Alzheimer’s Disease
Certified psychiatrist specializing in Alzheimer’s Disease offers immediate help, including medication and treatment. Contact +1(833)312-4222 for assistance.
Retirement and your senior years can be one of the most rewarding times of your life. Most elderly people look forward to spending relaxing time with their families and pursuing hobbies that keep them active and occupied.
It is common to have minor memory loss and some decline in physical and cognitive abilities, such as answering puzzles. This is normal after the age of 65 years, and it should not be too troubling. While it can start very mildly, when the cognitive impairment increases over a few months, it is a good reason to visit a doctor for a thorough evaluation.
The progression of Alzheimer’s can take several years, and it is vital that patients can achieve the best quality of life possible, despite their diagnosis. Alzheimer’s patients can maintain their social skills, and much of their premorbid personality, until the very late stage. They can still enjoy retirement and family life with the right care and support.
An early diagnosis is vital; with good care, therapy, a supportive environment, and medications, Alzheimer’s dementia progression can be slowed down significantly.
Dr. Valeria Serban
Medical School
Neurology Residency Training
Master of Philosophy (M.Ph.) - Neuroscience
Internal Medicine Residency
Neurology Residency
Doctor of Philosophy (Ph.D.) - Neuroscience
Clinical Neurophysiology Fellowship
Board Certification
Board Certified Psychiatrist with Multiple State Licenses MBBS (MD)
Dr. Valeria Serban is an experienced, Board Certified geriatric psychiatrist practicing general adult psychiatry and specializing in Geriatric Psychiatry. Dr. Valeria Serban has a background in neuroscience and has completed her Ph.D. in Neuroscience from the NYS Institute for Basic Research, City University of New York. She also obtained a Fellowship in Neurophysiology from Massachusetts General Hospital – Harvard Medical School, Boston, Massachusetts.
As a geriatric psychiatrist, Dr. Serban can help individuals between 18 to 120 years, with age-related cognitive decline like delirium, depression, dementia, mood disorders, anxiety disorders, psychosis, and other medical conditions resulting in psychiatric symptoms.
Dr. Tony Issac
Board Certified Psychiatrist in New York & New Jersey (MD)
Dr Tony Isaac is a double Board certified Psychiatrist with nine years experience practicing psychiatry. He provides compassionate discreet psychiatric evaluations, and psychiatric care services including medication management, and psychotherapy. Dr Isaac treats a wide range of psychiatric conditions including insomnia, panic attacks, depression, anxiety, OCD, bipolar disorder and schizophrenia. He conducts suicide assessments, and acute stabilization and will work with your family and employer to provide support.
Dr Issac also provides follow up appointments, and psychiatric services including psychotherapy and sensitive medication titration. Dr Issac can work with you to achieve a collaborative treatment plan and work towards recovery and healing.
Dr Issac is available for same day appointments during emergencies and is available for weekend appointments to ensure that you receive the care and the folow up which you deserve.
Dr. Gundu Reddy
Board Certified Psychiatrist with Multiple State Licenses MBBS (MD)
Dr. Gundu Reddy is a Board Certified Psychiatrist with fifteen years of experience practicing clinical psychiatry. She also has ten years of experience practicing forensic psychiatry. Dr. Reddy has trained in medication management, psychodynamic psychotherapy, and cognitive behavioral therapy.
Dr. Reddy has a special interest in integrative psychiatry and believes that multiple factors should be considered when evaluating and treating a patient. That includes genetic and developmental factors, medical illness, nutrition, hormones, as well as environmental and dynamic factors.
Schedule an Appointment with one of our Online Psychiatrists.
Clinical Services: California, Florida, Illinois, New Jersey, New York, South Carolina, Tennessee
Forensic Psychiatry Services: All of the US and Canada
Importance of diagnosis of Alzheimer's disease?
Experiencing mild cognitive decline with age is not worrisome. The problem occurs when many often ignore their initial symptoms, as the anxiety of having to visit a psychiatrist can be overwhelming by itself.
The correct diagnosis helps with understanding the disease and controlling some of the symptoms so that one can continue to live a fairly active life.
Receiving a timely diagnosis of dementia is important and can help
- Access information, support, and other resources that help the patient and their family understand and prepare.
