October 30, 2025 • 30 mins
Carolyn Larkin Taylor, M.D., is a seasoned neurologist who has dedicated over three decades to the practice of medicine. A graduate of the University of Notre Dame and Hahnemann Medical College, she completed a neurology residency at the University of Pennsylvania, where she was awarded the Humaneness in Medicine Award and recognized as one of Philadelphia’s Top Docs for Women. Her manuscript Through a Mother’s Eyes was awarded second place for best unpublished memoir by the Pacific Northwest Writers Association. Dr. Taylor also has authored Whispers of the Mind.
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Speaker 1 (00:06):
You are listening to Boomers Today with your host Frank Sampson.
Speaker 2 (00:16):
Well, welcome to Boomers Today. I'm your host, Frank Sampson.
Of course, each week we bring you important and very
useful information on issues facing baby boomers, their parents, and
other loved ones. And as I do on every one
of our podcasts, I thank all of you, and I
thank all of you because our listeners are growing each
(00:37):
and every day. And the reason that the listeners are
growing is because of you. We're sharing our show or
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Apple Podcasts, Spotify, iHeartRadio, Audible, or you just could ask
alexor Siri to take you to Boomers Today Radio. So
(00:59):
thank you so much for that. And I know why
you do share the podcasts with friends and family, because
we have wonderful guests and we're not going to disappoint you.
Today we have with us doctor Carolyn Taylor, who's an MD,
is a seasoned neurologist who has dedicated over three decades
(01:22):
to the practice of medicine. A graduate of the University
of Notre Dame and Hannemann Medical College, she completed a
neurology residency at the University of Pennsylvania, where she was
awarded the Humanis in Medicine Award and recognize as one
of Philadelphia's top docs for women. Her manuscript Through a
(01:44):
Mother's Eyes was awarded second place for Best Unpublished Memoir
by the Pacific Northwest Writers Association and Doctor taylor is
also authored Whispers of the Mind, which we'll talk about
it in a little while. So, Taylor, thank you so
much for joining us on Boomers today. I really appreciate it.
Speaker 3 (02:04):
Thank you. It's really my pleasure to be here.
Speaker 2 (02:06):
Yeah, so, I know we're going to talk quite a
bit about a type of dementia that is a tough one,
I know, and that's called Louis body. But maybe before
we get into that, I would love for you to
just share and I do this with guests who are
knowledgeable on this subject matter because we just can't do
it enough. And that is to really help educate our
(02:27):
listeners on the various types of dementia. I know there's
a lot of types, many that people have never heard
of before. But maybe you could go over the ones
that are probably more prevalent, like Alzheimer's and some of
the others and give them a little bit of an overview.
Speaker 4 (02:44):
Sure, I'd be happy to Dementia's an umbrella term that
describes chronic, progressive cognitive decline, and we talk about dementia.
That's all we're talking about. And you can think of
the dementia's there's many different types as a big pie,
and if you want to take slices out of that pie,
(03:05):
each slice is a different form of dementia. And there's
a lot of overlap. Actually, So the one that we
most commonly think of when we think of dementia is
and the most common is Alzheimer's dementia and Alzheimer's dementia.
All the dementias are characterized by what part of the
(03:26):
brain is predominantly degenerating. And just keep in mind there's
an overlap. So with Alzheimer's and with the other various dementias,
there are certain protein aggregates that accumulate, and pathologically we
define a dementia by those protein aggregate aggregates. So, for example,
(03:48):
Alzheimer's disease, you accumulate these amyloid plaques we call them
plaques and tangles. With lowybody dementia, you collect these proteins
that we refer to as Louis bodies. With frontotemporal dementia,
there's predominant accumulation of something called the TAUL protein, but
the particular protein aggregates don't matter so much. We don't
(04:13):
there's no tests we can do in your bloodstream to
determine these things. There are certain functional MRI scams that
can show what part of the brain isn't functioning as well,
and we can sort of characterize it a little bit
like that, but in effect, it's what affects the patient.
(04:36):
The different dementias have different overall presentations, so that's what
I'd like to mostly concentrate on. And the Alzheimer's dementia
is a very slow progressive decline in short term memory.
Mostly you will see some personality change, maybe a little
bit of apathy that precedes the significant cognitive decline.
Speaker 3 (04:59):
There's more visual.
Speaker 4 (05:00):
Spatial anomalies that occur with Alzheimer's. So for instance, if
you're playing golf, you may completely miss the ball when
you go to hit it because you see it somewhere else,
and it's very dangerous. So those people that are driving,
what we're going to talk a little bit about today
(05:21):
is probably the second most common form of dementia, which
is Louis body dementia, and that's a very confusing term.
It's even confusing for neurologists because there is Louis body
dementia and there's that you see with Parkinson's disease, and
there's Louis body disease, and both of them are accumulating
Louis bodies. The difference is that with Louis body dementia
(05:47):
that occurs with Parkinson's disease. You develop Parkinson's disease first,
and you have that for a long period of time,
and then thirty plus percent of people with Parkinson's later
on will develop a parkinson like dementia that's characterized by
these accumulation of Louis bodies. That's very different from Louis
body disease, where you it's predominantly a Louis body accumulation
(06:12):
with dementia first, and this occurs at an earlier age
than we see the Parkinson dementia, but they develop Parkinsonian
features as well, and which is.
Speaker 2 (06:22):
More started to interrupt between those two Louis body disease
and the Louis body with Parkinson's, which is more prevalent.
What do you see more of.
Speaker 4 (06:33):
We see more of Parkinson's disease with Louis body dementia.
