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Living With Alzheimer's (transcript)
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(ANNOUNCER)         

Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association, an association of independent, locally-operated and community-based Blue Cross and Blue Shield companies, supporting solutions that make safe, quality, affordable healthcare available to all Americans.

 

(ANNOUNCER)         

Second Opinion is produced in association with the University of Rochester Medical Center, Rochester, New York.

 

(MUSIC)

 

(DR. PETER SALGO) 

Welcome to Second Opinion, where you get to see firsthand how some of the country’s leading healthcare professionals tackle health issues that are important to you.  Now, each week our studio guests are put on the spot with medical cases based on real life experiences, and by the end of this program, you’ll learn the outcome of this week’s case and we hope you’ll be better able to take charge of your own healthcare.  I’m your host, Dr. Peter Salgo, and today our panel includes Dr. Frederick Marshall from the University of Rochester Medical Center, Lisa Gwyther from Duke University, special guest Manville Jennings, Dr. Jason Karlawish from the University of Pennsylvania, and Second Opinion primary care physician, Dr. Lou Papa, from the University of Rochester.  Welcome back, Lou, good to see you.

 

(DR. LOU PAPA)       

Thanks, Peter.  Good to see you.

 

(DR. PETER SALGO) 

Why don’t we get right to work over here.  Let me tell you about our patient.  Our patient today is Jasper.  He’s 71 years old.  He’s been married for almost 50 years, and he still works as an investment banker in a firm, by the way, which he’s founded himself 40 years ago.  He’s in relatively good health.  Both Jasper and his wife, we meet them for the first time --

 

(DR. LOU PAPA)       

Mm-hmm.

 

(DR. PETER SALGO) 

-- in their PCP’s office, because Jasper has received a diagnosis of Alzheimer’s disease, Lou.

 

(DR. LOU PAPA)       

Mm-hmm.

 

(DR. PETER SALGO) 

My interpretation of this chart is he went to his PCP.

 

(DR. LOU PAPA)       

Right.

 

(DR. PETER SALGO) 

His primary care physician sent him to a specialist.

 

(DR. LOU PAPA)       

Right.

 

(DR. PETER SALGO) 

Got the diagnosis, and now he’s back --

 

(DR. LOU PAPA)       

Right.

 

(DR. PETER SALGO) 

-- in the office.  So what’s likely to be going on now in this return visit?

 

(DR. LOU PAPA)       

Well, a lot of this is probably to come back and coordinate some of the care that’s going to go on.  Coming back is to kind of set up the discussion regarding is there going to be medication that’s going to be used, what type of support’s going to be available for the wife and the husband and the family, and ongoing care for their other medical problems, because they play a role as well.

 

(DR. PETER SALGO) 

Well, let’s back off just for a moment.  What is Alzheimer’s disease?

 

(DR. JASON KARLAWISH)  

Alzheimer’s disease is a disease of the brain.  It’s the most common cause of dementia in the western world, certainly the United States, and it causes a chronic and progressive loss of cognitive abilities that lead to functional problems like the ability to take care of daily affairs.

 

(DR. PETER SALGO) 

So it’s a big problem.

 

(DR. JASON KARLAWISH)  

It is a big problem.  The chief risk factor for getting Alzheimer’s disease is living longer, and in this last century we have seen an unprecedented increase in life expectancy.

 

(DR. FREDERICK MARSHALL)       

Unfortunately, this is a railroad train on the track and it’s coming our direction as a society.  We have about 5,000,000 people right now, in the United States, with Alzheimer’s disease.  That number is likely to double over the foreseeable future with the aging of the baby boom, and we’re in a situation now where understandably the term itself strikes fear into hurts.  You know, the moment that you share with a patient the diagnosis, “We think this is Alzheimer’s disease,” you have to sort of count on nothing else being heard for the remainder of that encounter.  People are devastated by the diagnosis.

 

(DR. PETER SALGO)             

Jasper’s PCP referred him to a specialist at the urging of Jasper’s wife, not an uncommon scenario.  She was concerned because he had a short temper, he had some memory lapses, and then the electricity was cut off at their home and she discovered that the bill hadn’t been paid in about --

 

(DR. LOU PAPA)       

Mm-hmm.

 

(DR. PETER SALGO) 

-- three months, something very out of character for him.

 

(DR. LOU PAPA)       

Right.

 

(DR. PETER SALGO) 

He was, in fact, a financial advisor.  Is financial trouble, financial mismanagement a common way people get referred?

 

(LISA GWYTHER)       

Yes.

