Cognitive Impairment from a Physician’s Point of View with Dr. Steven Tam

Virginia and Steve are joined by UCI Senior Health Center physician and UCI MIND researcher, Steven Tam, M.D., who describes some of the early symptoms of cognitive impairment, and the general approach he takes when assessing a patient.   He answers questions about current treatments.  He emphasizes the importance of gathering a complete history of the patient prior to making a diagnosis. 

Transcript

Intro 0:06  

From the University of California, Irvine, this is UCI MIND’s, Spotlight on Care, the podcast where we share stories, experiences, tips, and advice on caring for loved ones affected by Alzheimer's and other dementias. 

Virginia 0:23  

Hello, and welcome to Spotlight on Care. I'm Virginia Naeve and I'm here with my co-host, Steve O'Leary. Today, we're going to speak with a physician who can give us some professional perspective about the beginning signs of Alzheimer's disease, and what can be expected at the first visits to the doctor. Before we begin, Steve and I like to say a few words regarding our topic. So, Steve, were you in denial for a while with your wife, Patty having memory problems?

Steve 0:58  

Yes, yes and no. So, my wife and I work together in our business. And she would pretty consistently talk to me about the fact that she felt overwhelmed. And I didn't really relate to that because she'd been doing the same job for many years. As it turns out, she was overwhelmed. And I didn't find out about it until the people she was reporting to. She was a controller, and she was reporting to the CFO. And finally, they came and said, hey, there are so many mistakes happening and things like that. I felt miserable, that I hadn't paid attention to the pleas, that she was making. So, yeah, they were happening. I didn't see them around the home, but I saw them in our office.

Virginia 1:48  

So, you finally thought to yourself, okay, I got to get a professional in here

Steve 1:52  

Unfortunately, I ended up having to fire her.

Virginia 1:54  

Oh boy. Well, I have to say that with my mom, I didn't know where to start. I knew I had to get a doctor's opinion and advice about what was going on with her brain. I took her to her general practitioner and sat there in his office with her right beside me, which for me was uncomfortable and awkward. Because I really felt I couldn't tell him everything because she was right there and was, I going to hurt her feelings. And I really didn't know darn thing about this disease. So, it was not a great start. Well, anyway, let me introduce our guest. Our guest today is Dr. Steven Tam. He is a physician with the UCI Senior Health Center with a specialty in geriatric medicine and neurology, treating older adults with concerns about memory loss and dementia. Welcome Dr. Tam, we're glad you're here.

Dr. Tam 2:55  

Thank you for having me.

Virginia 2:56  

Well, let's see. Usually, Steve and I interview people going through caregiving, or have already gone through the caregiving process. But I'm really happy to interview someone who sees everything from the physician’s point of view. And I'm curious about so many things. So, let's get started. So, the first appointment, Dr. Tam, when someone makes an appointment to come see you about memory problems? Are they usually brought in by a family member? Or do they sometimes come by themselves?

Dr. Tam 3:32  

Yeah, again, thanks for having me. I think it sounds like we're gonna have some good discussion about topics and questions that I don't know that we ever normally cover, for folks. Regarding that first appointment, we probably see a variety of scenarios come up. We have folks that come in with a family member with different caregivers, or maybe they show up by themselves,

Virginia 3:58

because they're concerned 

Dr. Tam 4:00

No, so they may be concerned and maybe concerned from the caregiver or maybe concerned from the family. So, there's again, also a variety of situations that arise.

Virginia 4:09  

Right, right. Are they saying, well, my wife is repeating everything, or my mom here is repeating everything again. It was really awkward when I did that with my mom because I'm telling the doctor right in front of her, she's repeating everything. She's not remembering anything. What do they tell you when they first sit down with you?

Dr. Tam 4:35  

Yeah, I think we see kind of like you described, but pretty much a wide variety of symptoms, or signs or things that folks are doing, that may alarm the family member, the caregiver that brings out attention and and wants to bring it forward but sometimes it's remembering details of conversations or forgetting, like appointments and events, doing things around the house that, you know seem a little bit more challenging in terms of remembering that task and focusing in on those tasks.

