Exclusive Interview: Dr. Catherine Madison, Chief Neurologist at the Preventive Medicine Research Institute

How Families Can Better Cope with The Challenges of Dementia, Alzheimer’s, and Cognitive Decline

One of the most important subjects we cover here on this program is Alzheimer's. And so I'm happy to welcome on to the program Dr. Catherine Madison. She is consulting neurologist at Jewish Family and Children's Services and chief neurologist at the Preventive Medicine Research Institute. On top of this, she maintains a small private practice assisting families with the challenges of dementia. Dr. Madison, thanks so much for joining us on the show today.

Dr. Catherine Madison: Thank you for having me. It's an important topic.

Ric: One of the most confusing elements, I think, is that the most fundamental for most of us consumers, we sometimes talk about Alzheimer's disease and sometimes to talk about dementia. Are they the same thing or are they different?

Dr. Catherine Madison: I think that's a really, really good question to start with, because you're right, as a neurologist, over the years, I've always been surprised when families will, if I tell them they have like a vascular dementia and they'll say, Oh, thank goodness it isn't Alzheimer's. And so it's important to understand the basics here. Dementia is a neurodegenerative illness that is spread through the brain and compromised cognitive abilities such that an individual can no longer perform their normal daily activities and routines.

Ric: So the fact that you have dementia instead of Alzheimer's isn't necessarily a relief?

Dr. Catherine Madison: No, not at all. And when I say cognitive skills, I want to explain that, if I can, that that's everything ranging from how we understand and use language to how we make comparisons, form solutions as well as how we regulate our emotional responses.

Ric: And let's put that into the context of financial future, since this is a personal finance show. Do early signs of dementia or Alzheimer's, are they noticeable in terms of financial behavior?

Dr. Catherine Madison: There was a study which was out of Johns Hopkins University where they looked at credit scores and dementia in a nationwide sample of over 80,000 adults over the age of 65. About 27,000 received a diagnosis of dementia between 1999 and 2018. Those who develop dementia were at a higher risk of payment delinquency starting six years prior to diagnosis than those who didn't develop a dementia.

Ric: Wow. That would certainly argue that you need to be paying attention to your parents, to your spouse. And if you're beginning to notice unusual behavior such as failure to pay bills, not reconciling bank accounts, erratic trading with investments, perhaps that you might need to consider this as a clinical issue and not merely a quirk. And what should you do if you suspect that there's something that might be signaling a problem here?

Dr. Catherine Madison: Well, it can be hard sometimes getting someone in for a diagnosis. I mean, a family member or friend may suspect there's a problem, but the person themselves is like, oh, no, that's not an issue at all or no, I'm aware of those bills and I'm taking care of that. And so a very important concept to understand is that as we have changes in our brain, our ability to reflect on our own brain can become impaired. And the person who we love, who we're seeing a problem with, may not simply be denying the issue. They may not actually be able to see it. So there's a medical term for this called anosognosia (fancy word). But anosognosia is loss of insight into our own problems or deficits. And it's based on physiologic changes in the brain. So it's really important to recognize with a friend or a family member, no, they're not ignoring it. They may not be able to see it. And that affects how we approach them and how we can work with them.

Ric: What do you do? How do you respond if mom or dad or your spouse not merely refuse to believe it, but they're incapable of acknowledging what's happening? What can you do?

Dr. Catherine Madison: Well, there's a couple of different ways to approach it with couples. I often suggest that they approach it as a team. I have had instances where a husband knew that his wife had a problem, and so he suggested that they both get an evaluation. And that's fine for normal people, 65 years and older to go ahead and get a baseline neuropsychiatric or cognitive evaluation to serve as a benchmark for comparison with later. So try to take the spotlight away from the person who's having problems. See if you can more normalize it. Something that we can all face with aging and get as much information as possible to help everybody with their planning.

Ric: If there is a test result that comes back that suggests that there's an issue, what do you do then?

Dr. Catherine Madison: Well, it's kind of a complicated question there, Ric. I mean, you should be going over results and a diagnosis with a clinician. You should work with your primary provider or with a neurologist if there's a problem. What do we do about this? What are medications? What are steps we should take? Are there research trials we can get involved in? And so the conversation should start there with the provider.

Ric: Is there anyone that a concerned family member can reach out to for help? Before they were to go through the effort to complete a formal evaluation?

Dr. Catherine Madison: Probably the most valuable resource is a helpline run by the Alzheimer's Association. 1-800-272-3900. And you can actually get a live trained professional on the phone 24/7 who can give you advice about support groups, classes, online tools, day to day problems. What you're talking about is someone to try and help you get your friend or your loved one in for an evaluation. And people on that helpline may be able to give you some guidance with that as well. I also work with a wonderful organization called Seniors at Home, which is part of the Jewish Family and Children's Services, and they offer everything from support and management in the home to fiduciary services and a whole lot more. Talking with people in the dementia community can sometimes help you figure out strategies.

Ric: And I think if nothing else, it helps you realize you're not alone in this. You know, there are 6 million Alzheimer's patients in this country in addition to those with dementia. And too often, I think when we find ourselves dealing with a challenging situation, we tend to retract, we tend to pull back from society and from community, and we try to deal with it all by ourselves. And to know that there are others who have been where you're going can really be very helpful and help you realize you don't have to go it alone. I think if nothing else, that phone call can provide you that level of reassurance and make it easier to deal with what you're confronted with.