So you follow Parkinson's patient for a long period of time,
and they always want to know this question, am I
going to get dementia? Well about at least thirty percent
of people will. And there's a couple of prognostic signs
that you can look for early on. One that is
highly associated with dementia is something called REM sleep behavior
(06:59):
to disorder, and it doesn't always predict dementia, but that's
a bad clinical sign when someone is beginning to develop
one of these diseases and they develop REM sleep behavior disorder,
and that is acting out in your dreams. You know
how we're all paralyzed when we're dreaming. We think we're falling,
and we will go to scream and we can't. And
(07:21):
that's because during REM sleep, when we dream, we lose
all tone in our body. But with REM behavior sleep disorder,
that doesn't happen anymore. And when you're having a fight
with so many of your dreams, you're going to kick
and punch the person next to or you might fall
out of bed because you're you're you're fighting with someone
and so that's that's treatable with some medications. But the
(07:43):
important thing about that is it may be highly predictive
of the fact that you're going to develop dementia with
your Parkinson's disease.
Speaker 2 (07:52):
I'm sorry, so the kind of I have friends that
you know, we will talk.
Speaker 1 (07:58):
What do you dream about?
Speaker 2 (07:59):
Oh? God, I try.
Speaker 1 (08:00):
I thought that.
Speaker 2 (08:00):
I thought at a bad or. I mean, should people
be concerned that if it happens infrequently? Could that be
still a concern if something like that does happen?
Speaker 4 (08:10):
No, no, And I can tell you I don't want
our listeners to like start freaking out all of a sudden,
you know, yes, no, no, no, infrequently, I think that
can happen to anybody, right, And you can get this
without going on to develop dementia. But if you get
it in the older years and you're just developing some
(08:32):
Parkinsonian signs and symptoms which we can talk about, and
it's recurrent, it's every night, then that that can be
a bad prognostic sign that you're going to go on
and develop dementia. And with Parkinson's disease, you may have
the disease for quite a while. You may have it
for five to ten years before you start to develop
symptoms of dementia, and dementia with Lewis bodies is characterized
(08:56):
by hallucinations. So with all dementias, you can get hallucinations,
act very vivid formed visual hallucinations, but they're mostly like
with the Alzheimer's patient, they're more likely to occur in
concert with being ill, dehydrated, or you're developing an infection
(09:19):
and you get delirious and you might hallucinate, or if
you take a particular medication that can deprive your brain
of something called the petylcholine, and those would be the
over the counter cough and cold medications that tend to
dry you out, or benadryl. They can cause you to
hallucinate if you're elderly and you're sick. But hallucinations for
(09:40):
no other reason, just actively visually hallucinating is very very
characteristic of Louis body dementia.
Speaker 2 (09:47):
So we've talked about what you just said about the
benadryl and this, you know, some of the all over counter,
over the counter medications that cause drowsiness. Yeah, you know, yes,
we've had people say, do you know, obviously if it's
just for that purpose that your allergy or whatever, and
(10:11):
it's short term fine, but to take it as more
of a sleeping aid is not advisable. Can you maybe
expound upon that?
Speaker 4 (10:21):
Yes, absolutely, As our brains age, we tend to produce
less of a particular neuro transmitter called a setyl colin,
and we have so much when we're younger that you
can take one of these drugs like benadryl, which reduces
your acetyl coling, and you don't manifest any symptoms from
(10:44):
it except you dry up, and that's the purpose, or
you get sleepy, and that's the purpose of taking this
particular bill. But as we age and we don't have
as much as cetyl colin anyway. Acetyl Collin is a
critical ner, a transmitter for communicating information between neurons, and
you can suddenly just have difficulty speaking. You know, I
can't think of the word I want to use, or
(11:06):
you know, you go to calculate a tip for a
check in a restaurant. Gee, you're having a hard time
doing that, and you don't you know, yesterday you didn't
have a difficult time. And it can be that subtle.
But we need as much a pseudocolling as we know.
We can get So we always advise elderly people to
avoid using anything that they say is anti colonergic. And
(11:28):
the anti colinergic drugs are the ones that dry you up,
and benajol is one of them, and yes they make
you sleepy, but it's not an ideal sleep aid for anyone,
I would say, over the age of seventy.
Speaker 2 (11:39):
Yeah. So I just want to bring this up because
I'm sure some of our listeners are going, gon' I
don't know anybody that had Louis Body, but I think
they do all right, Yeah, I mean among Robin Williams
or actor Robin Williams, Ted Turner, Casey Caseum. I mean
(12:03):
those three shared more in common than being household names.
All three did suffer from Louis Body dementia. So I
mean you want to talk about that a little bit
as far as I mean, I think educating people that
it's you know about this is really important. So if
(12:25):
there's anything you want to add to.
Speaker 4 (12:29):
That, yes, I agree, yeah, Okay, it's underdiagnosed and when
people have friends that have dementia, it's just dementia, and
for all practical purposes it is I mean, what difference
does it make, what kind it is, except it makes
a difference in terms of how you treat it and
the prognosis that you're looking at, and which is very
(12:52):
helpful for families and the patient themselves to know, you know,
I have a certain amount of time that I'll probably
be good, and then you know I can expect this
or this or that to.
Speaker 3 (13:01):
Happen, Louis Buddy.
Speaker 4 (13:04):
Dementia's are probably the second most common after Alzheimer's disease,
so there's a lot more people that have it than
you realize. And I tried to distinguish between the two,
but it doesn't matter in the sense that the way
you're going to react is going to be very similar.
It's a strong association, as we talked about with hallucinations
(13:26):
and delusions, and they're often not happy hallucinations. They're not
you know, little kids coming in and sitting down next
to you and we're running through the room and playing.
They're often scary things, people trying to break into your
house or you see bugs crawling on the floor, and
they can be very frightening. You can look at a
shadow on the wall and think you see a monster.
(13:47):
Where you look outside and the trees blowing, you see
things that aren't really there, so you can get very
frightened and very paranoid. The hallucinations are almost always visual,
they're not auditory, so these little people, if you see people,
aren't going to talk to you. And that's one way
you can kind of broadly distinguish someone with psychiatric disease,
(14:11):
like its schizophrenic versus someone with dementia. The demented person
with hallucinations, they'll be visual. Usually in a psychiatric patient,
the hallucinations will be auditory. Interesting, yes, and so hallucinations
are very prominent. They're not treatable like hallucinations with other
(14:31):
types of dementia. So the Alzheimer's patient that might have
an hallucination on a regular basis because their dementia is
very regressed, you can often give them drugs in the
antipsychotic drug class that suppress dopamine and they'll improve remarkably.
