 Aloha Hawaii, I'm Wendy Lo and I'm your best friend as we journey to take your help back. We are coming to you live from downtown Honolulu from the Think Tech Studios of Hawaii. Today our topic of discussion will be on Alzheimer's disease. What is it and what you need to know. You know, this is one area that I'm really not well informed in. I personally, I don't know, I don't have a lot of knowledge on Alzheimer's so I'm so excited to meet and share all the knowledge that you have and my guests I'm speaking to. What I would like you to take away from today's discussion is knowing what the early signs and symptoms are for the disease and who you can turn to or support if you or a member of your family is afflicted. Today we are very honored to welcome Dr. Poetie Balaz. Balaz, a volunteer with the Alzheimer's Association. Dr. Balaz is a local girl who grew up right here in Hawaii and I say local girl, she's really a young, youngster with a lot of knowledge and a lot of heart for the people that she's working with. She attended the University of Hawaii at Manoa, the University of Oklahoma and obtained her doctorate in nursing practice from the University of Hawaii at Hilo. Dr. Balaz's professional interest involves native Hawaiian help, especially the kupuna, caregivers and the ohana who are affected by Alzheimer's disease and other related dementias. Welcome on board, Dr. Balaz. Thank you, Wendy. So just really quickly, what your name is, I'm having a hard time with a Z there. So tell us just a simple breakdown on what's your ethnic background. No problem. So I want to say first thank you for having me here. My ethnic background is I'm Hawaiian, Asian. We'll see Chinese, a little bit of Filipino and then European mix. So Portuguese, Irish and Czech, we'll see. So my last name is Czech and the Z sounds like an S-H like Balaz. Balaz. Don't worry, answer to it all. Okay, Dr. Balaz, can you tell us more about Alzheimer's disease and what is it and how does it different from the other dementias? Yeah, no problem. That's a great question. So I'll back it up just a real little bit. Most people will ask like what is the difference between Alzheimer's and dementia? And so dementia likes to think of it as like an umbrella term. And if you and I were standing under an umbrella, you would be Alzheimer's, I would be vascular, somebody else standing underneath would be Lewy body. So Alzheimer's is a type of dementia and it affects our learning, our memory, our thinking. It's progressive. It's irreversible. Also, they call it a degenerative disease. And so that's where a lot of the symptoms like the repetitive questions come out. There's a lot of similarities between the different dementias and there's some differences. So for example, a lot of people ask more about Lewy body, which is another umbrella term for Parkinson's dementia. But anyways, a lot of that is associated with hallucinations. Vascular dementia coming from like cerebral vascular strokes that has a lot of the similarities as well as difficulty with speaking. And then there's just there's over a hundred different types. So I think a lot of times what I'll tell people is if you don't speak to your PCP or neurologist or geriatrician, and then from the testing that we do, we can really narrow it down and then really target the type of treatments we're going to do based on the type. You know, more and more we are hearing about Alzheimer's and dementia, especially in the news when a loved one is wandered away. And because of Alzheimer's and you have to take, you know, precautions and security measures to keep the patient safe because of that. And so because of that, we've been hearing more and more about Alzheimer's. And you know, I'm just wondering, isn't just a normal part of aging? I mean, you know, is it because we're getting old, we lose our memory, our minds? Or, you know, can it be prevented? Can it be cured? And does diet have any effect on Alzheimer's and the patients? Those are all great questions. So let's go out in one at one. So Alzheimer's is the reason why there's so much buzz is the most prevalent type. 60 to 80 percent of cases are Alzheimer's alone in Hawaii. We have about 29,000 with that. And just jump in if I forget to answer one of them. But it is not a normal part of aging. That's one huge misconception because if that was true, then everybody would be diagnosed with it. But so it is not a normal part of aging. And I just want to reiterate that again, because I do hear that a lot, even from my patients, they're like, oh, and I'm old. Or the family member is like, well, she's old. She should have got it anyway. And no, that's not true. Can it be prevented at this time? No. Although research is continuing and the association is a big support of research. So hopefully we're not too far away from the cure. We do have medications. We have treatments. Again, it is irreversible. It is progressive. And even the medications we have won't cure it. We can kind of slow it down. Your question about diet is great. So what we like to say is what's good for your heart is good for your brain. And so looking at things like your nutrition, your physical fitness, socialization, which people are surprised is a big part of preventing Alzheimer's. So diet is one component to it among many other things. Wow, that's a good. I mean, it's good and bad news all in one. There's no prevention. There's no cure. But the fact that you said socialization, that helps. So I'm going to work on that further. I'm going to go to more parties or more dinners and socialize