 

(DR. JASON KARLAWISH)  

Yes.  The mantra is money, meds, telephone, transportation.  The earliest impairments, when the disease begins to cause disability, are in the abilities to manage money, medications, and taking care of telephone messages.  And money is -- that’s the toughest thing to take care of, and so, you know, oftentimes that’s where you’ll sort of be most likely to diagnose the disease, because of the challenges of taking care of financial matters.  In this case, this guy’s got a even larger time bomb, which is his business happens to be about money management, and that certainly, if I was seeing him, would be high on my list of something we need to talk about, you know.

 

(DR. PETER SALGO) 

Okay.

 

(LISA GWYTHER)       

In my experience, the first thing families notice is changes in money management.  And so I like to tell families that it’s more than memory, and they may not understand the loss of judgment, the loss of ability to do calculations that were simple for people before --

 

(DR. FREDERICK MARSHALL)       

Yeah.

 

(LISA GWYTHER)       

-- and how memory affects the ability to know what’s been paid and hasn’t been paid.

 

(DR. FREDERICK MARSHALL)       

I think about what I call domains of cognition, and a domain would be, for example, memory.  Another might be visual spatial processing, and another domain would be language functioning, the way one accesses words, the verbal fluency with which they express themselves, and probably the fourth domain of interest would be a little more nebulous, we call it executive functioning, the ability to plan and sequence and make decisions.

 

(DR. LOU PAPA)       

Well, let me back off again, because forgetfulness is not Alzheimer’s.

 

(DR. FREDERICK MARSHALL)       

Exactly.

 

(DR. LOU PAPA)       

There’s a lot of folks out there who forget a lot of stuff.  My car keys often aren’t where I think they should be.  So walk me through how you make the diagnosis.

 

(DR. FREDERICK MARSHALL)       

So right now I think the standard of art for diagnosis requires not just talking to the person who --

 

(DR. LOU PAPA)       

Mm-hmm.

 

(DR. FREDERICK MARSHALL)       

-- has the chief complaint of a memory problem, but also someone else, someone who can narrate over how much time what kind of cognitive problems have you seen.  And that history is really very key to diagnose whether or not there are cognitive problems that are typical of the pattern you see in Alzheimer’s disease.  So what we do is we take that history, carefully looking for evidence of impairment in multiple different domains, and then we do cognitive testing, in the office, that involves oftentimes paper-and-pencil-type things, questions, tests of memory, tests of language functioning.  At that point we’re really looking to validate our concerns that emerge from the history.

 

(DR. PETER SALGO) 

Manville, you’ve got some experience with the diagnosis.  When did you notice changes that made you think in you that something was wrong?

 

(MANVILLE JENNINGS)      

About maybe four or five years before I was diagnosed.  I just had a feel -- I thought it was cognitive problems that I was having.  I went to my primary.  He thought it was stress, but I still didn’t think that everything -- there is something else going on, because I was having some of the things that you were talking about, not so much with money, but with math.

 

(DR. PETER SALGO)

When you first had the diagnosis made, you heard that word, you had Alzheimer’s --

 

(MANVILLE JENNINGS)      

Mm-hmm.

 

(DR. PETER SALGO) 

-- what went through your mind?

 

(MANVILLE JENNINGS)      

Well, they said, you know, “You have Alzheimer’s.”  You know, that alone is like, “Oh, well, that -- that’s not good,” you know, but, “Oh, okay.  So I’m not crazy.  I’m” -- because that’s what I thought was going on.  I was saying what -- you know, I’m doing all these weird things and, you know, my wife, you know, she was telling me that, you know, I’m a completely different person, because we’d been apart because she was here and I was in Oregon for nine months.  And so, you know, when I came here she didn’t even recognize me.  And so when they told me, on my first -- the first time I was tested, I mean, it was like, “Oh, okay.  I’m not crazy.  I’ve got a disease.  And so, great, now I can -- you know, what’s next?”  You know, it -- I mean, I just didn’t  -- you know, go forward.  You know, “What am I supposed to do now?” 

 

(DR. PETER SALGO)

Jasper’s been assigned a diagnosis.  That diagnosis is Alzheimer’s disease.

 

(DR. JASON KARLAWISH)  

Right.

 

(DR. PETER SALGO) 

And Jasper’s wife tells the PCP that -- and it’s in the chart -- sometimes she wishes she hadn’t pushed her husband to see a specialist.  There’s no cure.

 

(DR. LOU PAPA)       

Right.