With Louis body disease or dementias where you're accumulating these
(14:54):
Louis bodies in the brain, those drugs make the hallucinations worse. Clinically,
we can get some idea what we're dealing with, because
as these patients percent, it's not always clear until you
follow them over time and see what course their disease
actually manifests as But if you treat them with antipsychotic medication,
(15:16):
they likesy prexident it's a common one. Quiet hiopene is
another one that people commonly use. They get markedly worse.
So you absolutely avoid those medications.
Speaker 2 (15:27):
So doctor, we're going to take a quick break. I
promise just I want to recognize our sponsor. We come back,
I like to just spend a moment. You've written a book,
and I like you to share with people a little
bit more about that. And then we're going to continue
our discussion on Louis body and talk about warning signs
and those types of things. So still a lot more
(15:50):
to a lot more to discuss. So I wanted to
ask all of you, do you know anyone who may
be concerned about an older driver? While Senior care Authorities
Beyond Driving with Dignity program is a facilitated self assessment
program for older drivers. This program has been designed to
serve as a vital tool to facilitate older drivers and
(16:13):
their families as they make the appropriate decision regarding the
future of one safe driving career. If the individual is
a safe driver. An advisor will provide him or her
with strategies and how to remain a safe driver as
a progress through the aging process. If driving retirement is
the appropriate decision, then the individual and their family are
(16:35):
offered possible alternatives, resources and a specific plan to ensure
a smooth and successful transition from the driver's seat to
the passenger seat. To learn more, go to w to
go to www dot Beyond Driving with dignity dot com
to connect with a senior care authority advisor in your area.
(16:57):
And for those of you within the healthcare industry listening,
we actually do a program. It's called Driving under the
Influence of Dementia and you can get CEE credits for that,
so feel free to contact us as well if you're
interested in learning more about that. So we are back
(17:21):
with doctor Taylor. So. I know you've written a book.
I know that wasn't the purpose of our interview today,
but I've written a book too, and it takes a
lot of work. So feel free to share with us
whatever you would like to about the book and how
people can get it.
Speaker 4 (17:42):
Yeah, okay, I would love to. I recently had a
book published at the title of it is Whispers of
the Mind a neurologist memoir and it is a collection
of about thirty essays, all independent essays of real medical stories.
And it's called a memoir because these are patients that
(18:03):
I dealt with over the years that exemplified different things,
different universal themes that I thought would be inspiring to readers.
And basically, it's stories about courage, grief, and hope that
connect us all and there's something in there for everybody.
I have stories about dementia, about Louis body disease, Parkinson's
(18:28):
and they're all told in the context of a particular
patient that I encountered that taught me something. There's a
few very personal stories in there as well, about things
I encountered in life that had to do with myself
but neurology and with loved ones and caring for loved ones.
Speaker 3 (18:46):
So I think it's a.
Speaker 4 (18:49):
Story that might resonate with some of your readers if
they like true medical stories.
Speaker 2 (18:54):
Great, So how can they get it.
Speaker 4 (18:58):
It's available at any of your major bookstores such as
Barnes and Noble. It's also available on Amazon, Kindle Books,
Apple Books. I do have a website for this particular
book and it's just my name, It's Carolyn Larkin Taylor
author dot com. But if you just google the name
(19:19):
of the book, you probably come up with my website
and it describes there how you can order the book.
Speaker 2 (19:25):
Great, great, thank you for that. So you know you
mentioned it briefly before we're talking about doctors diagnosing people
at dementia. Is it your feeling that when somebody is
given just a dementia diagnosis, that's it nothing more than
(19:45):
that that it's just too difficult to determine what type
of dementia. Is that usually the reason, or is it
possible that they just haven't been gone through additional tests
to determine it or both?
Speaker 3 (20:06):
I would say both.
Speaker 4 (20:08):
If you think you have dementia, I would highly recommend
seeing a specialist that deals with dementia that would usually
be a neurologist to get a complete work up, because
there are things that can mimic dementia and you don't
want to just go off and say, Okay, I've got dementia,
There's nothing I could do about it.
Speaker 3 (20:26):
There are medications that can really.
Speaker 4 (20:28):
Help a lot along the way, depending on the type
of dementia we think you have, and over a fairly
short period of time following you, we can really be
barely certain what it is that you have. I think
everybody should have you advanced imaging study like an MRI,
A series of blood work is always indicated as well,
(20:50):
because there are things that can mimic dementia like thiray deficiency,
vitamin B twelve deficiency, and you definitely don't want to
miss something like that. There can be autoimmune disease that
can cause dementia like symptoms, which is treatable. And there's
a condition called normal pressure hydrocephalus, which is an enlargement
(21:13):
of the fluid filled cavities in the brain that's very
very gradual, and when you look at a scan of
a patient who's elderly, it might look like it's just
atrophy of the brain, which occurs in age and doesn't
necessarily correlate with dementia, but it can also be an
overexpansion of these ventricles, and in that case, you can
(21:34):
refer a patient for a ventricular peritenial shunt, which is
in our surgical procedure. That's actually a very simple procedure
to normalize the pressure in the brain and that can
prevent the progression of dementia. So you always want to
exclude something that is treatable, that could easily be fixed,
and that's one purpose of an intensive workup. Lastly, I
(21:57):
don't want anybody to I hope nobody ever misses pseudo dementia,
which for all practical purposes looks just like someone developing
a rapidly progressive, demanding illness like Alzheimer's in an elderly individual.
But it's due to depression, and it can be just
out of the blue. Patient might not be crying or acting. Said,
(22:19):
that's how an elderly patient may manifest their depression as dementia.
Speaker 3 (22:25):
And that's another thing that would be shamed to miss.
Speaker 2 (22:28):
Are there any types of dementia that could be reversed?
Speaker 4 (22:35):
Well, if you're developing dementia from any of the things
we just mentioned, such as BE twelve deficiency, theory deficiency, what.
Speaker 3 (22:42):
About what about alcohol depression?