even further. With your experience, Dr. Balash, could you tell me what is the youngest of your patients that you've seen afflicted with Alzheimer's disease? Gosh, so we it can happen as young as in the 30s. So we do have a lot of times we talk about Alzheimer's. We think of the older population. We talk about 65 and older or those. So there is a younger onset type of Alzheimer's, which kind of hits people around in their 30s. In fact, there's a bill going through about it right now to get them access to programs that those who are older can get under the Order Americans Act. But anyways, coming back to the patients I've seen, most of mine, I have not seen too many of the younger onset. Most have been the older population. They're fifties and above, which is still young. Right. It is still young, but it's more acceptable. And I think if a 30-year-old came with some symptoms, you are probably going to resource other diagnoses to figure them out before you determine that they are with Alzheimer's. Is that correct? So with every patient that comes in, so a lot of times the blood work we're doing, the scans, what we're trying to do first before we put a diagnosis of dementia or a type of dementia in a person is we're looking for reversible causes first. So if we can find something that is mimicking it or something else that's happening and we can correct that, then those symptoms may disappear, may disappear also. And so, and then even if it is, you know, with the kick that everyone's on, we do talk a lot about as you brought up, there's no cure, but you know, things that we can do to try and prevent it or stay away from it. Well, I mean, we are going to grow old gracefully and as wisely as possible. So learning all these tips that you're sharing with us and about to share with us, we're really going to embrace it and absorb it and live it. And it's all about taking your health back and at what quality of life do you want to age in. So I'm so excited to just sit here and absorb all this knowledge that you have to share in your heart. This is way better than reading a text. So this is the way I like to receive my information. So Dr. Belaj, please share with us the 10 early signs and symptoms of Alzheimer's with comparison to the typical age related changes. Sure. So just so everybody know, you can also find this on the association's website and they have a lot of pamphlets. So the first one is a memory loss that disrupts daily life. So when we're talking about this, we're talking about things that a lot of people remember, like their repetitive questions, they can't really soak in newly learned information. So a lot of times they'll rely on people to remind them of things or post it or they're starting to use the alarm on their phones. So things like that where they need an extra step and extra help to remember things. You know, when you're like, Mom, you're going dentist appointment on Friday. And then you know, Mom does not remember there's an appointment, but you got upset and alarm. So for normal, like the rest of us, I mean, we all go here. I read we, you know, we might forget something, but really the key difference as we go through all of this is what I tell you. Most people is it, we all lose our keys, right? And we all lose our cars. Like I can never remember where I parked. I take pictures. Yeah, exactly. And my keys are forever losing my phone too. But the difference is that if you can recall or eventually think back to where you left it and found it, then you don't have the disease. Those with the disease cannot put that together. They wouldn't be able to retrace their steps or sit and be like, I was in the kitchen, then I went to the living room and then I went there. They don't have that since the system of replacing what they forgot. It's just totally blank. Yes. Okay. All right. So we have to just watch at what level we're playing at that. Is that correct? Okay. Okay. Number two slide shares with us the challenges in planning or solving problems. So this is what we're talking about. Like recipes, for example, like, you know, we all have that favorite recipe. We get out our mom or grandmother's book, right? And where we're, so somebody with the disease would have a difficulty following a recipe that's even laid out in front of them. They have a difficulty knowing like what is one cup, what's half a cup, and even identifying what is flour, what is sugar. They might think the sugar is flour, vice versa. And then we're talking about numbers. It's like the checkbook. They're having our time balancing or paying their monthly bills. And so for normal aging, I mean, we've all done it. We've all forgot to mark something in our checkbook. I mean, I've done it once and I thought I had like, I was like, cool, wow, look, I got way more money than I thought. He did that on purpose. Then I realized, oh, I forgot to subtract something. So we all do that, but it's the point that we can realize it. We see it. We know how to fix it. You know, somebody, you would start noticing this person to just have a hard time not paying their bills. They wouldn't be able to balance their checkbooks. The electric wouldn't pay that you would start just noticing all these little things coming up. You know, I once saw a video where this doctor's husband, they gave him the test of making a clock and drawing the numbers in the clock. And when he started drawing, he didn't even have a shape, a round shape. And all the numbers were outside of the round shape. So then they diagnosed him from there and then ran, of course, other