Detecting Alzheimer’s Early: Interview with Dr. Douglas Scharre

November is National Alzheimer’s Disease Awareness Month and in an effort to fight this debilitating disease that affects an estimated 5.7 million Americans, Chaffin Luhana LLP team members, Steven Cohn and Jocelyn Taylor interviewed Dr. Douglas Scharre.

Dr. Douglas Scharre is a Professor of Clinical Neurology and Psychiatry at the Ohio State University. He specializes in Alzheimer’s disease and other forms of dementia. He is best known for his work developing the Self-Administered Gerocognitive Exam (SAGE), a self-examination to detect signs of cognitive decline.

What is the difference between dementia and Alzheimer’s disease?

Dementia is a very vague term that says that you used to be thinking well, but now you’re not thinking well. People with dementia need help with activities of daily living.

So if you injure a part of your brain, and now it’s not working well, that’s dementia. Or if you had too many strokes from a vascular cause, that would be dementia.

If you had cancer of your brain, or an infection, or if your B-12 is too low, or your kidney and liver aren’t working to get toxins to your brain, that can also cause dementia. There are hundreds of causes of dementia.

Alzheimer’s is a particular type of dementia.

It is caused by abnormal accumulations of two toxic proteins: amyloid-beta and tau. They start killing brain cells.

They start out in the memory circuits. That’s why memory is such a key and important signal early on.

So, Alzheimer’s is a form of dementia caused by the progressive accumulation of these two toxic proteins.

Can you tell us a bit about the SAGE test?

The SAGE test is a self–administered pen and paper test that can identify the early signs of dementia.

It came by necessity when I would see all these patients coming into my office for cognitive disorders and memory problems. I said to myself, “I wish they’d come in two, three years ago.”

For example, I can recall one lady who came to my office. She had given her granddaughter a birthday card with money in it, and then two or three days later, the granddaughter got another card with more money. She had forgotten that she had already sent it.

Everyone in her family thought this was strange. It was the beginning of her cognitive issues. Everyone later pointed back to that and said, “Yeah, I can remember that’s sort of when it started.”

Yet it took three and a half years for her to get in to see anyone. By that time, her brain was being ravaged. I said that we need to find a better way, something practical and easy.

Patients don’t come in to see their doctors. Doctors don’t really ask, or don’t want to take the time to do screening tests because it takes so much time to administer them. I developed this self-administered test that doctors could use before or after the appointment, or in the waiting room or office room.

It’s very simple. It just requires a pen and paper, clipboard, four pieces of paper, and a little bit of ink, so it just costs a few cents. We made the test available freely available for anyone to use it.

It’s designed to identify individuals at an early stage so that they can get identified and treated sooner, and then improve the quality of life for themselves and their caregivers.

I made four different versions of the test to try to reduce learning effects. The scores are all equivalent.

We do a lot of community events to screen people. If you have four different forms of the test, you can alternate them, so people can’t cheat off the person next to them.

When we hold a screening, maybe a hundred people show up, and in fifteen minutes we have all the screens already done. It takes about ten seconds or so to score them once you know the scoring rules. We give them their score right then.

What are some early signs of dementia to be aware of?

Number one, it’s probably good to get a baseline. When you reach Medicare age, 65, you have an annual wellness visit.

Only 3% of the population has dementia at age 65. Most people are still thinking pretty well. So, this is a great time to do a baseline cognitive test.

Some people have different talents and things, and they score differently based on their baseline. Change over time is even better than just a single test.

Number two is the things that occur very early. They’ll start repeating questions as if they never asked before.

They may start forgetting the names of objects. “That thing, I need that thing to flip pancakes.” They can’t come up with the name. Everyone can do this from time to time, but they’re having more trouble with object names.

Then the third big area is their sense of direction will often get lost. It’s okay to get lost in an unfamiliar area, but if it’s a familiar area, that’s not normal.