- A timely diagnosis also helps demystify and destigmatize the condition.
- It helps with planning and investing in experiences to maximize the quality of life.
- The patient benefits from support and available drug and non-drug therapies that may improve their cognition.
- It explains and prepares the family, friends, and colleagues; it highlights what has changed in life and how they can help.
Several other life choices need to be made, such as financial decisions, settling legal affairs, and understanding the level of support one can get from the community.
It may be that the person is still working; in such cases, reducing hours and working with the employer to make adequate adjustments to continue working is ideal.
Four Classes of Alzheimer’s Disease Symptoms
The symptoms have been explained in a stage-wise representation as it is easier to follow. However, Alzheimer’s is known as a major neurocognitive disorder, and its symptoms can also be categorized as
Neurocognitive symptoms:
The neurocognitive symptoms experienced by a person suffering from Alzheimer’s disease deteriorate stage-wise. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation (including easily getting lost), mood swings, loss of motivation, not managing self-care, and behavioral issues.
Mood symptoms:
Many of the common mood symptoms of a person struggling with Alzheimer’s are the absence of interest in or concern about emotional, social, spiritual, philosophical, or physical life. These may be also due to depression and anxiety, both of which are very common along with an Alzheimer’s diagnosis.
Sleep disturbance:
A person suffering from Alzheimer’s often experiences insomnia and other sleep disturbances. Common problems are difficulties in falling asleep, arousal at night, repeated awakenings and waking up too early in the morning, sleepiness, and frequent naps during the day.
Agitation and psychosis:
This is common in the later stages of the disease. Verbal or physical agitation, irritability, anxious affect, disinhibited behavior such as aggression, and behavioral responses to delusions and hallucinations, are often noticed in the later stages of the condition. The use of antipsychotics is not always reliable and poses a risk of adverse drug interactions for elderly people.
Alzheimer's disease symptoms
One of the first signs that something is amiss is if the memory is affected, and one tends to forget basic tasks and recently learned information or activities. They may rely more on multiple reminders and tracking devices to stay ahead of routine activities.
Apart from memory, other signs that one may experience are
Early Stage Alzheimer’s disease
- Remembering a name
- Recalling recent events
- Remembering where they put a valuable object
- Making plans
- Staying organized
- Managing money
In its early stages, the person will be aware of their memory lapses and family and friends may also notice these changes.
Mid-stage Alzheimer's disease
At this stage of the disease, one will see marked problems such as
- Trouble solving basic problems or activities that were previously enjoyable.
- Keeping track of payments, their ability to plan, and working with numbers and bills may pose a challenge.
- Difficulty navigating familiar recipes, games, or problems with directions.
- They may have trouble maintaining time and losing track of the place. Sometimes, they may be confused about where they are and how they got there.
- One can experience problems with spatial awareness and visual images. Judging distances accurately, or understanding directions may be difficult.
Late Stage Alzheimer’s disease
(Agitation and psychosis)
In the last stages, the person will require care with movement, personal hygiene, and everyday activities.
- Unable to perform many physical activities, including walking, sitting, and eating.
- May not have control over their bowel and bladder movements.
- May not have a full conversation, but be able to say some words or phrases.
- Needs help with all activities all of the time.
- Remains unaware of recent experiences and their surroundings.
- Prone to more infections, especially pneumonia.
Alzheimer’s dementia diagnosis can be frightening, however, the progress of the disease can be slowed with therapy, medication, and family support. Therapy helps many come to terms with their diagnosis.
If you or someone you know is suffering from episodes of memory loss and mild cognitive decline, then reaching out for an evaluation can help immensely.
What is Alzheimer’s Disease?
Alzheimer’s disease is possibly the best-known example of dementia. To understand the extent of it, that is nearly one in nine Americans suffering from the disease above the age of 65 years. It is progressive and a combination of medications can help slow down the severity of the symptoms and its progression.
Alzheimer’s occurs when there is significant brain damage due to a protein buildup. A healthy brain has neurons that communicate and transmit signals through electric and chemical changes. Alzheimer’s disease interrupts these communications between the neurons, which leads to brain cells dying.
This happens due to the healthy neurons in the brain being damaged, losing crucial connections with other brain cells, and dying. This progression is slow, starting with mild forgetfulness, which then progresses into complete impairment over many years. With early intervention and medications, the development of the disease may be slowed.