tests. So that was very clear. And he couldn't, there was even no recall for him. And I really felt, oh my gosh. Okay. So that's again, difficulty in completing familiar tasks. Oh yes. Right. So that talks about that as well. And then confusing times and places. Oh, so that, so kind of going back to the one I said, like the, you know, the dentist. So when we talk with people who have dementia Alzheimer's, we want to talk to them in the present. We're not trying to talk to them in the future. So again, if you said like, mom, we're going to uncle's house on Friday to have dinner. Well, they're thinking you're talking to them in terms of now. So mom might go get ready now. And then come out and be like, I'm ready. Or she might get ready every single day until Friday. Oh. So they have a time, a hard time with dates, with the future planning. I mean, my father did this all the time. He always thought we were getting ready to go somewhere. And he'd come out in like his shirt and his pants. And I have to tell dad like, oh no. So what I would do is like, I'd put him in the car and we would like drive somewhere. And then I'd come back and he thought then we went somewhere and we had a great time or I'd take him to get ice cream. So it's kind of things like that. And so, you know, for the rest of us, you know, we forget the day of the week, but then we're able to figure it out, right? Right. Wow. And then the next one is trouble understanding, visual images, and relations. So people with dementia do have trouble sometimes with contrast, colors, the judging, you know, the distance between things. And so that's just some of the visual changes that really happen. You know, the spatial changes, trying to grab things off the table, understanding if there's a ledge, you know, how to step down. You know, and then, sorry, we're just on this topic. A lot of people ask about these kind of things. And just to throw it in there, sometimes people, if you're having people who wander, a lot of times they'll think a black or a dark colored rug is a hole and so they won't step over it or into it. And so that's something that we kind of use for a barrier. Oh, so new problems in speaking and writing. So we've all, we've all noticed that, you know, they have difficulty talking. And so this one is more pertaining to, like when you're having a conversation, sometimes they have a hard time carrying it on or continue to talk. So if you've ever noticed someone's talking to you and they're telling you to start, they're like, oh yeah, do you remember last summer when we went to and they just pause and then it just stops. And either they can continue it or they just restart over. Like after 10 seconds they're like, do you remember last summer when we went where the rest of us could laugh it off or pick up on it. And then sometimes they forget the name of things. Like in their head, they're like, I know that's a cup, you drink all of it. But they can't recall the name or they call it the wrong name. Oh, so pokey. Right now we're going to have to take a short break. We went through already six of the 10 signs. And you know, I'm kind of feeling in my heart like I'm failing this already. But no, we're going to work on not awareness is the main thing, knowing what to look for the signs and the symptoms and just trying our best to just carry on with life the best we can and more hopefully. And knowing that we take care of our brain like we take care of our heart. And so that's really critical too. That's the key right there. Very key, brain and heart. And that's why our brain and heart functions correctly. We've got longevity and quality of life ahead of us. So right now we are going to take a 60 second break and we'll be right back. Aloha, I'm Gwen Harris, the host here at Think Tech Hawaii, a digital media company serving the people of Hawaii. We provide a video platform for citizen journalists to raise public awareness in Hawaii. We are a Hawaii nonprofit that depends on the generosity of the supporters to keep on going. We'd be grateful if you'd go to thinktechawaii.com and make a donation to support us now. Thanks so much. Aloha, I'm Stan Osterman, a host here on Think Tech Hawaii, a digital media company serving the people of Hawaii. We provide a video platform for citizen journalists to raise public awareness here on the island. We are a Hawaii nonprofit that depends on the generosity of its supporters to keep on going. We'd be grateful if you'd go to thinktechawaii.com and make a donation to support us now. Mahalo. Aloha, here we are. I almost forgot where we were, but I'm going to continue on. We're here at Think Tech Hawaii. That was a joke, by the way. We're here with Dr. Poki Raj, and she is a volunteer extraordinaire with the Alzheimer's Association and doing a fabulous job. We're sitting here learning more and more about the symptoms and what we need to look for in ourselves, as well as our older community, I would like to say. But the bad news is that she shared with us there's no cure for this disease. It's ongoing, and she did mention to us, which is really important, that you must take care of yourself. Like you're taking care of your heart is the same as taking care of your brain. And we're going to do the same thing for our brain as we do for our heart with lots of rest, good nutrition, exercise, and socialization. So welcome back, Dr. Balaj. Thank you. All right. So we talked about the top six symptoms that we need to look for. So now we're going to continue on. And I suppose the next one is missing them and losing a lot of