Virginia 5:10  

Right. So, they're concerned, so they make an appointment with you

Steve 5:14  

I've got a question. 

Dr Tam 5:15

Yeah. 

Steve 5:16

Do you get a sense of fear? When you're talking to the patient about what's going on and being with you? Is there like, I'm, I'm scared, I'm afraid that something might be true.

Dr. Tam 5:28  

Yeah, um, you know, I think we again, same thing, we probably see a variety of scenarios. We have those folks that come in, they have a certain level of concern about what's happening to them, and they don't want to lose, but certain abilities that they would normally be able to do on their own. And you might get a sense of that, we certainly get folks that also get a sense of relief too that they're coming in that, you know, we have these, I'm having this challenge, I'm having this frustration with things. I just don't know what the cause of it, and I'm seeing a doctor, and, you know, maybe they can help guide me to what's going on. So, there's that component of it, too. So, there's a range, I think, just as well,

Virginia 6:15  

it would seem to me that a lot of people are hoping that you're going to say it's aging they’re you know, do you explain to them what is normal forgetfulness? Or that it's perhaps the start of something more serious?

Dr. Tam 6:34  

Yeah. So, I mean, their folks come in, and they they have a concern about what their symptoms might be. Right. And there is a gamut in terms of what their presentation is. And I think it does help to help folks understand the difference between normal aging changes with the memory.

Virginia 6:57  

Like, a lot of times I walk into my pantry and go, why did I walk in here?

Dr. Tam 7:01  

You know, and I think that a good majority of us out there probably experience certain things, you know, similar to a certain extent, right. And so, you know, the question comes up what, you know, you really have to distinguish between what normal is and what's not normal, right? And try to figure out what's what? The, an easy way to think about it is that normal aging changes, you can it typically, it's like an efficiency issue, how quickly the mind is able to come up with information, how quickly you can learn information. And you know, that if there's certain stressors, or certain a lot of events going on, sometimes it's going to just take longer to define that word, to find that name. Or to learn a task, right? I might have to look at something a few more times than usual. Right? Ultimately, the job can get done, you could still get to that point where you're pulling up that information, or you're learning that information for a later time point, right? What's not normal and not normal can mean a different number of things. All right is when you truly have a difficulty pulling up that information or learning that information. Something is blocking that information from coming up or getting stored on there. Right.

Virginia 8:28  

And it happens repeatedly. 

Dr. Tam 8:30  

Yeah, yeah. So it's not just one time, right? I mean, it's not in the time that you're in the hospital, or you just had surgery or just had anesthesia. Right. I don't think it's fair when we have a bunch of pain medication inside of us. And, you know, and give us a memory test when that's the case, right? So in those kinds of circumstances, you kind of have to put it in the right context. So how often it's happening, okay, how many things it's affecting, at home everyday life, everyday function from that circumstance to Steve, you mentioned at work, right? It's when these things when the symptoms start affecting regular everyday functions

Virginia 9:05

And other people are noticing

Dr Tam 9:07

Other people might notice and sometimes it is other people that notice it before you do for the individual too

Virginia 9:13  

Do you ever find out that it isn't something that's going to lead to dementia or Alzheimer's and that it actually is perhaps a vitamin B12 deficiency or a thyroid problem or some other medication that's causing their memory problems? How often does that happen?

