Dr. Zaldy Tan is leading a study into who is at risk for developing dementia, and why.
There is no cure for Alzheimer’s disease, the leading cause of dementia. And since the number of Alzheimer’s patients in the United States is expected to triple over the next 40 years, improved treatments and prevention are more crucial than ever, says Dr. Zaldy S. Tan, director of the Bernard and Maxine Platzer Lynn Family Memory and Healthy Aging Program, and medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai. Here, Dr. Tan, a leading memory and aging specialist, shares his vision for the future of dementia care.
What are the most significant ways we can improve care for dementia patients?
Managing dementia is extremely challenging, especially in primary care. Patients may miss appointments and have difficulty understanding medication instructions. They can develop behavioral issues and their caregivers become stressed. In our Bernard and Maxine Platzer Lynn Family Memory and Healthy Aging Program, we are building a truly multidisciplinary, collaborative team tailored to the complex needs of patients with dementia. It’s an innovative approach. Our team—a memory specialist, pharmacist, neuropsychologist, social worker, genetic counselor and nurse practitioner—gets to know each patient and their needs. It’s crucial to continually evaluate dementia patients from several perspectives, addressing their cognitive, behavioral and social challenges. This helps prevent unnecessary hospitalizations or trips to the emergency department, since people with dementia don’t do well in the hospital. We develop personalized, comprehensive care plans for each patient’s family or caregivers, as well as their primary care doctor.
It’s also crucial for us to address caregiver depression and burnout, which make it more likely that a patient will end up in the emergency department. We offer caregivers education, support and referrals to community-based services.
Why is your work with caregivers so important?
It is challenging for a family member to be thrust into the role of caregiver for a loved one with dementia whose needs may exceed most people’s knowledge and skills. In 2019, I published a study that found that attending a one-day intensive boot camp made caregivers more knowledgeable and more confident in their skills. Busy caregivers have limited time to devote to education and training; we found that even a one-day investment is enough to make a lasting difference.
As we develop more therapies to offer patients, there’s a lot of good that can be done to help people through this journey.”
What more do we need to learn about dementia risk and prevention?
There are segments of our diverse Los Angeles community whose dementia risk and outcomes remain largely unexplored. That’s why we are recruiting Asian American and Pacific Islander (AAPI) and LGBTQ+ individuals at increased family risk for dementia for a study on brain aging. We will be following them for life to help discover why some people develop dementia and some do not. Not much is known about the AAPI population’s risk for dementia—the little data we have seems to show that Asian people have a lower dementia risk. If that’s confirmed, perhaps there are resilience factors we could identify that can help reduce everyone’s risk of developing memory problems. It is also possible that the low incidence may reflect underreporting because there are cultural barriers to obtaining a diagnosis. If the data supports this, we can develop ways to address those barriers for AAPI populations, and for other cultural and ethnic minorities.
Though LGBTQ+ patients are diverse in terms of race and culture, one commonality may be exposure to adverse social determinants of health: discrimination, lack of access to good health care and social isolation. Many older LGBTQ+ adults live alone, without the benefit of traditional family structure and support. We don’t know whether these negative social determinants of health translate to an increased risk for developing dementia.
What are the most exciting advances in dementia research?
The recent Food and Drug Administration approval of disease-modifying therapies, including aducanumab, is a start, though it’s uncertain whether these treatments will be effective for slowing down cognitive and functional decline. We need more evidence about these medications’ effectiveness, safety and accessibility.
We are close to having a blood test that can tell clinicians, with a high degree of reliability, whether a patient is developing Alzheimer’s, even before they have symptoms. And I am very interested in personalized health, since each person has a unique set of risk and preventive factors for Alzheimer’s. In the future, I envision that we will treat patients on the path to memory loss with oral therapy or intravenous infusions, depending on what type of dementia they are most likely to develop. Monoclonal antibodies that clear the brain of the abnormal amyloid or tau proteins also hold promise as future Alzheimer’s disease treatments.
What inspired you to specialize in memory disorders?
My mom is the third of five sisters, and her two older sisters, my aunts, both had dementia. I’ve seen firsthand how it robs people of their memories and compromises relationships they treasure, so I have a personal interest in finding a way to reduce the risk of dementia and achieve the best care possible for people who do have it. As we develop more therapies to offer patients, a lot of good can be done to help people through this journey.
Dr. Zaldy Tan
Carmen and Louis Warschaw Chair in Neurology
Medical Director, Jona Goldrich Center for Alzheimer’s and Memory Disorders
Director, Bernard and Maxine Platzer Lynn Family Memory and Healthy Aging Program
Path to L.A.
Dr. Tan trained at Brown University and Harvard Medical School, and studied at Harvard Business School and School of Public Health. He moved to Los Angeles 10 years ago to be closer to his family.
In Another Life
If he wasn’t a doctor, Dr. Tan may have gone Hollywood. He studied screenwriting at the UCLA School of Theater, Film and Television.
“Being in the field of memory, I have a great appreciation for investing in and forming good memories when you’re young—or younger,” he says. “Material things lose value over time, but memories only become more valuable. In the end, the experiences we’ve had and the people we’ve met make us richer and will always be with us.”