items. Missing items. You mentioned that earlier. And I have a big smile on my face because it's just taking me back to my father. So most people do talk about this with their loved one, about them either putting things away, they can't find the money, the checkbooks, my father had toothpaste. I have no idea why toothpaste was his thing. They usually have something that they're still got. And so I would just buy the aimed toothpaste and I just had a bunch of them. And every time he wanted one, I'd give him one and he would hide them all over the house. And then at night I'd go through, they'd be in the bookshelves, the freezer, the drawers. And so they hide things, they misplace things. Or if he heard jingle in somebody's, in their shorts, he would assume that that was his change. And so they have these characteristics that you'll hear a lot of people share. And so it's kind of interesting. Very interesting. But for us, usually if you misplace something right outside of our keys or your book or your pen, you eventually can go back and find them. Or I needed to buy so much toothpaste for him because he could not remember where he put the toothpaste every time he hid it. Wow. Well, this is all news to me. Oh, wow. Too shame for you being an amazing young daughter that you are. Okay, so how about these decreased or poor judgments? So we do know that those, their abstract thinking, their judgment, everything starts to decline. So a lot of times we hear family speaking about, they sent a check to some organization or somebody called on the phone and they gave them the information. And a lot of these times it scammers. And so it's unfortunate that they target this population. But they don't have that type of judgment anymore to make those things. Sometimes that even pertains to safety too, leaving the stove on. And for the most part, all of us have all made bad decisions, but we're able to learn from it and not do it again. Right, right. Wow, gotcha. And then withdrawal. Yes, withdrawal. And again, I'm sorry, I'm not laughing at the word, I'm just laughing because it brings back memories. And when you're going through this disease, we always talk about the burden and challenges and it very much is there. But there's also a lot of life and happiness and positiveness in it. And if you can laugh about it and turn into a game, it makes the journey that much better. And so a lot of times we remember people, how they were at work, how they were at home. They liked to garden, they were an executive or maybe a delivery person. And so as the disease progresses, they've noticed the changes and then they're unable to do the things that they were able to do. So they start to withdraw and they don't want to leave and go in. And so like my father is a diver. He was part of Pahakuyah Lua and as he realized he couldn't do the things anymore, he stayed with my mom and just wanted to stay home. So it's harder to get him out. Wow, that would be critical. That would be a hard one to manage and changes in mood. So the disease very much can either, like if somebody was really happy, it can make them even more happy. It can also change them and make them the opposite of what we remember mom or dad or brother or sister to be. It can make them anxious. It can bring in confusion, disorientation. And so we just have to be aware that this disease can change the person, but mom or dad or whoever is still in there. But now it's the disease that has, we just have to accept that the disease is in control, not the person. Right, you know, and there were 10 symptoms that we just shared with everyone. I mean to have one or two is already bad, but there are 10 different ones that you may be experiencing all the time, 24-7, if you are the caregiver as you are for your father. And what a blessing for your father that you have such an understanding of this disease and that you are his primary caregiver. That's what a blessing for him. And then you actually get to not practice, but just live it and be maybe even more compassionate for your patients and the people that you're dealing with. So wow, I am just, wow, I'm amazed. So how does this disease affect us? And can you share some of the stats regarding Alzheimer's patients here in Hawaii? Sure, so I talked, I mentioned one stat earlier. So currently here in Hawaii, we have about 29,000 with the disease, nationally 5.4 million. But we kind of assume that the number is underrepresented because it's based on who's going to report it. And we have a lot of issues going into that cultural barriers and things like that. As far as caregivers, we have about 66,000 caregivers alone in Hawaii. And then we're looking at 16 million nationally. And by the year 2019 right now, we're looking at having the number jump up to about 35,000 people diagnosed here in Hawaii by 2025. It's adding to a lot of other healthcare strain. We know the healthcare of our caregivers are going down. They're adding about 44 million. The unpaid services alone here in Hawaii are in the millions for the hours, about 75 million. And millions in the, if we're totaling that into dollars, that caregivers are contributing on their own here in Hawaii. So it's very much present in here in Hawaii. And I think, you know, and I'm happy that much more awareness is growing. But it's really hard to find somebody that doesn't know somebody with a disease anymore. Right. You know, Dr. Malosh, you are an amazing volunteer with the Alzheimer's Association. So was your involvement because of your situation or were you already involved so passionately