Speaker 2 (22:44):
What about those that have been alcoholics, been big drinkers
I have heard, but again you would know that if
you stop, maybe it could be reversed or not necessarily.
Speaker 4 (23:02):
Some can be reversed, but not all of it, because
when you drink too much alcohol for long periods of time.
You damage the brain, you shrink the brain, you lose
brain cells, and so along with alcoholism is often poor
nutrition and vitamin deficiencies. And so if you stop drinking,
(23:23):
you stop that progression of damaging the brain. So you
kind of halt it. But you have to check for
vitamin deficiencies, and thymine is a big one, sometimes be
twelve and other nutrients can be very problematic with alcoholics,
(23:44):
certain minerals such as magnesium, but the big ones are
the vitamins that can cause a pseudo dementia. You can
replace the vitamins and people will really get better, but
not if they've been vitamin deficient for too long a
period of time.
Speaker 3 (23:59):
So timing is very very critical.
Speaker 2 (24:01):
Yeah, well, so what about warning signs those that are listening, going,
you know, my mom my, dad, whatever? I mean, they're
for becoming more forgetful. Short term memory isn't as good,
but that could be normal aging or depending on how old,
or that could be something that could be more serious.
So what would you say or maybe some of the
(24:23):
key warning signs or red flags that may point to
Louis body dementia or even other types of dementia.
Speaker 4 (24:31):
Okay, well, dementia in general. You know, I like to
tell the families, it's not the person that is forgets
what they where they put something as much as the
person that puts something in an odd place. So you
open the refrigerator and you find their spectacles, for instance,
(24:52):
and they've been looking all over the house for them
for days, and you know, they put them in the
refrigerator of all places, or they put a book in
the dishwasher. I mean, they do really bizarre things. But
the person that and all of us as we get older,
have difficulty with word finding, and we might have some
short term memory loss because it just isn't that important
(25:14):
to us to remember something, or we might be developing
some hearing loss or vision loss. All these things compound
your cognitive state. But red flags. One big red flag
is loss of insight. So the patient themselves is not
aware that there's any problem, and they'll argue with you
(25:37):
because they don't remember that they did something, and that's
usually a red flag. So the patient that comes to me,
the elderly patient that comes to me that says I'm
getting forgetful and I'm worried, doesn't worry me as much
as a patient whose family brings them to me and
tells me they're getting forgetful, and the patient says, no,
I'm not, I'm perfectly fine. So lack of insight is
(25:59):
which always says, you know, I'm in the in the industry,
and I said, I've never had a senior come to
be saying, Frank, you.
Speaker 2 (26:07):
Know what I need. I need memory care. I need
to go to memory care. I mean, it just doesn't.
Speaker 3 (26:11):
Happen, exactly, It doesn't happen. It doesn't happen. Yeah, yeah, yeah, good.
Speaker 2 (26:18):
So listen, we have a people that are listening to
the show, families that may be starting to go through
this with a love one, with people within the healthcare
industry listening to this. So just just you know, just
to kind of finish up here, because we only have
(26:40):
a we have a couple of minutes left, but just
words of wisdom that you would have. Where does somebody begin,
you know, there's they're starting, they're noticing this. Maybe they've
been even given a diagnosis of mc I mild cognitive impairment,
or maybe maybe they have been given a diagnosis of
(27:01):
dementia a family member. What do they do? Where do
they start?
Speaker 4 (27:07):
Okay, Well, mild cognitive impairment doesn't always progress to dementia,
and a lot of those and actual dementias is defined
by you now are functionally impacted every day by the
cognitive impairment.
Speaker 3 (27:23):
It's affecting your ability to function.
Speaker 4 (27:26):
The first place to go to is your primary doctor
and just get a good overall health checkup, make sure
you're not deficient and be twelve or thyroid or any
of these other things. And at that point, if everything's
fine and you still feel like there's an issue, then
I would request a referral to a specialist. And even
with the cognitive impairment that hasn't manifest very severely yet,
(27:49):
if it's going to progress, it's worthwhile, I think to
get something called a formal neuropsychological evaluation. So you hear
a lot about these mini mental status tests, which is
thirty points that they ask you in an appointment and
they give you a cognitive score. Well, they're just screening
tests to try to pick up those red flags. But
(28:11):
an actual test to see what's really going on is
like a three hour test performed by a neuropsychologist, and
that will show very early signs of things like difficulty
with executive function planning and organizing, or it might just
put you in a category that looks like, gee, this
might be more you know, depression related. There's some depression
(28:33):
going on here because all the other domains are completely intact.
And it can be very very useful in a very
early stage of predicting you know what's going to be
going on, and if it's not, you can at least
get a follow up in a year and see how
it compares to the one before to see if it's
been progressive. So I wouldn't stop with just you know,
seeing your primary doctor. I would definitely start there. But
(28:56):
there are things.
Speaker 3 (28:57):
There are new.
Speaker 4 (28:58):
Drugs now for Alzheimer's disease that are recommended for very
early stages of Alzheimer's disease.
Speaker 3 (29:04):
They're not cures.
Speaker 4 (29:06):
They're monoclonal antibodies that can help rich your brain of
those amyloid plaques, and they do reduce plaques by a
certain percentage per year, and they can slow down the
progression by twelve to twenty seven percent, which is a lot.
Speaker 2 (29:22):
So what have you seen with that? As it too
early to tell.
Speaker 4 (29:27):
I think it's too early to tell. There's not a
lot of patients getting it. It's very expensive, you have
to have a definite diagnosis, and there are some risks
involved with this particular drug. I think over time, it's
an infusion that you get every couple of weeks and
then monthly, but after you've been on it for eighteen months,
(29:49):
they're going to be able to have a sepcutaneous shot
that you can give yourself on a regular basis. But
there are problems that you can develop in the brains,
small areas of adem of small bleed. So it's not
an innocuous treatment at all, but it's something I wouldn't
I wouldn't roll out for the right person, right Yeah.
