Frequently Asked Questions

Neurologists generally serve as consultants to other physicians. When a patient has a chronic neurological disorder, the neurologist often provides ongoing care. Patients suffering from conditions like migraines, Parkinson's disease, Alzheimer's disease or multiple sclerosis fall into this latter group.

Neurologists can recommend surgical treatment, but do not perform surgery. When treatment includes surgery, neurologists will monitor surgically treated patients and supervise their continuing treatment.

Neurologists treat disorders of the nervous system, brain, spinal cord, nerves, muscles and pain. Common neurological disorders include:

• Stroke
• Headache and Migraines
• Epilepsy
• Parkinson's Disease
• Sleep Disorders
• Multiple Sclerosis
• Pain
• Tremor
• Brain Injuries
• Spinal Cord Injuries
• Brain Tumors
• Peripheral Nerve Disorders

Alzheimer's disease is a progressive, irreversible brain disorder that is associated with the presence of senile plaques and neurofibrillary tangles in the brain. Clinical symptoms vary, but memory loss is a key feature.

Dementia is an umbrella term used for any type of progressive, irreversible brain disease that causes loss of nerve cells in the brain accompanied by cognitive changes. Alzheimer's disease is a type of dementia. Dementia can be caused by other conditions including strokes, head trauma and Lewy bodies.

Alzheimer's is diagnosed by a careful history and evaluation of the patient, followed by appropriate tests.

• Physical and neurological examination
• Neurocognitive evaluation
• Structural Brain Imaging: MRI and CT scan
• Functional Brain Imaging: PET scan
• Functional Brain Evaluation: EEG
• Brain Fluid Analysis: Spinal Tap

Some rarer forms of Alzheimer's disease (with age of onset before age 60) are inherited in an autosomal dominant fashion- that is there is a 50% chance of the illness occurring in each offspring. The most common form of Alzheimer's manifests after age 65 and is influenced by genetics and the environment. In this form, it is possible to have a set of identical twins, one of whom has the condition, the other being unaffected.

While there is not yet a cure for Alzheimer's disease, several available drugs slow progression and enhance quality of life. Several hundred drugs are being currently being investigated.

FDA Approved Treatments for Alzheimer's Disease

• Tacrine, or Cognex, was the first drug approved by the Food and Drug Administration (FDA) for the treatment of Alzheimer's. It slows progression of Alzheimer's by increasing levels of the neurotransmitter acetylcholine. It needs to be taken four times a day and blood tests for liver function need to be monitored. Up to six out of ten people are unable to reach the maximum dosage due to side effects.
• Donepezil, or Aricept, was the second drug approved by the FDA to treat Alzheimer's. It works by raising the level of the chemical acetylcholine in the brain, slowing progression of some types of dementias. The dosing is once a day. Side effects include gastrointestinal discomfort.
• Rivastigmine, or Exelon, was approved by the FDA to treat Alzheimer's. It also, like Cognex and Aricept, increases levels of acetylcholine in the brain. It is given twice a day and side effects include gastrointestinal discomfort.
• Galantamine, or Razadyne, is last in the class of drugs that raise brain levels of acetylcholine. It has been approved by the FDA for treating Alzheimer's disease. It is given twice a day. Side effects include gastrointestinal discomfort.
• Memantine, or Akatinol, is an NMDA receptor agent, which prevents the harm to brain cells from excessive activity of the chemical glutamate. It was approved by the FDA for treating moderate to severe Alzheimer's dementia. Although approved for twice a day use, it may be given once a day.

Investigational Treatments (not FDA approved for treating Alzheimer's disease)

• Intravenous Immunoglobulin (IVIg) is derived from the pooled blood of thousands of donors. It is used for treating various autoimmune conditions and may have utility in treating Alzheimer's disease. It is currently in clinical trials.
• Neotropin, as the name suggests, is drug that possibly promotes the growth of nerve cell processes and maintains nerve cell viability. It is currently in clinical trials.
• Nootropics, the first class of agents used for treatment of memory loss have not been shown to be consistently effective and are not used routinely in the US.
• Alpha-tocopherol, or vitamin E, in doses of 2000 international units has been shown to slow progression of Alzheimer's disease. The drug works as a free radical scavenger and promotes nerve cell viability.
• Selegeline, or Eldepryl, is an agent that both raises the levels of certain neurochemicals and promotes nerve cell viability, has been used in the US for the treatment of Parkinson's disease. It has been shown to be effective for the treatment of Alzheimer's.
• Non-steroidal anti-inflammatory agents, or NSAIDS, include drugs such as ibuprofen (Motrin, Advil, etc) may have some utility in preventing Alzheimer's disease. However, NSAIDs were not effective in treating Alzheimer's.
• Gingko biloba, a free radical scavenger and possible brain activator, was said to be the third most commonly prescribed drug for the treatment of dementia in Germany. Preparations of the drug in the US vary and the right dose of the right preparations may slow progression of some types of memory loss.
• B-secretase inhibitors are the newest and most exciting class of drugs being developed for treating memory loss. These drugs stop formation of amyloid plaque and may halt progression of illnesses like Alzheimer's.
• Vaccines that dissolve plaques in the brain are also in development. A clinical trial using a vaccine developed by Elan was stopped because of serious side effects in some patients.
• Certain classes of the B vitamins are felt to be neuroprotective and are being used in clinical trials for treating memory loss.
• Calcium channel blockers, a class of drugs used to treat illnesses like hypertension and migraine, have been investigated in treating memory loss.
• Statins, a class of drugs used to lower cholesterol levels, may reduce amyloid plaque formation and thus may be helpful in some types of memory loss.

This unspoken fear is often the reason why women suffer in silence when they experience cognitive symptoms during menopause. Scared about what they may discover, many women opt not to seek treatment. However, menopause related memory and cognitive disturbances are being increasingly described in scientific literature and are generally responsive to treatment. They can and should be addressed and treated.

Yes. Estrogen influences language skills, mood, attention, and a number of other functions in addition to memory.

Estrogen docking sites are present in several regions of the brain, including those involved in memory (such as the hippocampus). When activated by estrogen, these sites, in turn, activate processes that are beneficial to the brain. In addition, estrogen may, in effect, raise levels of certain brain chemicals (neurotransmitters). These include the neurotransmitters acetylcholine (implicated in memory), serotonin (implicated in mood), noradrenaline (implicated in mood and other autonomic functions), and dopamine (implicated in motor coordination). Thus, estrogen facilitates networking between nerve cells, promoting their ability to "talk to" one another.

• Medical records
• List of medications, or all of your pill bottles
• Any recent laboratory work and neuroimaging done such as MRIs
• If you have the MRI films, please bring them with you to your visit