with this organization before it became a part of your life? It became a part of my life when I returned from Hawaii. So a little bit about my story is I had left Hawaii and my intention was, I had no intention of doing neurology, brain health and all of this. And geriatrics, I had left for the mainland. I was in Oklahoma. I went to LA to be closer. I wanted to become a plastic surgeon and conservatology. And geriatrics still had always been a love for me because culturally, right, our kupuna are held in such high esteem, excuse me. And my grandmother had denied me. So I grew up with all the kupuna because I was her namesake. When my father got diagnosed and I moved to LA to be closer, my mother called me and asked me to come home because she could no longer take care of dad on her own. So I came home. I mean, there wasn't all this buzz about Alzheimer's and all these resources and all these things going on. And so I really had to just immerse myself for this unexpected role that I had no idea I was going to embark on. And when I did that, I needed to find places that could help me. And so one of the first places I turned to was the Alzheimer's Association. And so it's been a great partnership then. It was Ivy was one of the first, our director of programs that I met. They also even helped me with my dissertation. And so from that, we just grew this relationship where they helped me in the beginning to learn to educate. And they did such a wonderful job and I wanted to return the favor and just help others have a more successful journey because like I tell my patients, I'm with them till the end. So I mean, give me a time for about how long has this been a journey for you? So it was before I even left. So we're over 10 years now. And so I came back in 2012. And so it's been seven years with me here as a primary. He was diagnosed and he still told me I needed to go. And so I did for a few years and came back. But my father is now in the end stages, which means he needs total care. He's bed bound. He can't speak. He can't move. He can't turn himself. He can't feed himself. Everything. So he needs constant 24-7 care, which is very common. This is kind of where people linger. And in the last years, about 40% spend, you know, maybe up to 10 years in this phase. They can. Everyone's story is different though. Wow. So I mean, I'm so proud of you as a young donor and just sacrificing your life and your time right now as you do the duty of taking care of your father. And what an honor that is for you. So I commend you and congratulate you. So what are some of the resources for our general public out there to go and tap into or receive? Not everyone has a doctorate or experience as you do. So what would you tell the audience out there? How can they get resources? I would definitely tell them to call Google or online in some way get in touch with the Alzheimer's Association. They have a lot of programs. One of the main ones I always ask people to join is their support groups. I'm blessed enough to be able to do their Neal Valley support group. But I tell people that is such a great place to go because you will learn from other caregivers and you can learn techniques and things that they've done. Also, they also have educational classes. They offer monthly and weekly. They also have care consultants. And one of their big another big program is their 21st 7 Helpline which is open 24-7. And anybody can call to just talk to get advice about anything that's happening. You can also become a volunteer by reaching out to them. Just like you. Just like me. All I did was call and then you can email them. Everybody in the office is very amazing and friendly. And you know everybody has their sector. So they they're very welcoming very much. Other things that you can get involved with with the Alzheimer's Association is June 21st is going to be the longest day. That's our biggest day to raise funds. And so if you want to find out more information you can go to the website. You can also volunteer to help with that. And then the Walk to Alzheimer's will be coming up on November 9th at Magic Island. And you can make your own team or you can volunteer. You can just come down and just hang out with us. Wow this is amazing and such valuable information to myself and to so many people out there. And you being a volunteer with a heart and the experience behind it all. And you know the reason why I'm really learning and understanding about this is because volunteers like yourself and I understand you have a new executive director in the Alzheimer's office. Yes. And may you say his name for us. Mr. L.J. is our new executive director. He is so excited for you all. You know he was with us with American Diabetes for many years. Many years and I sit on the board of directors for the last eight years there. And then we gave him over to you and just hoping and praying that he will do a magnificent job for the Alzheimer's community as he has done for the over 600,000 diabetics here in Hawaii. But great people, great hearts, great minds. I know that you are the Alzheimer's community is going to be well looked after because I know you and I know him and I'm sure all the other volunteers are just as equally passionate about what they're doing. So I really like to say mahalo Dr. Balazs for your time, for your time here, off of your busy schedule and maybe it's 30 minutes of rest and break for you from taking care of daddy. But again congratulations to you. I commend you and I honor you for such commitment to Ohana. Mahalo. Thank you for having me.