As a member of the EvoSquad, I am proud to present you with an interview we recently conducted with an expert who has in many ways lead the way in research for Alzheimer's Disease. Dr. Grossberg, a geriatric psychiatrist from Saint Louis University School of Medicine, was generous enough to set aside some time out of his extremely busy schedule so we could share some of his valuable insight on Alzheimer's Disease. I'd like to thank Dr. Grossberg for volunteering his time for our interview. Enjoy!
About Dr. Grossberg
Dr. Grossberg’s professional expertise is
devoted to geriatric psychiatry. In 1979 he started the first Geriatric
Psychiatry program in Missouri, and in 1985, the first Alzheimer’s Disease
Community Brain Bank. He is a former president of the American Association of
Geriatric Psychiatry and Past President of the International Psychogeriatric
Association (IPA). He has been a leader in developing mental health
programs and in treatment and research in geriatrics. He is a recipient of the
Missouri Adult Day Care Association Outstanding Physician Award for supporting
programs that allow seniors to continue living independently or at home with
their families and the Fleishman-Hillard Award for career contributions to
geriatrics.
Dr. Grossberg has edited 8 textbooks and
contributed over 400 articles, chapters, and abstracts to the geriatric
literature. In 2007 he published the Essential Herb-Drug-Vitamin Interaction
Guide. He currently serves as medical editor of CNS Senior Care; Section
Editor, Geriatric Psychiatry, of Current Psychiatry; and is on the editorial
boards of Demencia Hoy, the International Journal of Alzheimer’s Disease, and
the Journal of the American Medical Directors Association. He is a
consultant to the pharmaceutical industry in developing protocols for central
nervous system disorders in the elderly and is involved in a variety of basic
as well as clinical research projects in the area of dementing disorders, with
a focus on behavioral disturbances in dementia.
Dr. Grossberg has served as a consultant on
nursing homes to the US Department of Justice Civil Rights Division, chaired
the development of Clinical Practice Guidelines for the Treatment of Depression
in the Nursing Home for the American Medical Directors Association, and
developed educational guidelines on Alzheimer’s disease for the American
Academy of Family Practice.
Interview
What
is your field of specialty?
Geriatric Psychiatry is one of the
newer specialties of American medicine that involves first getting an MD at a
medical college, a residency for adult psychiatry for four years, and then doing
a fellowship in geriatrics, specifically geriatric psychiatry for at least one
year up to two years. Geriatric
Psychiatrists are board certified by the American board of Psychology and
Neurology and receive a special certification for geriatric psychiatry from the
same board.
What
made you choose this field?
The uniqueness of the field, which is
a combination of psychiatry, geriatric medicine, and neurology. What attracted me was this combination
because I like being able to learn about the brain-related issues that my
patients have, whether they are neurologic or psychiatric, or both. In addition, I am working with elderly
patients that often have co-morbid medical problems and are on multiple
medications that contribute or exacerbate neuropsychiatric symptoms. I find this combination/array fascinating.
How
would you define Alzheimer’s Disease in a short sentence?
Alzheimer’s Disease affects elder
individuals over the age of 65 causing forgetfulness, confusion, and
progressive decline in cognitive function.
Unfortunately, at the present time, it is incurable.
What
is Dementia and how does is relate to Alzheimer’s?
Alzheimer’s Disease is the most common
cause of dementia (also known as senility).
Dementia is a general term for the loss of cognitive function associated
with old age but can encompass a number of diseases including Alzheimer’s and
Parkinson’s disease.
Although
the exact cause for Alzheimer’s is still unknown, there are several hypotheses
as to what may cause the disease. Could you briefly elaborate on a few of
these?
Although we don’t have a cure for
Alzheimer’s Disease, I think we have a better understanding of how brain cells
die because of the disease. We have more
knowledge of how to potentially delay the onset of the disease and decease the
risk of being affected by it. It seems
that Alzheimer’s is caused by the accumulation of a protein called beta-amyloid
in the brain which form extracellular plaques.
There are also intracellular tangles which contribute the death of neural cells, producing the symptoms of
Alzheimer’s disease.
How
is Alzheimer’s disease diagnosed?
It is a clinical diagnosis based on
detailed patient history often from a reliable source other than the patient
themselves, such as a family member or close friend. The patient’s physical and neurological
conditions are examined as well, and if there are any progressive changes in
memory or cognitive function, further testing involving neurological imaging in
conducted to rule out other possibilities.
Ultimately, the combination of results of these diagnostics and the
doctor’s knowledge is used to diagnose the disease.
What
roles do genetics and lifestyle choices play in increasing or decreasing our
risk of Alzheimer’s Disease?