 

(DR. PETER SALGO) 

What’s the benefit of knowing?  Is there a benefit?

 

(LISA GWYTHER)       

Well, I think there is, and I think Manville talked about it.  It is much more scary not to know and to believe that you’re crazy.  The other benefit is that you can often avoid a lot of mistakes, avoid losing a lot of money, and have some say in what you want, your preferences, who you want to help you with various decisions.  It also provides a reason to make sure that you are spending time in your life doing things you want to do and still enjoy, and figure out how to modify what you are currently doing to make it doable.

 

(DR. PETER SALGO) 

Manville, is that fair?

 

(MANVILLE JENNINGS)      

Oh, yeah, definitely.  I mean, you have to live your life, and so you just make adjustments.

 

(DR. PETER SALGO) 

All right.

 

(DR. LOU PAPA)       

I think one of the things I have difficulty with, as a primary care doc, it’s when you have the patient that comes to you, or the spouse that comes to you, and says they’re forgetting a little bit.  And they get evaluated and they’re given some degree of cognitive impairment, and that may help them plan to some extent, but now they’re labeled and they’re constantly wondering, “Every time when I forget, you know, Aunt Mary’s phone number or birth date, where I left my keys on the coffee table, not on the kitchen table, is that the next step?”

 

(DR. PETER SALGO) 

Mm-hmm.

 

(DR. LOU PAPA)       

And for a -- and I understand, you know, it’s important to know about the progress of the disease and there’s things we can do, but as a primary care doctor, now I’ve labeled this patient.

 

(DR. PETER SALGO) 

Well, let me take it one step further.  Let’s jump ahead a theoretical five years.  Now there is a test, maybe even a genetic test, for a predisposition, which is pretty good, that says you’re going to get Alzheimer’s at some point in the future.  What if Jasper were 41, symptom-free --

 

(DR. LOU PAPA)       

Mm-hmm.

 

(DR. PETER SALGO) 

-- and he went to his doc and asked for the genetic test to know, in advance, if he will get Alzheimer’s, what are the pros and cons then?  Is that an ethical test to do?

 

(DR. JASON KARLAWISH)  

We can do it now, actually.

 

(DR. PETER SALGO) 

Okay.

 

(DR. JASON KARLAWISH)  

There are companies now that are selling the ability to have your genome sequenced, including the APOE gene which has risk prediction for developing Alzheimer’s disease, in the future.  And of course, where medicine likes to go and the public likes to go is let’s get it before it’s a clinical problem.  We’re, of course, not there yet.  So back to the gene test, yeah, if someone’s really motivated that they want to know what their geno type is, “Am I at risk for Alzheimer’s,” right now you can go find that out. 

 

(DR. PETER SALGO) 

From a medical perspective, is it ethical for us --

 

(DR. LOU PAPA)       

Mm-hmm.

 

(DR. PETER SALGO) 

-- as doctors, to offer this test, if we have no therapy and no way to really deal with it?

 

(DR. MARSHALL)      

So I would say that that is a highly personal decision between a doctor and a patient.  As a clinician, when I’m wearing my clinical hat with my quaver full of therapeutic arrows on my back --

 

(DR. PETER SALGO) 

None of which work for Alzheimer’s.

 

(DR. MARSHALL)      

-- none of which work for Alzheimer’s, my quaver right now -- and I don’t want to paint too bleak a picture, but we do not have disease modifying drugs for Alzheimer’s.  We have symptomatic therapies for memory.  I hesitate to encourage my patients to go for this.  As a researcher, as somebody who’s trying to push the ball down the field with respect to our therapies of the future, obviously it’s probably going to be not only important but critical --

 

(( )):        

Mm-hmm.

 

(DR. MARSHALL)      

-- for patients and -- or what I’ll -- what I will say subjects and researchers to pursue this.  There’s a difference between a patient and a doctor and a subject and a researcher.

 

(DR. JASON KARLAWISH)  

You know, Fred’s right and I think that what we’re engaged in right now is a dialogue of kind of resistance and accommodation between identifying people at risk, trying to intervene to reduce that risk, and if it works, then we kind of can redefine who’s at risk because we have a drug that affects risk.  That’s where we’d like to be.  We’re not there yet.  I think for now, if a practitioner wants to sort of engage in helping people predict their risk of Alzheimer’s by, say, getting the APOE test, you know, there’s some data to guide that practice, and it really requires wanting to spend the time to identify people who have a motivation and a neuropsychiatric makeup that can probably tolerate getting that information.  So, you know, if you’re going to do that, as a clinician, you probably need to make sure the patients don’t have severe depression or anxiety or a clear plan to engage in self-destructive behaviors if -- depending on what the result is.

