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Stories: Voices from the frontline

Nancy Isenberg, M.D., MPH

Nancy Isenberg, M.D., MPH, is a neurologist at Swedish Edmonds who cares for patients with Alzheimer’s disease and other forms of dementia. She is the medical director of the Swedish Center for Healthy Aging, where patients and their families receive comprehensive care that goes beyond treating dementia to address the emotional, physical and social challenges that come with it.

June is Alzheimer’s & Brain Awareness Month, so we called her up to find out what you need to know about the disease, what makes her approach to care different and what you can do to keep your brain sharp.

Let’s start by defining some terms. What’s the difference between dementia and Alzheimer’s disease?

Dementia means, strictly speaking, loss of cognitive function in two or more areas that impacts your overall ability to function independently in the world. It’s an umbrella term. Alzheimer's disease is the most common neurodegenerative cause of dementia, and it is frequently associated with vascular dementia.

Can either be cured?

There is currently no cure for Alzheimer’s disease. However, one in three cases of dementia is preventable, and we know that changes to the brain occur long before the disease. There is a stage called mild cognitive impairment—which a lot of people think of as a precursor to dementia—and some people who have that may have untreated sleep apnea, for example. So if you diagnose and treat their sleep apnea, their cognitive symptoms can improve. Another example is diabetes or hypertension. So when people start exercising, eating better and taking their medications as prescribed, their thinking often improves. It is very important when I meet with people with cognitive concerns that we look carefully at how to optimize brain health, as well. (See “Seven habits of healthy aging” below.)

If you can’t cure Alzheimer’s or dementia, how would you define your role in caring for your patients?

My role is to work collaboratively with patients and their families to develop a personalized, evidence-based diagnostic and treatment plan. There are lifestyle and dietary approaches that can improve thinking, improve blood flow to the brain and build new brain cells. Sometimes people are taking an over-the-counter medication such as Benadryl for sleep, which may worsen memory issues and increases risk of dementia. So it is important to complete a careful medication review as well.

With dementia, there's the emotional impact, the financial impact, the impact on the family. Every time I meet with a patient I try to provide the care that's needed in that moment for the whole person, as well as the family caregiver. Our collaborative and compassionate approach to care focuses on health span, quality of life and planning for the future, and it provides support for people with dementia and their families at any stage of disease, from mild cognitive impairment to advanced dementia.

What is the impact on the family? What can you do for them?

Addressing the needs of the family caregiver ensures that the individual living with dementia has their needs met at home. When that family caregiver feels they have the skills and resources to be there for the person with dementia and also finds purpose and a sense of connection, there’s a certain grace that emerges and many people can live well with dementia. There are also resources that can help people living with dementia and their families, such as the Alzheimer’s Association and the Washington State Dementia Action Collaborative Dementia Road Map, as well as trainings like compassion cultivation.

What makes your approach to care at Swedish’s Center for Healthy Aging different?

The mission of the center is to provide comprehensive, interdisciplinary and compassionate care for people with these cognitive challenges and their families. That also includes working collaboratively with primary care physicians on early interventions and helping to create cognitive care programs more broadly in primary care.

Seven habits of healthy aging

One in three cases of dementia is preventable. Dr. Isenberg offers these simple lifestyle tips to help lower your risk and improve your memory.

Heart-healthy diet – What’s good for the heart is good for the brain: a diet high in fruits, vegetables and whole grains/legumes can improve blood flow and reduce your chances of vascular dementia and Alzheimer’s disease.

Exercise – Like a heart-healthy diet, 30 minutes of exercise, five days a week—from aerobic workouts to strength training—is vital to brain health.

Sleep – Insomnia and sleep apnea have been linked to dementia, making it important to get at least seven hours of uninterrupted sleep per night.

Lifelong learning – The brain is like a muscle and can atrophy. Continuing to challenge the mind—with new activities, games and even community involvement—is like neurological weightlifting.

Positive outlook – This isn’t to say that thinking positive thoughts will stave off dementia, but focusing on the upsides of aging promotes resilience and is associated with a reduced risk of dementia.

Social connections – Loneliness is a silent killer and has been shown to increase your risk of dementia. It’s especially important now, when we have to physically isolate, to stay socially connected with friends, family and your community.

Collaborative care – This is what people with dementia and their families can expect at the Center for Healthy Aging: a multidisciplinary team of caregivers who will address all your cognitive, neuropsychological and social needs.

In case you missed it view our video conversation, between Dr. James Bowen and Dr. Nancy Isenberg, regarding Swedish’s comprehensive clinic model and how it builds community, decreases isolation and helps patients live well while managing complex neurologic conditions.

Interested in learning more about Dr. Isenberg’s innovative work? Please contact Philanthropy Officer Erika Nelsen at 206-386-6791 or erika.nelsen@swedish.org.