Dr. Tam 9:33  

That's a good question. I mean, you're essentially getting to like how often we will see a reversible cause of memory loss or cognitive loss on there. Nobody knows for sure the exact numbers, it's it but it probably does represent a small percentage out there. Different studies have different numbers anywhere from like 2%- 5% You know, in terms of what we know in the literature on there, in terms of true reversible causes Um, so I think from that perspective, it's worth evaluating for taking a good history, finding out if they have had a surgery and are taking a bunch of pain medications post-surgery, or if they're, you know, not have a sleep deprivation or, you know, a lot of stressors and mood problem. Or if they have other signs or symptoms that might point to some other form of, of clinical diagnosis or disease that's going on at that time. I've had folks patients present over the years, again, not a majority, necessarily, but a good small number of them. Were, you know, they had other signs of some other illness like a thyroid problem, a significant blood pressure issue where it was like too low all the time. And it was causing them a lot of problems with their thinking abilities. Right. And, you know, folks had taken it as a dementia or a memory problem. And, you know, after trying to adjust things, you know, we saw some improvement in those individuals when that was the case. So. So I think it's worth looking for, you know, taking good history, getting a good amount of information from folks and trying to see if there is something that's relevant,

Virginia 11:17  

And you do a workup for that? 

Dr. Tam 11:20  

Yeah, I think most clinicians will try to take that history. And, you know, try to get to that point where they do the necessary workup. It's driven by the information that they collect,

Virginia 11:32  

Do you find that a lot of times the patient or the family member or both, are in kind of a denial? 

Dr Tam 11:40  

Yeah, I mean, I think we see, again, also a gamut of different situations, that that present themselves. We've seen folks that they themselves, you know, again, the, because of the root of the symptom that we're talking about a cognitive loss, you know, something that they may not notice it's other individuals around them, right. So there might be some denial related to that. It might be some denial based on their personalities. There might be some denial or not enough information from family members or friends, because they just don't see that individual enough, right. So we certainly see those scenarios. We also see the flipside, where people really do think that there's trouble going on with their ability to do the tasks they were doing before.

Virginia 12:29  

Right. Right, you just kind of have to figure that out.

Dr Tam 12:33  

I think our role as clinicians and in the medical community is to try to be flexible with it as much as possible and get things into the right context and try to interpret that information. You know, we certainly see the gamut of presentations.

Steve 12:48  

So, when you're doing this history, or physical evaluation of them, do you, what do you think about the importance of that, for people in terms of seeing people early versus seeing people later?

Dr Tam 13:05  

So, collecting information and getting a good history. There's going to be value on all sides of it. Okay. And in terms of the different timeframes that we're talking about early on, versus later on, the value of that information early on, especially kind of helps you, you know, figure out, okay, what's going on, what do we have to be concerned about? What's this baseline that we're dealing with? How are we going to monitor this over time? Right. And there's certainly value in collecting that history and information later on as well to help figure out okay, if somebody has a memory issue, and is later on, what are, what are some of the situational information that might help us in terms of getting that person that with memory problems into the best situation possible, let's say, right, identifying things or situations that might be exacerbating their symptoms, or looking for things that might be more calming or soothing and helping them helping them redirect their symptoms, you know, so finding information, I think is valuable on all sides of it. 

Steve 14:16

Thank you.

Virginia 14:17  

Okay, that the timing of that was good, because I wanted to ask you about the diagnosis of mild cognitive impairment, MCI, as opposed to coming right out and saying, I think this might be an Alzheimer's disease situation. I, mom's doctor, for five years, told me that it was MCI and after a while, I was thinking, gee whiz, when's he really going to say what my mom has? Do you come right out? And in the beginning, maybe the initial appointment and say, this is mild cognitive impairment or you on the way to, you know, you're on the way to Alzheimer's. How do you how do you handle that? 

