 2018, a separate committee took a new look at the issue and proposed that Alzheimer’s be defined by biomarkers indicating the presence of amyloid and tau proteins. Those proteins have been found to accumulate in the brains of Alzheimer’s patients, disrupting the functions of neurons and other brain cells.

This new way of looking at Alzheimer’s diagnosis marked a significant shift, Petersen said, noting that cognitive symptoms don’t appear until years after the biological processes have begun to unfold.

“The good news is that if we can detect these biologic changes early, through PET scans or fluid biomarkers, we may be able to intervene during that window to prevent the subsequent cognitive decline,” he said.

Petersen also spoke about the development of therapies to lower the amount of amyloid protein in the brain. One of those therapies, a monoclonal antibody treatment known as lecanemab, recently became the first drug fully approved by the Food and Drug Administration to slow the progression of Alzheimer’s.

Petersen said studies suggest that removing amyloid from the brain has a clinical impact, but he noted that these drugs only treat one component of a complex disease.

“It’s very important as a first step in the right direction, but we really have more work to do,” he said.

In another session, Esther Oh, M.D., Ph.D., associate professor of medicine, psychiatry and behavioral sciences and pathology at the Johns Hopkins University School of Medicine, talked about the relationship between delirium and dementia. Delirium is a sudden change in a person’s mental state that can lead to confusion, loss of independence and an increased rate of medical complications.

Delirium is often thought to be a temporary and reversible condition, but research has shown that even a single episode of delirium can significantly increase a patient’s risk of dementia, Oh said. She cited a 2012 study, published in the New England Journal of Medicine, that showed that postoperative patients who experienced delirium were less likely to return to their presurgery cognitive baselines.

The severity and duration of a delirium episode also have a significant effect on a patient’s long-term outlook, she said.

“Some health care providers might think, ‘We’ve heard that prevention is the best way, but now that they have delirium, this is going to be really hard to treat,’” Oh said. “But I think the lesson here is not to give up on our patients. Anything you do to reduce the delirium severity and duration can make a big impact.”

Oh said that up to 40% of delirium cases are preventable, and she advocated for a holistic approach that includes orienting patients and providing activities that engage their cognitive functions. She added that pharmacological treatments such as antipsychotics have proved to be ineffective in preventing delirium.

“This is a syndrome, not a disease,” she said. “Addressing the underlying etiology is what’s most important.”