Spotting Early Signs and Risks for Cognitive Decline, with James R. Kilgore, DMSc, PhD, PA-C

In the few decades that James R. Kilgore, DMSc, PhD, PA-C, has practiced medicine, he’s observed firsthand the rising prevalence of cognitive decline and development of Alzheimer disease in the aging US population. While he and his peers are very well-equipped to diagnose, refer and begin to treat Alzheimer disease in anyone, it requires a good deal of recognition from the new patient, and their loved ones, to prompt the process themselves.

In an interview with The Educated Patient, Kilgore, associate professor of PA Medicine at the University of Lynchburg, reviewed the clear signs, symptoms and risk factors for early cognitive decline. Kilgore details not only clear cognitive and behavioral symptoms of cognitive decline, but lifestyle trends and comorbid conditions that may indicate a heightened risk of developing Alzheimer.

Here are some key takeaways from Kilgore on identifying risk of cognitive decline.

On what triggers early Alzheimer screening

Usually as early as their 50s, people may begin to notice that they can't remember where their keys are, they forget a phone number, they actually might forget a person's name. They get a little bit of concern. So what we are seeing is that more people are coming in asking to be screened to make sure that they do not have (Alzheimer).

On initial Alzheimer disease screening at the clinician’s office

“In general, our process for most patients who come in is to do some simple screening test. The one that we use most commonly is called an AD8, which is a cognitive screening test. It has 8 questions on it; these are self-administered questions, which are very simple and easy to use. In fact, some of these questions have in front of me have, 'Are you having problems making decisions like financial decisions, got less interest in hobbies? Do you repeat the same thing over and over? Do you ask the question same question over and over? You're having trouble using things like a computer or your microwave remote control? Did you forget the day, the month, the year? You have trouble balancing that checkbook? Did you forget an appointment? Do you have problems thinking or with your memory or, like with me, I can't locate my phone most the time.’”

On the PHQ-9 and GAD 7 screening tools

“The PHQ9 is a patient health questionnaire which asks you general questions about your health—how you get around, are you functioning, exercise, eating, etc. And then we do a GAD 7, which is a general anxiety disorder. And I know you say, Okay, what's this got to do with it? Well, what we're finding is that psychological wellbeing is an important component in diagnosing cognitive decline, dementia and Alzheimer's. And a recent study found that early, before you even go through testing, people will notice that they'll have a decline either in their purpose in life, or they'll have a decrease in personal growth. They become sort of blase. They just don't have the energy. They're not engaged, they're not out with their family. They're more lonely, they're more isolated.”

On the possible role of cardiovascular health and diet in Alzheimer development

“We know that we could do...both blood tests and radiological tests to look for things like amyloid or cholesterol deposition, etc, which sort of relates to cardiovascular disease and cognitive decline together. But we also know that for individuals that are eating red meat more than 3 times a week, they have an increased risk of dementia by 14%. So, we also know that if a person decreases the amount of these processed red meats that they're taking in, that they also have a 20% decrease in having dementia or Alzheimer’s.”

On Alzheimer diagnoses following the COVID-19 pandemic

“We've heard that people have trouble breathing, cardiovascular problems, and what we call the brain fog associated with long Covid. So, individuals that have had COVID and or have long Covid and have cognitive decline of memory loss or difficulty functioning, you need to let your provider know. That's another indication that we're looking at, and we're really only three years post-COVID, so we're getting early data out in these studies that inflammation plays a role.”