People with dementia often have decreased insight, which is one of the big problems with this disease.

They don’t think they are having issues, so they don’t tell the doctor about it.

The family will notice this change, but they may not know what it is or what to do about it. It’s very insidious, it’s slow. So the family doesn’t talk about it, the patient doesn’t talk about it, and no one identifies it.

That’s the primary reason why we suggest a practical test. Give it to people. You can actually test and say, “Wow, maybe something’s going on here. Let’s check it out and see what the problem might be.”

If someone starts showing signs of dementia, what next steps should they take?

We suggest that you bring the SAGE test results in to show your doctor. Or you can take the test at your doctor’s office.

Then the doctor can try to figure out what might be causing the cognitive symptoms. Maybe you have diabetes, or you hit your head, or you have sleep apnea. Those could potentially be the cause.

But if you don’t have any other conditions, the doctor can say, “Maybe it is an early Alzheimer’s case. Let’s test a few things.”

Maybe you’ll get a scan. Maybe they’ll check B-12 or thyroid. They will diagnose you early and get you on medications.

The medications work better the earlier they’re started. So, the faster you get on the medications, the better they work for the patient.

What treatments are currently available for Alzheimer’s?

Our current treatments can slow the rate of decline, but they can’t cure the disease. The patient is still getting worse, but it’s slowing the course down. They last for about seven or eight years.

Eventually, the disease catches up, and then the drug won’t be useful. But for a long time, you can have a significant benefit with the use of the current medications we have.

We’re working very hard and as fast as we can to identify new treatment options for individuals with Alzheimer’s disease. And they’re coming. We’ve had a lot of very nice study results in early phase human trials.

I’m very hopeful that we’re going find a disease-modifying agent that will significantly slow down the course. Even if you just delay the effects of Alzheimer’s by five years, you could cut the number of cases in half. That’s millions of people and billions of dollars that would be saved.

The problem with all these new disease-modifying agents is that they do not work if you come in with mild to moderate Alzheimer’s disease. It’s too late. So, we have to identify this earlier, when people are in a mild cognitive impairment state.

The medications seem to work best in the very early stages of Alzheimer’s.

So that’s why are equally working hard to get people to be screened so that we can identify them very early and get them on the treatment.

What can people do to support the fight against Alzheimer’s disease?

Call your congressperson. Advocate for more funding through the government. If you have some funds to donate, give to your local university that’s doing Alzheimer’s research, or to the Alzheimer’s Association.

In addition, get involved in a clinical trial. That’s how we get the drugs out faster.

We’re looking for cognitively normal people to compare with early dementia.

If you go to clinicaltrials.gov, it lists all the clinical trials being done in the US. Then you can type in Alzheimer’s or dementia, and it will list all the trials in your area. There will be numbers there to call to and ask if you qualify.

Many of the trials have an open-label extension. What that means is that after the trial period ends, all the participants will have access to the medication.

There’s always the potential risk for any new medications in terms of potential side effects, but this is all explained very carefully in a form called an informed consent form. You will receive this ahead of time. You get to read it over and discuss with your doctor and your family before you agree.

Are any non-pharmaceutical treatments currently being studied?

There are lots of things we’re investigating. I just published a paper earlier this year about deep brain stimulation. We place little electroplates in the brain. This is used a lot in Parkinson’s disease to help with tremors, but we’re the first in the world to try it in the frontal lobe of Alzheimer’s patients.

We had a pilot study of three participants. Two of the three improved significantly over the control group, so that’s very promising. We’re trying to gather up funds to continue that project for the next phase.

We’re also looking at focused ultrasound. It’s noninvasive technique, so you’re not sticking little electrodes in the brain.

From the outside of the skull, you can focus ultrasound waves to try to help open up the barrier between the blood and the brain to get rid of those toxic proteins faster. It may also get treatments in better.

All of these are devices and other procedures that may be extremely helpful in the fight against Alzheimer’s.