Speaker 2 (30:10):
Actor Carolyn markin Taylor, thank you so much for joining
us on Boomers Today. Really appreciate it. Check out our
book Whispers Are the Mine, and thank you everybody for
joining us. Please be safe out there and we talk
to everybody next week.
Speaker 1 (30:27):
You've been listening to Boomers Today with Frank Sampson. To
learn more about today's show, visit Boomerstoday Radio dot com
and join us next time for another edition of Boomers Today.
You are listening to Boomers Today with your host Frank Sampson.
Speaker 2 (00:16):
Well, welcome to Boomers Today. I'm your host, Frank Sampson.
Of course, each week we bring you important and very
useful information on issues facing baby boomers, their parents, and
other loved ones. And as I do on every one
of our podcasts, I thank all of you, and I
thank all of you because our listeners are growing each
(00:37):
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alexor Siri to take you to Boomers Today Radio. So
(00:59):
thank you so much for that. And I know why
you do share the podcasts with friends and family, because
we have wonderful guests and we're not going to disappoint you.
Today we have with us doctor Carolyn Taylor, who's an MD,
is a seasoned neurologist who has dedicated over three decades
(01:22):
to the practice of medicine. A graduate of the University
of Notre Dame and Hannemann Medical College, she completed a
neurology residency at the University of Pennsylvania, where she was
awarded the Humanis in Medicine Award and recognize as one
of Philadelphia's top docs for women. Her manuscript Through a
(01:44):
Mother's Eyes was awarded second place for Best Unpublished Memoir
by the Pacific Northwest Writers Association and Doctor taylor is
also authored Whispers of the Mind, which we'll talk about
it in a little while. So, Taylor, thank you so
much for joining us on Boomers today. I really appreciate it.
Speaker 3 (02:04):
Thank you. It's really my pleasure to be here.
Speaker 2 (02:06):
Yeah, so, I know we're going to talk quite a
bit about a type of dementia that is a tough one,
I know, and that's called Louis body. But maybe before
we get into that, I would love for you to
just share and I do this with guests who are
knowledgeable on this subject matter because we just can't do
it enough. And that is to really help educate our
(02:27):
listeners on the various types of dementia. I know there's
a lot of types, many that people have never heard
of before. But maybe you could go over the ones
that are probably more prevalent, like Alzheimer's and some of
the others and give them a little bit of an overview.
Speaker 4 (02:44):
Sure, I'd be happy to Dementia's an umbrella term that
describes chronic, progressive cognitive decline, and we talk about dementia.
That's all we're talking about. And you can think of
the dementia's there's many different types as a big pie,
and if you want to take slices out of that pie,
(03:05):
each slice is a different form of dementia. And there's
a lot of overlap. Actually, So the one that we
most commonly think of when we think of dementia is
and the most common is Alzheimer's dementia and Alzheimer's dementia.
All the dementias are characterized by what part of the
(03:26):
brain is predominantly degenerating. And just keep in mind there's
an overlap. So with Alzheimer's and with the other various dementias,
there are certain protein aggregates that accumulate, and pathologically we
define a dementia by those protein aggregate aggregates. So, for example,
(03:48):
Alzheimer's disease, you accumulate these amyloid plaques we call them
plaques and tangles. With lowybody dementia, you collect these proteins
that we refer to as Louis bodies. With frontotemporal dementia,
there's predominant accumulation of something called the TAUL protein, but
the particular protein aggregates don't matter so much. We don't
(04:13):
there's no tests we can do in your bloodstream to
determine these things. There are certain functional MRI scams that
can show what part of the brain isn't functioning as well,
and we can sort of characterize it a little bit
like that, but in effect, it's what affects the patient.
(04:36):
The different dementias have different overall presentations, so that's what
I'd like to mostly concentrate on. And the Alzheimer's dementia
is a very slow progressive decline in short term memory.
Mostly you will see some personality change, maybe a little
bit of apathy that precedes the significant cognitive decline.
Speaker 3 (04:59):
There's more visual.
Speaker 4 (05:00):
Spatial anomalies that occur with Alzheimer's. So for instance, if
you're playing golf, you may completely miss the ball when
you go to hit it because you see it somewhere else,
and it's very dangerous. So those people that are driving,
what we're going to talk a little bit about today
(05:21):
is probably the second most common form of dementia, which
is Louis body dementia, and that's a very confusing term.
It's even confusing for neurologists because there is Louis body
dementia and there's that you see with Parkinson's disease, and
there's Louis body disease, and both of them are accumulating
Louis bodies. The difference is that with Louis body dementia
(05:47):
that occurs with Parkinson's disease. You develop Parkinson's disease first,
and you have that for a long period of time,
and then thirty plus percent of people with Parkinson's later
on will develop a parkinson like dementia that's characterized by
these accumulation of Louis bodies. That's very different from Louis
body disease, where you it's predominantly a Louis body accumulation
(06:12):
with dementia first, and this occurs at an earlier age
than we see the Parkinson dementia, but they develop Parkinsonian
features as well, and which is.
Speaker 2 (06:22):
More started to interrupt between those two Louis body disease
and the Louis body with Parkinson's, which is more prevalent.
What do you see more of.
Speaker 4 (06:33):
We see more of Parkinson's disease with Louis body dementia.
So you follow Parkinson's patient for a long period of time,
and they always want to know this question, am I
going to get dementia? Well about at least thirty percent
of people will. And there's a couple of prognostic signs
that you can look for early on. One that is
highly associated with dementia is something called REM sleep behavior
(06:59):
to disorder, and it doesn't always predict dementia, but that's
a bad clinical sign when someone is beginning to develop
one of these diseases and they develop REM sleep behavior disorder,
and that is acting out in your dreams. You know
how we're all paralyzed when we're dreaming. We think we're falling,
and we will go to scream and we can't. And
(07:21):
that's because during REM sleep, when we dream, we lose
all tone in our body. But with REM behavior sleep disorder,
that doesn't happen anymore. And when you're having a fight
with so many of your dreams, you're going to kick
and punch the person next to or you might fall
out of bed because you're you're you're fighting with someone
and so that's that's treatable with some medications. But the
(07:43):
important thing about that is it may be highly predictive
of the fact that you're going to develop dementia with
your Parkinson's disease.