The cause of the disease is due to high levels of protein buildup in the brain. The protein amyloid collects in plaques and tau tangles. While amyloid plaques form in the spaces between the nerve cells; the neurofibrillary tau tangles are knotted brain cells. The amyloid plaques and tau tangles slowly degenerate the neural connections.
The hippocampus is the center of learning and memory in the brain. Usually, this is the section that is affected first during the progression of the disease. Memory problems are therefore the first signs of trouble.
Amyloid plaques Beta-amyloid 42, is a form of the amyloid protein called amyloid precursor. This form is thought to be especially damaging. In the Alzheimer’s brain, abnormal levels of this naturally occurring protein clump together to form plaques that collect between neurons and disrupt cell function. Research is ongoing to better understand how, and at what stage of the disease, the various forms of beta-amyloid influence Alzheimer’s.
Ongoing research has shown improvements in treatments, slowing the degeneration of the nerves with medications. Alzheimer’s disease takes many years to progress. However, the cognitive decline of the disease, despite controlling the amyloid buildup continues in many cases.
What is the differential diagnosis of Alzheimer's Disease?
Differential diagnosis of Alzheimer’s can take many forms. For instance, it may be because of some reversible causes such as age-associated memory impairment, alcohol or drug abuse, vitamin-B12 deficiency, patients on dialysis, thyroid problems, adverse drug interactions, psychosis, and delirium.
Irreversible causes of dementia symptoms such as Lewy body dementia, vascular dementia, and frontotemporal lobar degeneration are also other differential diagnoses of the disease. Irreversible dementia can be treated with medication and the progress of the disease can be slowed.
Pseudodementia is another common differential diagnosis and refers to depression that has symptoms of cognitive decline, similar to that of dementia; these symptoms can be treated with medications.
With a correct diagnosis and treatment, reversible causes of dementia can be completely cured.
How do you test for Alzheimer's disease?
If you or someone you know is experiencing memory lapses, and other forms of cognitive decline, then getting a thorough evaluation is advisable. Alzheimer’s disease is often a diagnosis of elimination, especially when combined with a history of progressive cognitive decline.
During the evaluation, several factors will be considered, including
- History, medical conditions, and a psychiatric evaluation
- MOca/ folstein minim mental (bedside screening tests)
- A blood test to eliminate reversible causes of dementia
- Conduct an MRI Brain to look for concurrent vascular disease and Lewy Bodies
- Prescribe a trial of SSRI to screen out pseudodementia
- Conduct further neuropsychological testing if needed
MOca/ MMSE (Folstein mini-mental state exam)
The MoCA is similar to an older test called the Mini-Mental State Exam (MMSE). Both tests use a 30-point scale and take only a few minutes to complete.
MMSE: This is an older evaluation, but an easier test when compared to MOCA. This test is better at evaluating people already diagnosed with dementia. It can measure mild cognitive inflictions. It is easy to complete and is better suited to monitor gradual decline in cognition.
MOCA: This test is harder than MMSE and better equipped to measure between normal cognition and mild impairments. It is used to test for early dementia detection. The MOCA test is ineffective for people who have already been diagnosed with dementia.
Neither of these tests is used to explore the cause of cognitive impairment or dementia.
Blood tests to eliminate reversible causes of dementia
These conditions have symptoms of dementia but occur due to underlying medical conditions that result in dementia-like symptoms. With the correct evaluations, diagnosis, and medications, the symptoms of reversible dementia can be eased and cured. One of our psychiatrists can evaluate, diagnose, and treat the underlying causes of your condition.
The main causes of reversible dementia are
Vitamin deficiencies: Vitamin deficiencies can mimic the symptoms of dementia. The most common deficiencies that cause cognitive impairment are vitamin B12, D3, and folate.
Low vitamin D3 levels are associated with both dementia and strokes. Blood folate deficiencies are common with age. Studies found that low serum folate levels are associated with poor neural signaling and an increased risk of dementia.
Metabolic diseases or abnormalities: The brain’s structural and functional changes from many years before the onset of dementia symptoms. High blood pressure, high blood glucose levels, abdominal obesity, hypothyroidism, hypoparathyroidism, and dyslipidemia (having blood lipid levels that are too high or low) can cause dementia-like symptoms.