Dr Tam 15:02  

Yeah, I think, like all my answers for today, I would say, I think it varies depending on the presentation, I think the important thing to understand is that you know, what the different diagnoses are, we kind of talked about what normal aging changes relate to essentially, when we say mild cognitive impairment, it does mean that there are, you know, there is an issue with cognition or memory that's there, right. But it's at a certain stage, and at that stage, or that level, those levels of impairment, a person can still function quite well, they can still go about their daily business and take care of the things that they need to do. So that's part of defining what mild cognitive impairment is and what MCI is, right? When we get into dementia, or major neurocognitive disorder, right, which is the umbrella term for what Alzheimer's disease is the category and Alzheimer's disease is the most common form of it, then we're talking about where those levels of cognitive impairment are truly impacting and truly affecting a person's ability to, to work, to do the daily things that they need to do at home go about their daily function, right. And, you know, there's different staging stages that are out there in terms of where somebody is, within one, one variation of or another. But, you know, those are kind of three large bucket definitions of, of the spectrum of memory change, right. And, you know, for folks that have MCI, or mild cognitive impairment, depending on if there are other causes, right? They may stay relatively stable. Right. And it might take a while for it to progress along. Some of it is just understanding what that baseline is when we do an assessment, and then monitoring it over time and seeing what level of progression there might be. So to answer your question, do we go out and just say, is there MCI or dementia? I think it is case by case and where somebody is, right. So we certainly have folks that well, you know, they get evaluated, we talked to them, we evaluate them, they may truly be at that MCI stage. And it might be not the following year or later on, right, that we come to see that they've progressed farther along. Right. And we certainly get cases that are folks that come in, and they they have a presentation where maybe they may be more at that major neurocognitive disorder that dementia slash Alzheimer's disease type dementia

Virginia 17:41  

The first appointment that you have generally with people, is it? Does it tend to be in the very beginning of their difficulties or is it they really know something's wrong?

Dr Tam 17:54  

We see, I think most clinicians will see a wide variety as well. We will see folks that come in at the beginning symptoms of hey something or early symptoms of I know something is off more than what to expect from normal. And we certainly get folks that come in that are normal, and they're really just concerned. And then we get folks that might be at those later stages too. And, you know, different things like they might be and there might be different reasons for why they present at different stages. Again, we touched on some of it in terms of denial, maybe isolation, maybe some of these other issues is just preventing some of it from coming to the forefront of what's going on and coming to the doctor's office.

Steve 18:43  

So, would you advise caregivers? I'm putting words in your mouth here, but you can say no, would you advise caregivers who are or loved ones, maybe it's a better choice of words, who sense something to come in sooner rather than later? Or would you say, you know, you can be your own judge as to how the how difficult this has been becoming?

Dr Tam 19:06  

Yeah, I mean, I think a good it is a good idea. If a family member, a loved one, a close individual, you know, if they are sensing, you know, something is change, a significant change. You know, it's worth speaking with your physician about, you know, what's going on, on the whole topic of screening for Alzheimer's disease and major neurocognitive disorders. There's still some, you know, debate about, you know, should we screen everybody at this point, but I think if you're sensing that something is it has changed in a person's ability and function. It's probably worth, you know, touching base with their physician or having them touch base with their physician however it is, you know, being supportive and being there for them to go with them if that's the case.

Virginia 20:02  

As far as medications go, we've all heard of Aricept and Namenda. Do you generally prescribe those in the very, very beginning? Or do you have to do follow up a little bit more follow up before you'll be writing a prescription for that or, and also let us know how effective they actually are.