Speaker 2 (07:52):
I'm sorry, so the kind of I have friends that
you know, we will talk.
Speaker 1 (07:58):
What do you dream about?
Speaker 2 (07:59):
Oh? God, I try.
Speaker 1 (08:00):
I thought that.
Speaker 2 (08:00):
I thought at a bad or. I mean, should people
be concerned that if it happens infrequently? Could that be
still a concern if something like that does happen?
Speaker 4 (08:10):
No, no, And I can tell you I don't want
our listeners to like start freaking out all of a sudden,
you know, yes, no, no, no, infrequently, I think that
can happen to anybody, right, And you can get this
without going on to develop dementia. But if you get
it in the older years and you're just developing some
(08:32):
Parkinsonian signs and symptoms which we can talk about, and
it's recurrent, it's every night, then that that can be
a bad prognostic sign that you're going to go on
and develop dementia. And with Parkinson's disease, you may have
the disease for quite a while. You may have it
for five to ten years before you start to develop
symptoms of dementia, and dementia with Lewis bodies is characterized
(08:56):
by hallucinations. So with all dementias, you can get hallucinations,
act very vivid formed visual hallucinations, but they're mostly like
with the Alzheimer's patient, they're more likely to occur in
concert with being ill, dehydrated, or you're developing an infection
(09:19):
and you get delirious and you might hallucinate, or if
you take a particular medication that can deprive your brain
of something called the petylcholine, and those would be the
over the counter cough and cold medications that tend to
dry you out, or benadryl. They can cause you to
hallucinate if you're elderly and you're sick. But hallucinations for
(09:40):
no other reason, just actively visually hallucinating is very very
characteristic of Louis body dementia.
Speaker 2 (09:47):
So we've talked about what you just said about the
benadryl and this, you know, some of the all over counter,
over the counter medications that cause drowsiness. Yeah, you know, yes,
we've had people say, do you know, obviously if it's
just for that purpose that your allergy or whatever, and
(10:11):
it's short term fine, but to take it as more
of a sleeping aid is not advisable. Can you maybe
expound upon that?
Speaker 4 (10:21):
Yes, absolutely, As our brains age, we tend to produce
less of a particular neuro transmitter called a setyl colin,
and we have so much when we're younger that you
can take one of these drugs like benadryl, which reduces
your acetyl coling, and you don't manifest any symptoms from
(10:44):
it except you dry up, and that's the purpose, or
you get sleepy, and that's the purpose of taking this
particular bill. But as we age and we don't have
as much as cetyl colin anyway. Acetyl Collin is a
critical ner, a transmitter for communicating information between neurons, and
you can suddenly just have difficulty speaking. You know, I
can't think of the word I want to use, or
(11:06):
you know, you go to calculate a tip for a
check in a restaurant. Gee, you're having a hard time
doing that, and you don't you know, yesterday you didn't
have a difficult time. And it can be that subtle.
But we need as much a pseudocolling as we know.
We can get So we always advise elderly people to
avoid using anything that they say is anti colonergic. And
(11:28):
the anti colinergic drugs are the ones that dry you up,
and benajol is one of them, and yes they make
you sleepy, but it's not an ideal sleep aid for anyone,
I would say, over the age of seventy.
Speaker 2 (11:39):
Yeah. So I just want to bring this up because
I'm sure some of our listeners are going, gon' I
don't know anybody that had Louis Body, but I think
they do all right, Yeah, I mean among Robin Williams
or actor Robin Williams, Ted Turner, Casey Caseum. I mean
(12:03):
those three shared more in common than being household names.
All three did suffer from Louis Body dementia. So I
mean you want to talk about that a little bit
as far as I mean, I think educating people that
it's you know about this is really important. So if
(12:25):
there's anything you want to add to.
Speaker 4 (12:29):
That, yes, I agree, yeah, Okay, it's underdiagnosed and when
people have friends that have dementia, it's just dementia, and
for all practical purposes it is I mean, what difference
does it make, what kind it is, except it makes
a difference in terms of how you treat it and
the prognosis that you're looking at, and which is very
(12:52):
helpful for families and the patient themselves to know, you know,
I have a certain amount of time that I'll probably
be good, and then you know I can expect this
or this or that to.
Speaker 3 (13:01):
Happen, Louis Buddy.
Speaker 4 (13:04):
Dementia's are probably the second most common after Alzheimer's disease,
so there's a lot more people that have it than
you realize. And I tried to distinguish between the two,
but it doesn't matter in the sense that the way
you're going to react is going to be very similar.
It's a strong association, as we talked about with hallucinations
(13:26):
and delusions, and they're often not happy hallucinations. They're not
you know, little kids coming in and sitting down next
to you and we're running through the room and playing.
They're often scary things, people trying to break into your
house or you see bugs crawling on the floor, and
they can be very frightening. You can look at a
shadow on the wall and think you see a monster.
(13:47):
Where you look outside and the trees blowing, you see
things that aren't really there, so you can get very
frightened and very paranoid. The hallucinations are almost always visual,
they're not auditory, so these little people, if you see people,
aren't going to talk to you. And that's one way
you can kind of broadly distinguish someone with psychiatric disease,
(14:11):
like its schizophrenic versus someone with dementia. The demented person
with hallucinations, they'll be visual. Usually in a psychiatric patient,
the hallucinations will be auditory. Interesting, yes, and so hallucinations
are very prominent. They're not treatable like hallucinations with other
(14:31):
types of dementia. So the Alzheimer's patient that might have
an hallucination on a regular basis because their dementia is
very regressed, you can often give them drugs in the
antipsychotic drug class that suppress dopamine and they'll improve remarkably.
With Louis body disease or dementias where you're accumulating these
(14:54):
Louis bodies in the brain, those drugs make the hallucinations worse. Clinically,
we can get some idea what we're dealing with, because
as these patients percent, it's not always clear until you
follow them over time and see what course their disease
actually manifests as But if you treat them with antipsychotic medication,
(15:16):
they likesy prexident it's a common one. Quiet hiopene is
another one that people commonly use. They get markedly worse.
