Voices from the frontline: Ariana Tart-Zelvin, Ph.D., talks about helping dementia patients
[6 MIN READ]
In this article:
-
Ariana Tart-Zelvin, a neuropsychologist with the Swedish Program for Healthy Aging, shares details on working with patients with Alzheimer’s and other neurodegenerative conditions.
-
Dementia is on the rise as the population lives longer.
-
Lifestyle changes may help prevent Alzheimer’s, while lifestyle interventions can help patients cope with the disease.
Alzheimer's is the most common neurodegenerative cause of dementia in the United States. Startlingly, the Centers for Disease Control and Prevention has reported that by the year 2060, some 14 million people are projected to be diagnosed with the disease. In recognition of Alzheimer’s Awareness Month, and to learn more about how we can take control of our own risk factors for dementia, we spoke with neuropsychologist Ariana Tart-Zelvin, Ph.D., of the Swedish Program for Healthy Aging.
As a neuropsychologist, what conditions do you treat and how does your role fit within the Swedish Program for Healthy Aging?
A neuropsychologist is a psychologist who has specialized training in brain and behavior relationships. I see patients with Alzheimer’s and Parkinson’s disease, various dementias, multiple sclerosis, ALS, brain tumors and brain injuries.
I primarily work with Dr. Nancy Isenberg, who is a neurologist and the director of the program. To complement her work, I do neuropsychological testing to determine a patient’s current cognitive and emotional functioning. This includes establishing a patient’s cognitive strengths and weaknesses, as well as identifying possible mood symptoms. I also engage in cognitive rehabilitation with patients, where I teach them evidence-based strategies to improve cognitive abilities.
What can interventions do for patients with neurodegenerative diseases like Alzheimer’s?
Lifestyle interventions can help individuals combat neurodegenerative processes. Eating well, getting good quality sleep, exercising and challenging our brains are incredibly helpful. That said, sometimes those changes can seem daunting or unrealistic for certain patients. However, something as simple as teaching patients to have a designated place in their home to put their phone, wallet, keys and mask every day they come home can create a habit that will be helpful later on. As a patient experiences decline in cognitive functioning, such as in memory, the person has already formed this habit, which can withstand some decline.
Cognitive testing can also provide data that allows me to make appropriate and helpful recommendations for patients and their families. If, for example, I learn that a patient benefits from the repetition of material during testing, I can encourage their family or caregiver to build in reminders throughout the day about upcoming appointments or other important events. But if repetition doesn’t help, then I recommend families redirect their energy and resources elsewhere. We can learn a lot from testing and use that information to help a patient’s strengths address some of their weaknesses.
What kinds of tests do you use?
I use tests that measure all our cognitive domains, both on paper and with a computer. I look at memory, attention, processing speed, visuospatial abilities, language, executive functioning and intellectual abilities. I also examine mood and functional abilities and ask about physical symptoms, because those factors can be very impactful on someone's everyday life and cognitive functioning.
For example, I look at symptoms of depression and anxiety that might be exacerbating some existing cognitive difficulties or might even be causing them. If we address the mood factors, we can sometimes see an improvement in cognitive functioning and day-to-day activities.
I also start each evaluation with a very thorough interview to get a sense of what the patient thinks is going on. I can establish cognitive, physical and emotional concerns, along with the onset and course of their reported symptoms. I'll often interview a family member, a caregiver, maybe even an employer, who might be able to provide another perspective on what's going on with the patient. Following an evaluation, patients get a very thorough report that summarizes their performance, as well as treatment recommendations.
Why are we seeing more cases of dementia?
There are several reasons. One of which is simply because of the percentage of the population that is reaching the age at which we typically see the onset of dementia.
Another reason is, especially in the United States, people engage in a lot of unhealthy lifestyle behaviors that can contribute to medical conditions associated with an increased risk for dementia. For example, obesity, diabetes and sedentary lifestyles, where we spend hours sitting and working on screens, are on the rise in the general population. Diabetes is what we call a vascular risk factor and can increase the risk for later developing vascular dementia.
Are you seeing this increase firsthand?
As the only neuropsychologist with the program, it’s flattering to see how my role is needed. However, I’m hoping we can expand our neuropsychology services to see more patients in a timely manner. The need is clearly there.
What can someone do to reduce their risk of developing dementia in the future?
We now know that genes play a very small role in developing dementia later in life. It's a big relief for those with a family history, but it also puts the large majority of the responsibility in our hands to make good lifestyle choices.
That includes five key aspects that start with following the Mediterranean diet, which is considered anti-inflammatory and beneficial for your cognitive functioning, as well as your mood.
Then there’s getting at least seven hours of uninterrupted sleep per night and exercising regularly — including 45 to 60 minutes of aerobic exercise, five days a week.
There are also a couple of less tangible things you can do. Socialization — really using your brain in conversations with other people — is so important. But most of all, find a sense of purpose in and around you.
Even volunteering once a year has been shown to reduce someone's risk of dementia later in life. Research has shown us that just two weeks of regular aerobic exercise can be more beneficial to someone's memory than any medication or pill.
Find a doctor
If you have questions about Alzheimer’s disease or dementia in older adults, contact the Swedish Program for Healthy Aging. We can accommodate both in-person and virtual visits.
Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.
Join our Patient and Family Advisory Council.
Additional resources
New research brings hope for detecting and preventing Alzheimer's disease
Tips for healthy aging: a conversation about dementia with Dr. Nancy Isenberg
Alzheimer’s and healthy aging information from the CDC
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.