Although genetic risk is unavoidable
and plays a significant role in causing the disease, levels of physical,
social, and spiritual activity also can have an affect on a person’s risk to
the condition. In addition, lifestyle
choices including the food you eat play a role in changing your risks as
well. For example, a Mediterranean diet
consisting of high omega-3 fats and low levels of red meat combined with
moderate amounts of alcohol can decrease one’s risk to Alzheimer’s.
Currently,
what sort of treatment do we use for those affected by Alzheimer’s disease?
There are currently two classes of FDA
approved medicines for Alzheimer’s Disease: cholinesterase inhibitors, which
have three common medications and NMDA receptor antagonists, which only has one
medication, memantine (known as Nemenda). We are
currently using medications such as Aricept, Exelon, and Razadyne
(cholinesterase inhibitors) with NMDA receptor antagonists (known as
combination therapy) to slow the rate of progression of the disease over time.
What
else can people do to reduce their risk for Alzheimer’s?
In addition to the lifestyle
modifications I previously mentioned such as changing one's diet, studies
indicate that higher levels of cardiovascular fitness are associated with lower
risks for Alzheimer’s disease. Maintaining cardiovascular health is another
lifestyle modification that can help people reduce their risk to Alzheimer’s
even if they have genetic predispositions towards the disease.
How
do you think evolution relates to the field of medicine in general and
specifically geriatric psychiatry? Why do you think it is important for
students to learn and understand the theory of evolution?
Well first of all, I believe that all
doctors should believe the theory of evolution because it shows that they are
impartial and believe in the scientific process. It is very similar to a person understanding
their cultural/ancestral roots. When I
apply this basic concept of understanding one’s roots to treating patients, I
try to understand the “roots” of the patient and where they are coming from. Understanding the theory of evolution also
helps one adapt a mindset that allows us to understand changes in a patient’s
interpersonal relationships and find what stressors or environmental factors
may affect them.
What
do you think about grid computing projects? What kind of role do you think they
will play in advancing treatments for Alzheimer’s disease?
I believe that grid computing can play
a significant role in Alzheimer’s research, particularly in epidemiological
studies for the disease. I also think
that it can contribute by looking at large populations to examine their risk
factors and protective factors relative to the development of Alzheimer’s. I think it is very exciting.
Reflecting on my Experience
1. Describe your feelings about or response to the interview.
I was excited and interested. I was mainly excited to speak to Dr. Grossberg about Alzheimer's because I wanted to learn more about the disease and how it pertains to those working in the medical field. Because it is still not completely understood, Alzheimer's disease is very interesting to me. I am amazed at how far we have come in the recent years with the help of new imaging technology.
2. What changes occurred as a result of your interview?
As a result of my interview, I have become much more aware of dementia and conditions that are related to it, such as Alzheimer's. I previously did not know what medications were used to treat Alzheimer's nor did I understand how that medication was administered. I am also more aware of what I can do to reduce my risk of Alzheimer's disease using minor modifications to my diet and lifestyle.
1. Describe your feelings about or response to the interview.
I was excited and interested. I was mainly excited to speak to Dr. Grossberg about Alzheimer's because I wanted to learn more about the disease and how it pertains to those working in the medical field. Because it is still not completely understood, Alzheimer's disease is very interesting to me. I am amazed at how far we have come in the recent years with the help of new imaging technology.
2. What changes occurred as a result of your interview?
As a result of my interview, I have become much more aware of dementia and conditions that are related to it, such as Alzheimer's. I previously did not know what medications were used to treat Alzheimer's nor did I understand how that medication was administered. I am also more aware of what I can do to reduce my risk of Alzheimer's disease using minor modifications to my diet and lifestyle.
3. Did anything about the interview disturb you?
No, nothing about the interview was particularly disturbing. It was more eye-opening, if anything.
4. Describe the connections found between the interview and your research and classwork.
When connecting our research on our blog to the interview, it was easy to connect Alzheimer's related concepts together. For example: our research is working with UCLA to determine the primary structure of the protein that accumulates in the brain, beta amyloid. If we can determine its structure, it opens up the possibility of being able to prevent its formation to prevent Alzheimer's disease. If this is made possible, new medications and treatment methods might replace and/or modify current medications and methods of treatment.
When connecting Alzheimer's disease to our Evolution class, I found that the two are very similar in the sense that they are both "works-in-progress". Although we do not know everything about the two subjects, many scientists speculate that Alzheimer's and other neurodegenerative diseases are a result of the evolution of the human brain. Because our cerebrum is newer than other parts of the brain, it and other more recently evolved parts of our nervous system are more susceptible to such conditions.