So you absolutely avoid those medications.
Speaker 2 (15:27):
So doctor, we're going to take a quick break. I
promise just I want to recognize our sponsor. We come back,
I like to just spend a moment. You've written a book,
and I like you to share with people a little
bit more about that. And then we're going to continue
our discussion on Louis body and talk about warning signs
and those types of things. So still a lot more
(15:50):
to a lot more to discuss. So I wanted to
ask all of you, do you know anyone who may
be concerned about an older driver? While Senior care Authorities
Beyond Driving with Dignity program is a facilitated self assessment
program for older drivers. This program has been designed to
serve as a vital tool to facilitate older drivers and
(16:13):
their families as they make the appropriate decision regarding the
future of one safe driving career. If the individual is
a safe driver. An advisor will provide him or her
with strategies and how to remain a safe driver as
a progress through the aging process. If driving retirement is
the appropriate decision, then the individual and their family are
(16:35):
offered possible alternatives, resources and a specific plan to ensure
a smooth and successful transition from the driver's seat to
the passenger seat. To learn more, go to w to
go to www dot Beyond Driving with dignity dot com
to connect with a senior care authority advisor in your area.
(16:57):
And for those of you within the healthcare industry listening,
we actually do a program. It's called Driving under the
Influence of Dementia and you can get CEE credits for that,
so feel free to contact us as well if you're
interested in learning more about that. So we are back
(17:21):
with doctor Taylor. So. I know you've written a book.
I know that wasn't the purpose of our interview today,
but I've written a book too, and it takes a
lot of work. So feel free to share with us
whatever you would like to about the book and how
people can get it.
Speaker 4 (17:42):
Yeah, okay, I would love to. I recently had a
book published at the title of it is Whispers of
the Mind a neurologist memoir and it is a collection
of about thirty essays, all independent essays of real medical stories.
And it's called a memoir because these are patients that
(18:03):
I dealt with over the years that exemplified different things,
different universal themes that I thought would be inspiring to readers.
And basically, it's stories about courage, grief, and hope that
connect us all and there's something in there for everybody.
I have stories about dementia, about Louis body disease, Parkinson's
(18:28):
and they're all told in the context of a particular
patient that I encountered that taught me something. There's a
few very personal stories in there as well, about things
I encountered in life that had to do with myself
but neurology and with loved ones and caring for loved ones.
Speaker 3 (18:46):
So I think it's a.
Speaker 4 (18:49):
Story that might resonate with some of your readers if
they like true medical stories.
Speaker 2 (18:54):
Great, So how can they get it.
Speaker 4 (18:58):
It's available at any of your major bookstores such as
Barnes and Noble. It's also available on Amazon, Kindle Books,
Apple Books. I do have a website for this particular
book and it's just my name, It's Carolyn Larkin Taylor
author dot com. But if you just google the name
(19:19):
of the book, you probably come up with my website
and it describes there how you can order the book.
Speaker 2 (19:25):
Great, great, thank you for that. So you know you
mentioned it briefly before we're talking about doctors diagnosing people
at dementia. Is it your feeling that when somebody is
given just a dementia diagnosis, that's it nothing more than
(19:45):
that that it's just too difficult to determine what type
of dementia. Is that usually the reason, or is it
possible that they just haven't been gone through additional tests
to determine it or both?
Speaker 3 (20:06):
I would say both.
Speaker 4 (20:08):
If you think you have dementia, I would highly recommend
seeing a specialist that deals with dementia that would usually
be a neurologist to get a complete work up, because
there are things that can mimic dementia and you don't
want to just go off and say, Okay, I've got dementia,
There's nothing I could do about it.
Speaker 3 (20:26):
There are medications that can really.
Speaker 4 (20:28):
Help a lot along the way, depending on the type
of dementia we think you have, and over a fairly
short period of time following you, we can really be
barely certain what it is that you have. I think
everybody should have you advanced imaging study like an MRI,
A series of blood work is always indicated as well,
(20:50):
because there are things that can mimic dementia like thiray deficiency,
vitamin B twelve deficiency, and you definitely don't want to
miss something like that. There can be autoimmune disease that
can cause dementia like symptoms, which is treatable. And there's
a condition called normal pressure hydrocephalus, which is an enlargement
(21:13):
of the fluid filled cavities in the brain that's very
very gradual, and when you look at a scan of
a patient who's elderly, it might look like it's just
atrophy of the brain, which occurs in age and doesn't
necessarily correlate with dementia, but it can also be an
overexpansion of these ventricles, and in that case, you can
(21:34):
refer a patient for a ventricular peritenial shunt, which is
in our surgical procedure. That's actually a very simple procedure
to normalize the pressure in the brain and that can
prevent the progression of dementia. So you always want to
exclude something that is treatable, that could easily be fixed,
and that's one purpose of an intensive workup. Lastly, I
(21:57):
don't want anybody to I hope nobody ever misses pseudo dementia,
which for all practical purposes looks just like someone developing
a rapidly progressive, demanding illness like Alzheimer's in an elderly individual.
But it's due to depression, and it can be just
out of the blue. Patient might not be crying or acting. Said,
(22:19):
that's how an elderly patient may manifest their depression as dementia.
Speaker 3 (22:25):
And that's another thing that would be shamed to miss.
Speaker 2 (22:28):
Are there any types of dementia that could be reversed?
Speaker 4 (22:35):
Well, if you're developing dementia from any of the things
we just mentioned, such as BE twelve deficiency, theory deficiency, what.
Speaker 3 (22:42):
About what about alcohol depression?
Speaker 2 (22:44):
What about those that have been alcoholics, been big drinkers
I have heard, but again you would know that if
you stop, maybe it could be reversed or not necessarily.
Speaker 4 (23:02):
Some can be reversed, but not all of it, because
when you drink too much alcohol for long periods of time.
