The impact of Alzheimer’s disease

Ron Petersen, MD, PhD, is Director of the Mayo Alzheimer's Disease Research Center. 2

What is age-related memory loss?

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Typical changes  Typical age-related changes involve: • • • • •

Making a bad decision once in a while Missing an occasional monthly payment Forgetting which day it is and remembering later Sometimes forgetting which word to use Losing things from time to time

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Problematic changes

Joyce has a diagnosis of Alzheimer’s disease. 5

Problematic changes 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Memory changes that disrupt daily life Challenges in planning or solving problems Difficulty completing familiar tasks Confusion with time or place Trouble with visual images and spatial relationships New problems with words in speaking or writing Misplacing things and losing the ability to retrace steps Decreased or poor judgment Withdrawal from work or social activities Changes in mood and personality

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What is dementia?

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Understanding dementia

Dementia Reversible dementias

Frontotemporal dementia

Vascular dementia

Lewy body disease

Alzheimer's disease 8

Problematic changes

Steve has a diagnosis of Alzheimer’s disease, the most common form of dementia. 9

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What is dementia?  Loss of cognitive functioning serious enough to interfere with daily functioning  Causes changes in: • • • • • • •

Memory Language Thought Navigation Behavior Personality/Mood Planning and Organizing

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Reversible causes of dementia Depression, delirium Emotional disorders Metabolic disorders (e.g., hypothyroidism) Eye and ear impairments Nutritional (e.g., B12 deficiency) Tumors Infections Alcohol, drugs, medication interactions 11

Irreversible types of dementia

 Alzheimer's disease: the most common type  Over 70% of people with dementia have Alzheimer’s disease

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Mild Cognitive Impairment  Severe enough to show up on tests  Not severe enough to affect daily life  Increases risk of developing Alzheimer’s disease

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Vascular dementia  Second most common form of dementia  Caused by damage as result of reduced blood flow from one or more strokes

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Mixed dementia  Alzheimer’s disease and another type of dementia can exist at the same time  This may account for nearly half of the causes where Alzheimer’s is present

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Dementia with Lewy bodies  Wide variations in attention and alertness  May include:  Hallucinations  Tremors  Rigidity

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Frontotemporal dementia  Sometimes called “Pick’s disease”  Begins at a younger age  Progresses more quickly than Alzheimer’s disease  First symptoms are usually personality changes and disorientation

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More rare types of dementia Other more rare dementias include:  Creutzfeldt-Jakob disease  Parkinson’s disease  Huntington’s disease  Normal pressure hydrocephalus  Wernicke-Korsaoff syndrome

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Alzheimer’s disease

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Lots of misconceptions

Laura’s husband, Jay, has a diagnosis of Alzheimer’s disease. 20

What is Alzheimer’s disease? Alzheimer’s disease:      

is a brain disorder is a progressive disease is the most common form of dementia has no cure is eventually fatal has been diagnosed in over 5 million Americans

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How the brain works  There are 100 billion nerve cells, or neurons, creating a branching network.  Signals traveling through the neuron forest form memories, thoughts and feelings  Alzheimer’s disease destroys neurons

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Neurons affected by Alzheimer’s disease dead cells full of tangles

sparse, damaged cells amyloid plaques withered branches

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Which functions are affected?

Language, Sense of temperature, touch, pain Vision

Basic functions, including breathing

Judgment, reasoning

Memory, language, hearing

Movement, balance

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Healthy vs. Alzheimer’s brain

Ventricles enlarge Cortex shrivels, especially near hippocampus

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Brain functioning affects memory

Kitty’s husband, Bill, has a diagnosis of Alzheimer’s disease. 26

Who is at risk?

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Major risk factors  The primary risk factor is age  The incidence is higher in women due to women living longer  Down syndrome is correlated with Alzheimer’s  Family history can increase risk  There are two categories of genes

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Frequently asked questions  If I have had a head injury, am I at greater risk for Alzheimer’s disease?  Does my diabetes and my high blood pressure put me at higher risk?  Can doing crossword puzzles reduce my risk?  Could broccoli or other foods be prevention tools?  Will memory screening tools help me avoid a visit to the doctor?

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Getting a thorough diagnosis

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Selecting a Doctor  Doctors can diagnosis Alzheimer’s disease with accuracy  Choose from:  Regular primary care physician  Geriatrician  Neurologist  Psychiatrist  Neuropsychologist

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Preparing for the doctor’s visit  Keep a log • Write a list of symptoms, be specific • Include when, how often and where • Develop the list with input from other family members

 List current and previous health problems  Bring all medication (prescriptions, vitamins, herbal supplements and over the counter medication)

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The doctor’s visit  Medical and family history  Physical and neurological exam  Lab tests  Mental status exam  May include brain imaging (MRI, CT scan)  May include neuropsych tests

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When the diagnosis is Alzheimer’s disease…

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Emotions run high

shock fear

guilt

confusion

grief anger denial

worry acceptance relief

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Stages of Alzheimer’s disease  Early Stage • Recent memory loss • Difficulty managing money, driving, or handling social situations

 Middle Stage • Difficulty with language • Problems keeping track of personal items • May need help with grooming

 Late Stage • Long- and short-term memory affected • Needs care around the clock

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Plan early

Monica Parker, MD, is a Geriatric Medicine specialist at Emory University. 37

Plan early  Be an active partner in long-term care plan  Develop a relationship with your healthcare team  Get legal and financial issues in order  Grow a support system  Educate yourself about the disease

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Medications to treat symptoms  Cholinesterase inhibitors for mild to moderate symptoms  Donepezil (Aricept®)  Rivastigmine (Exelon®)  Galantamine (Razadyne®)

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Medications to treat symptoms  NMDA receptor antagonist (glutamate regulator) for moderate to severe symptoms  Memantine (Namenda®)

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Medications to treat symptoms

Ron Petersen, MD, is Director of the Mayo Alzheimer’s Disease Research Center. 41

Clinical research studies  Clinical trials fuel progress toward treatments  Participants receive a high standard of care

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Alzheimer’s Association resources to help

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Programs and services  Educational programs for families and professionals  24-hour helpline  Information and referrals  Care consultations  Support groups  Online Community  Safety services

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Make a difference!

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Alzheimer’s advocacy  Generate action  Stay on top of policy and legislative issues  Help elevate Alzheimer’s from a disease to a cause

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Build Your Community

Betsy’s husband, John, has a diagnosis of Alzheimer’s disease. 47

To learn more …

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Contact us!  When Alzheimer’s disease touches your life turn to us  Nationwide 24-hour Helpline  Whether you need information or just want to talk, call us at 1.800.272.3900

 www.alz.org  Our award-winning Web site is a rich resource of evidence-based content

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This program is the property of the Alzheimer's Association and its contents may be used only by its authorized training staff and licensed representatives of the Association for presentations of “Memory Loss, Dementia and Alzheimer’s Disease: The Basics”. It may not be reproduced or used for any other purpose without the prior written consent of Alzheimer's Association. © 2010 Alzheimer's Association. All rights reserved.

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