Drug effects and interactions: Many drug interactions in older individuals can display symptoms of dementia. The most common medications with adverse drug interactions are anti-depressants, antiplatelets, anti-psychotics, antihistamines, and omeprazole. Benzodiazepines, antihypertensives, and drugs with anticholinergic properties can also induce dementia-like symptoms. They may result in several neuropsychological deficits.
Depression: Pseudodementia is a term used to describe intellectual decline stemming from the lack of energy or effort. A decline in cognition is swift in the case of depression; far more so than Alzheimer’s or other forms of the condition.
Excessive alcohol consumption: The alcohol metabolite acetaldehyde was shown to be a direct neurotoxic. Chronic alcohol-induced dementia symptoms can result in memory problems, executive dysfunction, and poor spatial awareness of an individual.
Stress: Chronic stress releases cortisol, the stress hormone, which can affect memory. Struggling with stress for long periods can result in compromised immunity.
Inflammation: Inflammation is an immune response to an injury, pathogens, oxidative stress, and toxins. Persistent chronic inflammation has been linked with increased chances of dementia.
Lung problems: Lung problems can result in a shortage of oxygen supply to the brain. Patients suffering from conditions such as COPD or chronic obstructive pulmonary disorder have a higher risk of experiencing dementia symptoms, than the rest of the population.
Sleep issues: Sleep problems, such as undiagnosed sleep apnea can damage the brain significantly. However, this damage is reversible with a correct diagnosis. Studies revealed that patients suffering from sleep apnea brain damage showed significant improvement after using the CPAP machine for three months or more.
Systemic Lupus: An autoimmune disorder, Systemic Lupus Erythematosus (SLE) can affect genetic, and epigenetic factors (environmental aspects that affect a person’s behaviors, without impacting the genes). It can also affect hormones and the immune system. The damage to the body can be unpredictable. Many organs, including the brain, may be affected causing neuropsychiatric symptoms.
MRI Brain to look for concurrent Lewy body and vascular dementia
Alzheimer’s disease is a mixed proteinopathy (amyloid and tau) tangles. It is frequently associated with other age-related processes such as cerebrovascular disease and Lewy body disease.
Conducting MRI brain scans allows doctors to make a better differential diagnosis of dementia and precise monitoring of disease progression using brain imaging features.
SSRIs to rule out pseudo dementia
Selective serotonin reuptake inhibitors (SSRIs) are currently the most commonly used antidepressants, often emerging as the first-choice treatment based on their efficacy and ease of use. Sleep disorders and poor appetite are often the first symptoms to improve in response to pharmacological treatment.
Neuropsychological testing for Alzheimer's disease
The Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog) is a test often used by psychiatrists to measure the cognitive impairment of their patients. Although ADAS-Cog was initially developed to measure moderate to severe cognitive impairment, it is also used to measure mild cognitive decline, the efficacy of which is debated.
Alzheimer's disease treatment
An early intervention can make a marked difference in the treatment options. For instance, in the early stages, psychotherapy for Alzheimer’s disease has shown remarkable improvements.
Psychotherapy for Alzheimer's Disease Treatment
Providing different types of support with psychotherapy includes cognitive behavioral therapy, interpersonal therapy, acceptance and commitment therapy, and motivational interviewing. These help individuals accept and adjust to lifestyle changes with cognitive impairment. It can enhance their quality of life and their overall sense of well-being.
- Talk therapy with a counselor or group support
- Cognitive Stimulation therapy
- Cognitive Behavioral Therapy
Cognitive Behavior therapy (CBT) is one of the most common forms of talk therapy and is used to treat multiple psychiatric conditions, mostly anxiety and depression. It works by changing a person’s thoughts and behavior patterns to treat their symptoms.
Cognitive stimulation therapy (CST) is a common therapy option for people suffering from mild to moderate dementia or Alzheimer’s disease. It focuses on themed activities that center around continued learning for improved cognitive abilities, emotionally and socially stimulated with group therapy.
Puzzles, games, and other activities with participants and facilitators help them stay focused and improve their memory. If CST is administered on a one-on-one basis, it is then known as iCST; however, CST is usually conducted in group settings as the social aspect of the therapy is crucial for improvement.