You damage the brain, you shrink the brain, you lose
brain cells, and so along with alcoholism is often poor
nutrition and vitamin deficiencies. And so if you stop drinking,
(23:23):
you stop that progression of damaging the brain. So you
kind of halt it. But you have to check for
vitamin deficiencies, and thymine is a big one, sometimes be
twelve and other nutrients can be very problematic with alcoholics,
(23:44):
certain minerals such as magnesium, but the big ones are
the vitamins that can cause a pseudo dementia. You can
replace the vitamins and people will really get better, but
not if they've been vitamin deficient for too long a
period of time.
Speaker 3 (23:59):
So timing is very very critical.
Speaker 2 (24:01):
Yeah, well, so what about warning signs those that are listening, going,
you know, my mom my, dad, whatever? I mean, they're
for becoming more forgetful. Short term memory isn't as good,
but that could be normal aging or depending on how old,
or that could be something that could be more serious.
So what would you say or maybe some of the
(24:23):
key warning signs or red flags that may point to
Louis body dementia or even other types of dementia.
Speaker 4 (24:31):
Okay, well, dementia in general. You know, I like to
tell the families, it's not the person that is forgets
what they where they put something as much as the
person that puts something in an odd place. So you
open the refrigerator and you find their spectacles, for instance,
(24:52):
and they've been looking all over the house for them
for days, and you know, they put them in the
refrigerator of all places, or they put a book in
the dishwasher. I mean, they do really bizarre things. But
the person that and all of us as we get older,
have difficulty with word finding, and we might have some
short term memory loss because it just isn't that important
(25:14):
to us to remember something, or we might be developing
some hearing loss or vision loss. All these things compound
your cognitive state. But red flags. One big red flag
is loss of insight. So the patient themselves is not
aware that there's any problem, and they'll argue with you
(25:37):
because they don't remember that they did something, and that's
usually a red flag. So the patient that comes to me,
the elderly patient that comes to me that says I'm
getting forgetful and I'm worried, doesn't worry me as much
as a patient whose family brings them to me and
tells me they're getting forgetful, and the patient says, no,
I'm not, I'm perfectly fine. So lack of insight is
(25:59):
which always says, you know, I'm in the in the industry,
and I said, I've never had a senior come to
be saying, Frank, you.
Speaker 2 (26:07):
Know what I need. I need memory care. I need
to go to memory care. I mean, it just doesn't.
Speaker 3 (26:11):
Happen, exactly, It doesn't happen. It doesn't happen. Yeah, yeah, yeah, good.
Speaker 2 (26:18):
So listen, we have a people that are listening to
the show, families that may be starting to go through
this with a love one, with people within the healthcare
industry listening to this. So just just you know, just
to kind of finish up here, because we only have
(26:40):
a we have a couple of minutes left, but just
words of wisdom that you would have. Where does somebody begin,
you know, there's they're starting, they're noticing this. Maybe they've
been even given a diagnosis of mc I mild cognitive impairment,
or maybe maybe they have been given a diagnosis of
(27:01):
dementia a family member. What do they do? Where do
they start?
Speaker 4 (27:07):
Okay, Well, mild cognitive impairment doesn't always progress to dementia,
and a lot of those and actual dementias is defined
by you now are functionally impacted every day by the
cognitive impairment.
Speaker 3 (27:23):
It's affecting your ability to function.
Speaker 4 (27:26):
The first place to go to is your primary doctor
and just get a good overall health checkup, make sure
you're not deficient and be twelve or thyroid or any
of these other things. And at that point, if everything's
fine and you still feel like there's an issue, then
I would request a referral to a specialist. And even
with the cognitive impairment that hasn't manifest very severely yet,
(27:49):
if it's going to progress, it's worthwhile, I think to
get something called a formal neuropsychological evaluation. So you hear
a lot about these mini mental status tests, which is
thirty points that they ask you in an appointment and
they give you a cognitive score. Well, they're just screening
tests to try to pick up those red flags. But
(28:11):
an actual test to see what's really going on is
like a three hour test performed by a neuropsychologist, and
that will show very early signs of things like difficulty
with executive function planning and organizing, or it might just
put you in a category that looks like, gee, this
might be more you know, depression related. There's some depression
(28:33):
going on here because all the other domains are completely intact.
And it can be very very useful in a very
early stage of predicting you know what's going to be
going on, and if it's not, you can at least
get a follow up in a year and see how
it compares to the one before to see if it's
been progressive. So I wouldn't stop with just you know,
seeing your primary doctor. I would definitely start there. But
(28:56):
there are things.
Speaker 3 (28:57):
There are new.
Speaker 4 (28:58):
Drugs now for Alzheimer's disease that are recommended for very
early stages of Alzheimer's disease.
Speaker 3 (29:04):
They're not cures.
Speaker 4 (29:06):
They're monoclonal antibodies that can help rich your brain of
those amyloid plaques, and they do reduce plaques by a
certain percentage per year, and they can slow down the
progression by twelve to twenty seven percent, which is a lot.
Speaker 2 (29:22):
So what have you seen with that? As it too
early to tell.
Speaker 4 (29:27):
I think it's too early to tell. There's not a
lot of patients getting it. It's very expensive, you have
to have a definite diagnosis, and there are some risks
involved with this particular drug. I think over time, it's
an infusion that you get every couple of weeks and
then monthly, but after you've been on it for eighteen months,
(29:49):
they're going to be able to have a sepcutaneous shot
that you can give yourself on a regular basis. But
there are problems that you can develop in the brains,
small areas of adem of small bleed. So it's not
an innocuous treatment at all, but it's something I wouldn't
I wouldn't roll out for the right person, right Yeah.
Speaker 2 (30:10):
Actor Carolyn markin Taylor, thank you so much for joining
us on Boomers Today. Really appreciate it. Check out our
book Whispers Are the Mine, and thank you everybody for
joining us. Please be safe out there and we talk
to everybody next week.
Speaker 1 (30:27):
You've been listening to Boomers Today with Frank Sampson. To
learn more about today's show, visit Boomerstoday Radio dot com
and join us next time for another edition of Boomers Today.
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