Dr Tam 20:25  

So, the cholinesterase inhibitors, which is Aricept, and its similar family of medications Donepezil, it’s the other name for it, and Namenda is the other class that's out there. And you'll see various combinations of the two. You know, those are the current FDA approved medications that are out there for Alzheimer's disease, and, you know, some other forms of major neurocognitive disorder will have some use for it as well. And so what we generally try to do is, we, you know, after getting the history, trying to come to a diagnosis, it is worth a discussion of whether or not the medications might be benefit to somebody, you know, there's been various studies about how long do we use it for what's the potential risk of stopping if it's on for a really long time? And, you know, what does that do to my loved one and the person with memory issues. So there's been a lot of discussion about that, I think we preface it and say that, you know, a trial of one of these medications, and usually it's Aricept earlier on or Donepezil and like, and then Namenda a little bit later and added on, we usually preface it and say, Hey, these medications are certainly not necessarily going to stop the process, right, that's not what they have the ability to do, we've seen them have the ability to do, you know, they might help with some of in terms of what they translates to, in terms of research, we've seen that in might help a little bit in terms of cognition, or performance in certain functions, or maybe with certain other cognitive symptoms, right? On, you know, from that perspective, there might be some benefit. And maybe that helps a person, do the things that they need to do every day a little bit better, so that they are, you know, staying in their routines a little bit better, they're able to function a little bit better at home, or perform their activities of daily living, right, that's what we call daily functions. Okay. And so by doing so, there might be a worth of value in doing that may or may not help the remembering a few things, or a list of things from that sense. So, you know, we do think that there's some value in trying to initiate that trial. And we preface it in terms of what the potential benefit, like I just described right there. And that it's not disease altering, in terms of it's going to stop the course of it right from that standpoint. And I think we more and more getting used to saying that, hey, let's try it for a certain period of time, see if it works, knowing that there are the side effects associated with it. And certainly, if we have the side effects in this talk more and say, is it worth taking it? I think it's, it's taking the time to have these discussions regarding it. And so yes, I think, long answer for your question. We will try it at some points earlier on, if we can, or will continue to follow and maybe offer it later on to just depends on, we try to, you know, different physician, different clinicians have different styles out there. But, you know, sometimes it helps to try to partner up and with the person with a memory issue in their family or their loved ones, and say, hey, maybe we can approach it that way.

Steve 23:43  

So, I have a question. You may not want to answer this one. What do you think about Prevagen?

Dr Tam 23:48  

I may not want to answer that one, so you know, with Prevagen, and I'm just gonna probably just keep that a little bit shorter on there. Um, I think Prevagen other supplements, other nutraceuticals out there, there just isn't a ton of like the randomized controlled data evidence that we would use to drive like FDA products on there. So, I think we take a lot of them with a lot of caution. You know, certainly a lot of folks are out there trying them. You know, I think the big thing is looking out for any side effects potentially, and, and giving it that same kind of timeframe and trial and say, if it's not necessarily helping you and you're trying this, you know, ask yourself, is it worth continuing to take that's probably about as granular that I can get with it, just because I don't know the science fully behind it. And I don't think anybody truly knows that this time point yet on there, you know.

Steve 24:42  

Thanks. It's talked about a lot, you know, so I just wanted to hear what you might say about it, which was very PC but also helpful. 

Virginia 24:52  

Speaking of medications, I remember when mom had to visit the hospital several times, you know, turned her upside down. And she was prescribed some medications when she would get back from the hospital in her assisted living facility because her behavior wasn't good. What do you think about those medications?

Dr Tam 25:20  

So that probably speaks to some of the other symptoms related to Alzheimer's disease and dementia, or major neurocognitive disorder and some of the other offshoot type symptoms that might present themselves. And it might not just be behaviors, it might be changes in like sleep patterns, or changes in mood, or whatnot. And so, I think the general approach that most of us would like to try to take is to see, you know, you mentioned your mother being in the hospital, right hospital sometimes can be very upsetting place, it turns….

Virginia 25:56  

Was very upsetting for her 

Dr Tam 25:57  

Yeah, and you know, walls look different. Windows look different, the amount of light is different people coming in and out of the room is very different. So, I'd say that, sometimes we will try to reset those settings as much as possible, maybe try to redirect as much as possible, we try to use, we would encourage, like non pharmacotherapies, as much as possible, in both in all those cabinets, right, or all those different symptom areas in terms of behaviors, and sleep and mood and whatnot. Usually, we try to have a comfortable situation as much as possible. You know, if you're in a pretty normal setting, and then all of a sudden, you know, you go to Las Vegas, and you hear a lot of the bells ringing and whatnot, you know that that can be a big change and identifying that that's important, right? So again, gathering that information, like we were talking about gathering that history helps you get to that point, and identifying what those triggers are that might help you reset the surroundings in the setting. Right? If that's the case, so Well, I think we generally try to encourage that as much as possible. On sometimes reaching for a certain medication might be indicated when like safety is involved, or, you know, in those kinds of circumstances where somebody really hasn't slept for 48 hours or something like that, you know, and then we try to use that from that from resetting. And I think that that's the perspective of when to use medications, you know, safety, trying to calm those behaviors as much as possible. And then after the, you know, if that's done, and we can't get there, then we might have to escalate and reach for that, if that's the case, those medications, the medications that are used for behavior and whatnot. I mean, there's going to be side effects with a good chunk of medications that are out there potentially. So, I think we have to take that in, you know, cautiously in in mind, with some principles of like starting low and going slow as we increasing up and watching for side effects and whatnot.