 

(DR. PETER SALGO) 

And with that, let’s pause for just a moment.  Let me see if I can sum up.  We’ve been covering an awful lot of ground here.  I think, first of all, it’s important to note that not all dementia is Alzheimer’s.  Not all forgetfulness is dementia.  Getting an accurate diagnosis often requires consulting with specialists, and they’ve got a toolbox of new and established diagnostic tests.  And while receiving the diagnosis of Alzheimer’s can be confusing, I would say certainly would be frightening, it could also help families to be proactive in developing the best possible care plan going forward.  We’re all on the same page here?  All right.  Lou, let’s say Jasper and his wife --

 

(DR. LOU PAPA)       

Mm-hmm.

 

(DR. PETER SALGO) 

-- are in your office.  How do you answer this question, “What’s next?”

 

(DR. LOU PAPA)       

Well, I think, first of all, is, you know, be able to understand what their questions are ahead of time, and then understand what their goal is with therapy.  There are therapies that are available, not just drug therapy, but drug therapy is part of it, and making sure that they have the support that they need for ongoing care, because it will -- it needs to be very clear to them it’s going to be a progressive disease.  There’s going to be progressive decline, and there’s going to be things that have to be discussed.  Working, driving, continuing to live in the current living environment, how much family do you have around that’s going to be helpful, those are probably at the top of my list before I even get to the drugs. 

 

(DR. PETER SALGO) 

Manville, did you ask that question, “What’s next”?

 

(MANVILLE JENNINGS)      

My wife and I did, basically, you know, and what we did is we went to the local Alzheimer’s Association and started our new life, basically.

 

(DR. PETER SALGO) 

And when you asked, “What’s next?” what did you want to hear as answer?

 

(MANVILLE JENNINGS)      

“We can help you.”

 

(DR. PETER SALGO) 

I’ll tell you some things that Jasper says.  Jasper indicates he doesn’t want to tell anybody.  He’s afraid it’s going to hurt his business.  He doesn’t want anybody to feel sorry for him.  So let’s parse this out.  I know you’ve both been chomping at the bit to talk about his business with managing other people’s money.

 

(DR. JASON KARLAWISH)  

Yeah.

 

(DR. PETER SALGO) 

Ethical, on his part, not to tell anyone?  What do you think?

 

(LISA GWYTHER)       

Well, I think with a business you have to do something.  Number one, he will get frustrated in not being able to perform the way he used to.  Number two, the -- his clients are at risk, his family is at risk in terms of his income from the business, and he has an opportunity to make a graceful exit, but it’s one of the first things that needs to be considered.  Not everyone has to give up their work, if they’re not owner of the business or the decision-maker.

 

(DR. PETER SALGO) 

But does he have a right to continue working?

 

(DR. JASON KARLAWISH)  

I’d lateral the right issue and just say, you know, you’ve got a disease whose first symptoms impair your ability to manage money, and indeed, in fact, one of the things that you and your wife noticed was that you were having troubles managing your electric bill.  Your business relies on good computational skills to manage money, so you’re disabled in that ability now.  So you need to think about right now how to transition that business out of your authority.

 

(DR. LOU PAPA)       

Absolutely.

 

(DR. JASON KARLAWISH)  

And sometimes maybe walk out of the office very upset with that information, but you really have an obligation to say, you know, you as a family need to work on this, because if you fail to pay attention to this problem, you will have problems.

 

(DR. LOU PAPA)       

I agree with you a hundred percent.  And actually, when I have this discussion with patients I am very blunt, and I tell them does this -- you need to decide as if this passes the sniff test or not.  If you are somebody who is having their money managed by you and your investments went sour, and you found out the major manager had known they had cognitive problems, how would you react to that?  If you were driving a car and you had difficulty with that, and you knew you had problems negotiating that road and you hit a child, how do you think that parent would feel?  You have to make the impression this is difficult.  They’re going to be teed off, they’re going to be right out pissed that you’re going to take their car keys away, but we need a plan to --

 

(DR. PETER SALGO) 

Because you are.

 

(DR. LOU PAPA)       

Because we’re going to do that --

 

(DR. JASON KARLAWISH)  

Yeah.

 

(DR. LOU PAPA)       

-- because it becomes more than an issue for you upsetting the patient.  Someone else’s life, livelihood, health is going to be put risk.

