Q&A with Dr. Pauldurai
Q: Please introduce yourself.
A: My name is Dr. Jennifer Pauldurai and I am an Inovacognitive behavioral neurologist. I help people with changes in thinking and memory.
Q: What exactly is Alzheimer’s disease, and how common is it?
A: Alzheimer’s disease is a neurodegenerative disease that causes dementia. It is caused in part by the accumulation of abnormally folded protein plaques called amyloid plaques. These amyloid plaques, along with changes in blood flow, inflammation, and other variables accumulate to a state of dysfunction in the brain. This can cause symptoms of forgetfulness, mood change, appetite change, and functional decline. As this disease progresses, people will need more assistance with daily activities.
When the brain is unable to work well independently to do basic human survival tasks like work, eat, manage daily affairs, then we call this dementia. While Alzheimer’s disease is the most common cause of dementia, you can actually get dementia from many other types of diseases (like stroke, repetitive head trauma, infections, hydrocephalus). Alzheimer’s disease becomes more prevalent as we age, and because society is tending to live longer, we are seeing greater prevalence of this disease.There are currently 7 million people in the US with Alzheimer’s disease, with projections upward of 13 million afflicted by this disease by 2050. Another perspective is to say, about 1 in 9 people over the age of 65 have Alzheimer’s Disease.
Q: What are the current best practices for screening and early detection of Alzheimer’s?
A: Typically, everyone over the age of 65 gets memory screening through their primary care doctors during the annual wellness checks. These brief screenings do not always capture early signs of a neurodegenerative disease (we can compensate well in the early stages), so I always suggest that if there is a cognitive change that is becoming progressively more distressing to your daily life, it is better to get a neurologic evaluation. This may include brain imaging, neuropsychological testing, and other blood tests to better understand your risks for dementia.
Everyone is allowed to have a bad memory day — brains are complex, and it is okay to feel less sharp when we are tired or stressed. However, if this brain fog persists and interferes with your ability to function (pay your bills, take your medicines, maintain your job), it is worth looking into with more assessment. Talk to your primary care about the next steps in evaluation, and if a neurology evaluation is needed.
Q: Are there specific lifestyle changes or preventive measures you recommend to reduce the risk of developing Alzheimer’s?
A: Brain diseases do not develop suddenly overnight; they are often the result of a lifetime of choices and co-existing conditions. While there is no 100% guaranteed way to prevent Alzheimer’s disease, many of our lifestyle choices can help our brain remain in the best health possible to delay and lessen the symptoms of a brain disease. I encourage everyone to keep their bodies medically healthy. This means following PCP recommendations to evaluate for diabetes, blood pressure, and cholesterol problems. Get good rest and evaluate for sleep apnea. Eat nutritious, well-balanced meals (my favorite for the brain is the MIND diet), and maintain daily physical activity, usually 30 minutes a day of moderate exercise; avoid a sedentary lifestyle. Additionally, keep your brain cognitively and socially engaged with hobbies, community engagement, and other ways to challenge and inspire your brain. Find that spark of excitement to keep your brain active, and this will help prevent the onset of degenerative disease like Alzheimer’s disease.
Q: How important is early diagnosis in managing the progression of the disease?
A: Early detection of a neurodegenerative disease is important in implementing targeted medical and lifestyle strategies to slow down the progression of decline. If there is a known trigger to brain cell death, say for example, untreated sleep apnea, then fixing this problem will have a huge impact on your overall health and longevity. Additionally, there are newer medical therapies to remove amyloid (the abnormal Alzheimer’s plaque) from the brain. These infusion medications can be high risk, so they are most beneficial for people who are relatively minimally affected by Alzheimer’s disease symptoms. So, early detection allows for early treatments. Early detection also allows the opportunity to plan your future on your terms — where you would like to live, what kind of assistance you prefer to have. Knowledge and self-advocacy are important in grappling with incurable illnesses like Alzheimer’s disease.
Q: What are some of the most promising developments in Alzheimer’s research right now?
A: There are two new FDA approved infusion medications on the market (lecanemab and donanemab), proven to slow down the progression of Alzheimer’s disease by tagging and removing amyloid and its precursors. Amyloid and tau research is the most promising domain in advancing Alzheimer’s disease treatments. Other research that is soon to be published is looking at how amyloid sticks to brain tissue, how glucose control can help reduce formation of amyloid plaque, how energy supplements and anti-inflammatory nutrients can reduce the build-up of plaque and brain damage. There is also a lot of research into looking at brain health risk factors, like how best to treat traumatic brain injury, how best to control mood disorders later in life, and the impact that these interventions can have on incidence of dementia.
Q: Can you tell us about any new or emerging treatments being explored at Inova?
A: The new anti-amyloid monoclonal antibody infusions are the most exciting developments in Alzheimer’s disease treatment right now. Lecanemab was approved in 2023 and donanemab was approved in 2024. These medications are intended to slow down the declines in Alzheimer’s disease, best for people in the very early stages of the disease. Both of these medications have intensive treatment programs that involve infusions every 2 or 4 weeks, safety MRI monitoring, and frequent clinician visits over the course of at least a year, and sometimes longer. Akin to chemotherapy, these monoclonal antibody medications have a high risk profile, but the benefits of slowing down Alzheimer’s disease may be worth pursuing this more aggressive and disease-modifying treatment.
Q: Are there any unique support services or programs that Inova offers to patients and caregivers?
A: Inova is lucky to be well connected with the local dementia support community. We are privileged to partner with care navigation services such as the Medicare GUIDE program to guide patients and families through every step of the dementia journey. We also value disease and care partner education, with active webinars, educational events and support groups that we run in collaboration with our local partners.
Q: How does Inova support patients and their families after an Alzheimer’s diagnosis, beyond clinical care?
A: Throughout the course of dementia, you may need social services, home health services, support groups, or rehabilitation services. As a large, multidisciplinary network, Inova offers most of those services within our network and we can provide a seamless plan of care without the need to find individual agencies to call upon for help. We have an excellent patient care coordinator, whose sole role is to guide you through the next steps in disease management.
Q: What should families do if they’re concerned about memory issues in a loved one, but the person is resistant to seeking help?
A: Meet your loved one where they are. Getting an evaluation for dementia can be stressful, a threat to autonomy, and just plain embarrassing to admit to. Instead of forcing your concerns or ideas onto someone else, learn more about their wishes. Try to find a common ground. Many people may not admit or recognize that they have forgetfulness but may truly value aging in place at home. In this scenario, try advocating for a brain health evaluation with words like: “Let’s make sure you are able to live safely at home for as long as possible.” This is a less threatening way to present the idea and express concern in their terms.
Q: What kinds of resources or education does Inova offer to help families better understand and navigate the disease?
A: We work very closely with local dementia education, dementia support groups, and national level dementia advocacy groups. The best local resource is the Alzheimer’s Association — they offer webinars, training and supports groups. After you meet with your Inova physician, they will be able to give you more targeted, and disease-specific resources.
Q: Is there anything else you’d like to add, especially in recognition of June as Alzheimer’s Awareness Month?
A: Talking about brain health and how to prevent dementia and Alzheimer’s disease is a very special topic. Too often, I meet people in “chaos mode” as they have not planned for their future needs. I would much rather be able to offer you resources and education before you need it, so thank you for advocating and learning more about how to keep your brain healthy.