Virginia 28:04  

Looking back, we did use it just on a temporary basis. But, I remember I went over one day to visit and the woman at the desk said, we had to write up your mother today. And I said, Excuse me? And she said she hauled off and hit someone and bruised them. And I said, what she was the most gentle person you'd ever want to meet in your whole life. So she was upside down. And I think that they use I don't remember the name of the medication. Yeah, but it was temporary.

Dr. Tam 28:33  

If safety is a concern for the individual, or maybe others around them or caregivers, I mean, we would try to encourage that, after any other kind of de-escalation strategies have been in place, you know, only on a temporary basis on a lower dose basis, you know, for those reasons on there. And then sometimes, you know, that's kind of the last resort or from that sense, too.

Virginia 28:58  

Right. So I was going to ask you about hallucinations. You hear about these occasionally. And one time my mom came out of a room and she said there's a man in my room. There was no man in her room. I do hear from people that their loved one is having quite a few hallucinations, is that generally frontotemporal or is? Is that typical for Alzheimer's and other dementias.

Dr. Tam 29:27 

Like we were saying earlier about gathering information and trying to understand the situation as much as possible and getting the right context. Sometimes we'll see hallucinations, neuro psychiatric symptoms and other kinds of behavioral symptoms driven by it. You know, at different stages of And with different forms of dementia, and neurocognitive disorder, major neurocognitive disorders out there. So like, Lewy Body disease is another type of dementia, and that might carry more like the hallucinations or, or symptoms associated with it. Sometimes with Alzheimer's disease, like later on, it might also just be triggered by, you know, not understanding or not grasping what is in front of someone. And interpreting it correctly, you know. So, I mean, we hear about seeing reflections in the mirror and not recognizing who that person is seeing something that may look like a person, a coat and a hat on one of those standing coat hangers, right? Or rack or, you know,

Steve 30:40

 Coat trees! 

Dr. Tam 30:41

Coat tree, something like that. So it might be misinterpreted from that sense. So, you know, so, again, going back to the medication question, do we need to medicate everything, it might just be, Hey, okay, let's remove a change of  mirror or move that coat tree or kind of look at, you know, get better lighting in place, or redirecting somebody to a different task, asking the question, does this actually truly bother them? Right? Is it does it really seem to cause a lot of fear or concern in the individual? Going back to your question. Sometimes we do get hallucinations or misperceptions of what's going on with various types of dementia slash major neurocognitive disorders that are out there. I think in terms of assessing the impact of it, getting the background information behind it are the other things that we need to, to just decipher or figure out afterwards.

Virginia 31:40  

When you see your patient for the first time about these issues, what comes next for them? Or do you set up a series of appointments, or you just tell them to keep an eye on things and come back when they feel like they want to come back to you? What how do you handle that?

Dr Tam 31:59  

Like, like the other situations, there's probably going to be a range, I think, in general, what we would try to do is we would try to start the assessment, get the assessment done, and figure out okay, what's the right kind of follow up plan? Right, um, like the medications that you talked about? Or that we talked about having them coming in, you know, soon after, and seeing, you know, what side effects they may have, what kind of impact that they're having. So I think we certainly do want follow up to see how somebody is might be changing in terms of their function and their performance. And, you know, what other symptoms that might be coming up whether a needs they might have, you know, and then also what are the needs the caregiver might have to in terms of or the family member, the loved one, you know, how are they doing with things? So, I think that that's relevant in there, too.

Steve 32:50  

Do you ever use the term “a plan”? When you're talking to, you know, a couple or a family and say, Okay, here's where we're at. And here's what I think, you know, you should consider as a plan-of-action moving forward.

