2011 Alzheimer’s Disease Facts and Figures Dementia caregiver spouses had 6 times therisk of incident dementia compared to those who had spouses without dementia Norton MC, J Am Geriatr Soc 2010
Work Force Concerns• 57 new geriatric psychiatrists certified per year• 54/120 (45%) training spots filled per year• Now: 1 geri psych doc per 23,000 patients• 2030: 1 geri psych doc per 27,000 patients ABPN, 2010 Annual Report Jeste DV, Psychtri News 2012
In a Nutshell Chronic DiseasesLifestyle Engagement
Increased risk for cognitive decline All low level of evidence• Low plasma selenium• Depression• Diabetes• Metabolic syndrome• Current tobacco use Williams JW, AHRQ Publication No. 10-E005 2010
Increased risk factors for AD Moderate Level of Evidence Low Level of Evidence• Conjugated equine estrogen + • Some NSAID’s methyl progesterone • Depression • Diabetes • Mid-life hyperlipidemia • Traumatic brain injuries in • Pesticide exposure • Never married, less social support • Current tobacco use Williams JW, AHRQ Publication No. 10-E005 2010
My ApproachHeart HealthyCognitive EngagementRegularly Scheduled SocialEngagement
Heart Healthy• “Anything associated with keeping your heart healthy.”• Physical exercise• Low fat, low cholesterol diet• No smoking
Physical Exercise“Physical exercise on more days then not for at least 30 min at a pace that you cannot carry a conversation.”
Regular Cognitive Engagement• ANY mentally stimulating activity - Reading - Puzzles - Games - Musical instruments• Pick what you may already be doing• Pick what you like doing
Regular Scheduled Social Engagement• Regular: AT LEAST once weekly• Scheduled: Combats apathy, supplies structure• Does not include errands or chores
• Disease• Life Story• Dimensions (Personality)• Motivated Behaviors
References• Dotson VM, Beydoun MA, Zonderman AB. Recurrent depressive symptoms and the incidence of dementia and mild cognitive impairment. Neurology 2010;75:27-34.• Emery VOB. Alzheimer disease: Are we intervening too late? Pro. J Neural Trans 2011;118:1361-1378.• Gu Y, Schupf N, Cosentino SA, et al. Nutrient intake and plasma beta-amyloid. Neurology 2012;78:1832-1840.• Jeste DV. Aging and mental health: Bad news and good news. Psychiatr News 2012; 4:3.• Katon W, Lyles CR, Parker MM, et al. Association of depression with increased risk of dementia in patients with type 2 diabetes: The Diabetes and Aging Study. Arch Gen Psychiatry 2012;69:410- 417.
References• McHugh PR & Slavney PR. Perspectives of Psychiatry. The Johns Hopkins University Press, 2nd edition, 1998.• Miller KJ, Siddarth P, Gaines JM, et al. The memory fitness program: Cognitive effects of a healthy aging intervention. Am J Geriatri Psychiatry 2012;20:514-523.• Norton MC, Smith KR, Ostbye T, et al. Greater risk of dementia when spouse has dementia? The Cache County study. JAGS 2010; 58:895-900.• Pimentel-Coelho PM & Rivest S. The early contribution of cerebrovascular factors to pathogenesis of Alzheimer’s disease. Eur J Neurosci 2012;35:1917-1937.• Rodrigue KM, Kennedy KM, Devous MD, et al. Beta-amyloid burden in healthy aging: Regional distribution and cognitive consequences. Neurology 2012;78:387-395.
References• Singh-Manoux A, Czernichow C, Elbaz A, et al. Obesity phenotypes in midlife and cognition in early old age: The Whitehall II cohort study. Neurology 2012;79:755-762.• Solomon A, Kivipelto M, Soininen H. Prevention of Alzheimer’s disease: Moving backward through the lifespan. J Alzheimer Dis 2012 [In Press].• Vemuri P, Lesnick TG, Przybelski SA, et al. Effect of lifestyle activities on AD biomarkers and cognition. Ann Neurol 2012 [In Press]• Vigen CLP, Mack WJ, Keefe RSE, et al. Cognitive effects of atypical antipsychotic medications in patients with Alzheimer’s disease: Outcomes from CATIE-AD. Am J Psychiatry 2011;168:831-839.