Although the benefits of CST in group settings cannot be denied, individual CST can also have a positive impact on a person’s cognitive abilities and emotions. Medication along with therapy is the ideal treatment option.
Community & family support for Alzheimer's disease
Just as every individual with Alzheimer’s disease progresses differently, so too can the caregiving experience vary. However, some strategies can help a caregiver and help make your caregiving journey as rewarding as it is challenging.
Family therapy is often an option for loved ones, along with patients, to help spouses and children cope with the diagnosis and the upcoming cognitive decline. Providing a therapeutic environment, with home help and assisted living, will also be a requirement in the later stages of the disease.
Affordability and the patient’s requirements dictate what level of in-home help is needed. It ranges from a few hours a week of caregiving assistance to live-in help. Hiring help for basic tasks like shopping, housekeeping, or running other errands, can help free up more time to provide more focused care for the person.
Adult daycare offers activities and socialization opportunities for your loved one and the chance for you to continue working or attend to other needs. While this may not always be the ideal option, professional, academic, and personal commitments can mitigate the need for adult day care programs that specialize in dementia care.
Respite care gives a caregiver a block of time to rest, travel, or attend to other things. Enlist friends and family who live near you to run errands, bring a hot meal, or watch the patient so you can take a well-deserved break. Volunteers or paid help can also provide in-home respite services. Or you can explore out-of-home respite programs such as adult daycare centers and nursing homes.
Medications for Alzheimer's disease treatment
Cholinesterase inhibitors (ChEIs)
This medication is used to treat mild to moderate symptoms of dementia. They are used to treat up to moderate symptoms of Alzheimer’s disease. This class of drugs is prescribed for both Parkinson’s disease and AD.
Cholinesterase inhibitors allow neural connections to communicate and thrive. People suffering from dementia lose brain cells as they die after losing neural connections.
Other medications also affect the brain’s chemical messaging system, but they affect different areas of the brain.
N-methyl-D-aspartate (NMDA) receptor antagonist
One drug, memantine, is licensed for use in moderate to severe dementia in AD. NMDA and ChEIs both affect different chemical reactions in the brain. Both are known to improve memory in a person suffering from dementia.
Anti-amyloid antibodies
These work on amyloid proteins that build plaques, causing Alzheimer’s disease. It slows down the progression of the symptoms, although it does not cure it.
Another medication recently has been approved for early stages of Alzheimer’s disease; it was approved by the US Food and Drug Administration (FDA) as a treatment for early Alzheimer’s disease in July 2023.
Alzheimer's disease treatment for insomnia
The most commonly used drugs are melatonin, z-hypnotics, sedating antidepressants, and antipsychotics. Benzodiazepines are avoided because they may worsen cognitive function.
Cholinesterase inhibitors, the first-line treatment for AD, can also improve sleep quality. Recent studies have shown a correlation between melatonin and AD; it has been shown to have cytoprotective (a process by which chemical compounds protect cells against harmful agents), antioxidant, and anti-amyloidogenic effects.
Alzheimer's disease treatment for depression
Selective serotonin reuptake inhibitors (SSRIs) are currently the most commonly used antidepressants, often emerging as the first-choice treatment based on their efficacy and ease of use. Sleep disorders and poor appetite are often the first symptoms to improve in response to pharmacological treatment.
Alzheimer's disease treatment for agitation
Atypical antipsychotic drugs target the serotonin and dopamine chemical pathways in the brain. All atypical antipsychotics must carry a safety warning, as mandated by the FDA; the medication has been associated with an increased risk of death in older patients with dementia-related psych.
A psychiatrist will consider a combination of talk therapy, CST, and medications to slow the progress of a person’s cognitive decline. An Alzheimer’s disease diagnosis is negatively viewed by most due to the severe cognitive impairments in its later stages; what is less talked about is that an early diagnosis can help a person live happier and more active years before deterioration.
An Alzheimer’s diagnosis does not mean that a person cannot live many happy and active years. Instead, it means that while there is a slow cognitive decline caregiving will vary stage-wise. A person can still retain their premorbid personality for many years with medication, therapy, and support, enjoying their time with their family and loved ones.