 

(LISA GWYTHER)       

I start with the family, and I usually talk about the role of protective kin.  There are some times when you are going to have to make decisions that your relative won’t like or won’t understand at that point, but it means that you need consensus among family members, you need support from your physician and other people to do that.

 

(DR. LOU PAPA)       

It is the hardest thing, and in caring for patients that have Alzheimer’s disease and other dementing illnesses, for me, as the primary care doctor, it is the hardest thing is when it comes down, they can’t be driving anymore, they can’t live in their house anymore, they can’t work anymore.  It is one of the most challenging things that requires the most phone calls, requires the most cajoling, requires the most office visits, more than anything else.

 

(DR. PETER SALGO) 

Let me, before --

 

(LISA GWYTHER)       

But it should.

 

(DR. LOU PAPA)       

Absolutely.

 

(LISA GWYTHER)       

It should.

 

(DR. LOU PAPA)       

Absolutely.

 

(LISA GWYTHER)       

Those are tough decisions.

 

(DR. LOU PAPA)       

Absolutely.

 

(LISA GWYTHER)       

Yeah.

 

(DR. FREDERICK MARSHALL)       

People with Alzheimer’s are people and they should do what they can do.

 

(DR. LOU PAPA)       

Yeah.

 

(LISA GWYTHER)       

Right.

 

(DR. FREDERICK MARSHALL)       

And the diagnosis of Alzheimer’s disease --

 

(DR. LOU PAPA)       

Right.

 

(DR. FREDERICK MARSHALL)       

-- as a diagnosis -- somebody walks into my office and gets that diagnosis, they’re the same person --

 

(DR. LOU PAPA)       

Right.

 

(DR. FREDERICK MARSHALL)       

-- when they leave my office.

 

(DR. PETER SALGO) 

Okay.

 

(DR. FREDERICK MARSHALL)       

And so I think it’s really important that we customize our sense of what is this -- it’s not so much about what you can’t do.

 

(DR. LOU PAPA)       

Right.

 

(DR. FREDERICK MARSHALL)       

It should be about what you can do, what gives your life meaning, what do you enjoy, how do you help your patient find those things?

 

(DR. PETER SALGO) 

Also what I heard from this discussion is by making this diagnosis you can come up with coping strategies --

 

(DR. LOU PAPA)       

Mm-hmm.

 

(DR. PETER SALGO) 

-- now knowing what the future may hold --

 

(DR. FREDERICK MARSHALL)       

Right.

 

(DR. PETER SALGO) 

-- for folks who are going to be facing these challenges.  So what strategies, Manville, are you using now to make your life better and to make your days work?

 

(MANVILLE JENNINGS)      

I try to stay away from situations where I might get frustrated, and that’s been probably the hardest thing to do when you’re so used to doing, you know, your job and you can’t do it anymore.  And so I come up with other things to do.

 

(DR. PETER SALGO) 

Mm-hmm.

 

(MANVILLE JENNINGS)      

I even do things that my doctor says I shouldn't be doing.

 

(DR. PETER SALGO) 

Give me an example.  I won’t tell anybody, just a few million people out there.

 

(MANVILLE JENNINGS)      

I’m very active.  I run, I ride my bike, hike.  He doesn’t want me riding my bike, doesn’t want me, you know, running.

 

(DR. PETER SALGO) 

I won’t tell him.

 

(MANVILLE JENNINGS)      

You know, I just can’t -- you know, that’s not how I live my life.

 

(DR. PETER SALGO) 

Let me tell you something.  Jasper says that his wife is driving him crazy because, for example, when they were ready to come to the doctor’s office, she buttoned his shirt.  Does that ring any bells, that she’s becoming immediately overprotective because of the diagnosis?

 

(MANVILLE JENNINGS)      

That’s fine. 

 

(DR. PETER SALGO) 

That’s fine.

 

(MANVILLE JENNINGS)      

I mean, if my wife wasn’t with me all the time, I’d be lost, so, you know -- I mean, we do, you know -- we clash, but it’s mostly how I dress, and it’s been like that for 30 years.  So, I mean, you know --

 

(LISA GWYTHER)       

That’s not the disease.

 

(MANVILLE JENNINGS)      

Yeah.

 

(DR. LOU PAPA)       

It’s bad fashion.

 

(DR. PETER SALGO) 

Everybody wants to make sure that an Alzheimer’s patient is safe, but everybody also wants the Alzheimer’s patient to be as independent as possible.

 

(LISA GWYTHER)       

Right.

 

(DR. PETER SALGO) 

How do you go down this line?