Dr Tam 33:03  

Yeah, I think people want different things. Um, you know, certainly we want. So cer- I mean, we get folks that asked for different things. I mean, I think I'm alluding to, hey, you know, a follow up plan, you know, we should try to do this, that, and then following up afterwards, and seeing where we're at with things, that that's what I'm alluding to, in terms of plan. And certainly you get folks also that are like we were saying at the very beginning, they might be more normal, right? They might be very well normal on there. And, you know, asking what's the follow up or the plan for that, right? That might be a follow up in a year or two years, it kind of work, you work together with that person to figure out, Okay, what's the right plan and see what sounds good?

Steve 33:45  

Thanks. 

Virginia 33:46

So they just keep in touch with you. 

Dr. Tam 33:48  

Yeah, well, I mean, we see variety of things, some folks that might be just totally relieved that their testing is normal. And maybe it's, I'll check you back out in three years. I mean, I've certainly had that I'm, I'm fine. You know, I've heard folks say, I'm fine with where I'm at. And maybe I'll just come back. If anything changes. I know that I have folks that are a little bit more cautious about it and say that, okay, let's come back in a year or two, and talk more if that's the case. So, you know, those are different kinds of plans, depending on what person's symptoms might be, gosh, I wish everything would just fit in one box. But it's unfortunately, I don't I don't think most of us feel that way that it is

Virginia 34:24  

Kind of leads me to my final question here. What do you wish the patient and family members knew about Alzheimer's disease or dementia in general, before they come to see with their concerns?

Dr. Tam 34:38  

The big thing surrounding Alzheimer's disease and dementia in general is that there's a lot of stigmata associated with it right that, you know, I have this, this might be a sentence for me, you know some of the terminology. But I think in you know, there's no treatment for it, per se, that's going to cure it or, but I do think it's worth folks knowing that it's identifying, Hey, what is going on as much as possible to kind of help sort out? Okay, what can we do to figure out what is going to give you the best quality of life? Because I think that that's what most of us want in life, right? Whatever the disease might be, right? Maybe even it's diabetes, you can think about it from that perspective, what's going to give me the best quality of life from that perspective. So I think there is some stigmata associated with it. And it might prevent some folks from coming in, you know, but I think it is worth getting checked out, talking about it, discussing it so that, hey, maybe things can, you know, be done a little bit easier? As a result of that? 

Virginia 33:44

Do you have any final questions? 

Steve 35:46  

No, that that's the answer I was asked looking for earlier, that I think that's critical. We see people or talk to people that are further down the process, the caregivers lost, and now it's like, very difficult to get them in because they're convinced, you know, that they've got the new C, you know, it's it's Alzheimer's, and I don't, I don't, I don't want to deal with it. I want to know about it. I don't want to have anything to do with it. And it would have been better if they came in a year before two years before, because they could deal with it, and hopefully can deal with it better.

Virginia 36:22  

Well, thank you so much. for joining us today. We really appreciate it all this information. And unfortunately, there's a lot of people out there who are going to find this helpful. It's unfortunate that it's it needs to be said, but we appreciate everything that you told us today. And maybe you can join us again some time for another topic. 

Dr. Tam 36: 47

Yeah, absolutely.

Steve 36:49  

I just like to add something that we say to service people. Thank you for your service you all for taking this on and making this something that you care about and work towards.

Dr. Tam 36:59  

You're welcome. 

Virginia 37:00

And thank you to our listeners for tuning in today. And be sure to check back soon for more important caregiving topics. On Spotlight on Care.

Outro 37:10  

Spotlight on Care is produced by the University of California Irvine, Institute for Memory Impairments and Neurological Disorders. UCI MIND interviews focus on personal caregiving journeys, and may not represent the views of UCI mind. individuals concerned about cognitive disorders, prevention, or treatment should seek expert diagnosis and care. Please subscribe to the Spotlight on Care podcast wherever you listen. For more information, visit mind.uci.e