 

(LISA GWYTHER)       

You have to find ways to retain control, as somebody with any disability and with any chronic illness, and I think what we’ve got to understand, this is a chronic illness.  So what you have to do is learn to live with it, and that means making daily decisions about what you do and don’t do, who you do it with, who -- you know, what sorts of activity bring you pleasure, like Manville’s exercise is important to his quality of life, and he’s going to continue doing that and take any precautions that he potentially could take to make sure he doesn’t get lost or do something else that might harm his ability to continue doing them.

 

(DR. PETER SALGO) 

But we’re looking at one point in time.

 

(LISA GWYTHER)       

Mm-hmm.

 

(DR. PETER SALGO)

Alzheimer’s disease progresses.

 

(DR. LOU PAPA)       

Mm-hmm.

 

(DR. PETER SALGO) 

So knowing what’s likely to happen to Jasper, for example, how do you get the family engaged to watch for them and deal with them?

 

(DR. FREDERICK MARSHALL)       

So I think, you know, that’s the critical point in longitudinal, really fine comprehensive care.  You have to educate the family that, unfortunately, because it’s a moving target, you have to be always vigilant for the next new thing that’s happening.  You finally accommodate yourself to one stage of the illness, and the next stage is upon you.

 

(DR. JASON KARLAWISH)  

I think what you want to encourage people to focus on is what’s going to maximize the person’s dignity and pleasure, and I think that’s how I like to focus people.  And by the way, I’ll put this provocatively, I like that focus better than the focus on hope, because I think when you’re dealing with a chronic and progressive illness I don’t think that’s a very useful dialogue.  I think it’s more about dignity and pleasure.

 

(DR. PETER SALGO) 

Okay.  So let me stop just for a moment and sum up, because once again we’ve covered an awful lot of information here.  I think it is fair to say that there is currently no cure for Alzheimer’s and the disease is progressive over many, many years through various stages.  So particularly in the early stages of the disease, patients can, with the support and understanding of those around them, continue to enjoy meaningful activities.  Manville, how are you doing?

 

(MANVILLE JENNINGS)      

I’m doing pretty good.

 

(DR. PETER SALGO) 

Do you have any things that you wish you could do that you’re not doing, things you’d like to do now that --

 

(MANVILLE JENNINGS)      

Oh, all sorts of things, but, you know, I can’t do them.  I mean, I could try but I -- what’s the point?  Like I said, you know, there’s no reason for me to, you know, really push the envelope when I just get discouraged.

 

(DR. PETER SALGO) 

Mm-hmm.

 

(DR. LOU PAPA)       

Mm-hmm.

 

(MANVILLE JENNINGS)      

So . . .

 

(DR. PETER SALGO) 

I know that you’ve written a piece of advice for doctors, which is find a cure, and what I’m going to do is open this up in the few seconds we’ve got left.  Cure, anybody see one coming?

 

(DR. JASON KARLAWISH)  

Cure, like what we did with small pox, I don’t think so.  I think if we look at other diseases of aging as a model, osteoporosis, coronary disease, hypertension, I think what we will -- our best estimate of success ought to be how to slow down the progression of the disease.  We should also focus on treating the symptoms better.

 

(DR. FREDERICK MARSHALL)       

I guess I want to believe that the march of science will cure this disease some day.  It’s a very tough nut to crack from a biological point of view.

 

(DR. PETER SALGO) 

All right.  Well, we are out of time.  I want to thank all of you for coming today, and especially you, Manville. 

 

(MANVILLE JENNINGS)      

Thank you.

 

(DR. PETER SALGO) 

Thank you so much.  I know this isn’t easy to share, and it’s been a pleasure to meet you.

 

(MANVILLE JENNINGS)      

Thank you.

 

(DR. LOU PAPA)       

Absolutely.

 

(DR. PETER SALGO) 

Thank you for joining us.  We are out of time.  I hope you continue the conversation on our website.  There you’re going to find the transcript of this show, more videos about Alzheimer’s, and links to resources.  The address is Second Opinion dash TV dot O-R-G.  Thanks for watching.  Thank you all for being here, I mean all of you.  I’m Dr. Peter Salgo and I’ll see you next time for another  Second Opinion.

 

(MUSIC)

 

(ANNOUNCER)         

Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association, an association of independent, locally-operated and community-based Blue Cross and Blue Shield companies, supporting solutions that make safe, quality, affordable healthcare available to all Americans.

 

(ANNOUNCER)         

Second Opinion is produced in association with the University of Rochester Medical Center, Rochester, New York.