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Dementia of the Alzheimer\'s Type


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Presentation on this population and current trends in treatment.

Published in: Health & Medicine, Education
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Dementia of the Alzheimer\'s Type

  1. 1. Dementia of the Alzheimer’s Type Presented by Sonya B-Parks
  2. 2. The Brain connection <ul><li>Neurons produce the neurotransmitter, acetylcholine, they break connections with other nerve cells and die </li></ul><ul><li>Two types of abnormal lesions: </li></ul><ul><ul><li>Beta-amyloid plaques </li></ul></ul><ul><ul><li>neurofibrillary tangles </li></ul></ul>
  3. 3. Brain connection cont.
  4. 4. Criteria for Dementia of the Alzheimer’s Type 294.1x <ul><li>-Development of multiple cognitive deficits manifested by (1) memory impairment (2) plus one (or more) of the following: </li></ul><ul><li>a. aphasia (language disturbance) </li></ul><ul><li>b. apraxia (inability to carry out motor activities despite intact mobility) </li></ul><ul><li>c. agnosia (failure to identify objects despite intact senses) </li></ul><ul><li>d. disturbance in executive functioning (i.e., planning, organizing, abstracting) </li></ul><ul><li>-Symptoms impair social/occupational functioning-a decline from previous level. Gradual onset, continuing cognitive decline </li></ul><ul><li>-Cognitive deficits are not due to the following: </li></ul><ul><li>1. other central nervous disease </li></ul><ul><li>2. systemic conditions </li></ul><ul><li>3. substance-induced conditions </li></ul><ul><li>-Deficits do not occur solely during a delirium and are not better accounted for by another Axis I disorder </li></ul>
  5. 5. Coding Alzheimer’s <ul><li>Based on presence of disturbed behavior: </li></ul><ul><li>294.10 Without Behavioral Disturbance </li></ul><ul><li>294.11 With Behavioral Disturbance </li></ul><ul><li>Specify subtype: </li></ul><ul><li>With Early Onset-65 </li></ul><ul><li>With Late Onset-65 </li></ul><ul><li>Codes often used: </li></ul><ul><li>331.0 Alzheimer's disease on Axis III </li></ul><ul><li>310.1 Personality Change Due to Alzheimer's Disease, Aggressive Type </li></ul><ul><li>293.83 Mood Disorder Due to Alzheimer's Disease, With Depressive Features </li></ul>
  6. 6. Stages of Alzheimer’s dementia <ul><li>Stage 1-Early </li></ul><ul><li>Low motivation, learning, and reactions, short-term memory loss </li></ul><ul><li>Stage 2-Mild </li></ul><ul><li>Memory worsens, slowed speech, difficulty making decisions </li></ul><ul><li>Stage 3-Moderate </li></ul><ul><li>Inappropriate behavior, impaired judgment, problems expressing self </li></ul><ul><li>Stage 4-Late </li></ul><ul><li>Unable to communicate, and take care of basic needs </li></ul>
  7. 7. Illustration of Stages <ul><li> </li></ul>
  8. 8. Probable Alzheimer's <ul><li>MMSE & Cognitive functions: language (aphasia), motor skills (apraxia), and perception (agnosia) </li></ul><ul><li>Impaired activities of daily living and altered behavior </li></ul><ul><li>Family history </li></ul><ul><li>The following lab results: </li></ul><ul><ul><li>Normal cerebrospinal fluid (lumbar puncture test). </li></ul></ul><ul><ul><li>Normal electroencephalogram (EEG) test of brain activity. Evidence of cerebral atrophy in a series of CT scans. </li></ul></ul>
  9. 9. Facts and Figures for 2008 <ul><li>5.2 million Americans living with Alzheimer’s and that number is expected to </li></ul><ul><li>grow to as many as 16 million by 2050. </li></ul><ul><li>Today, every 71 seconds an American develops Alzheimer’s. By mid-century an American will develop Alzheimer’s every 33 seconds. </li></ul><ul><li>A quarter million American children age 8 -18 yrs old are caring for a loved one with Alzheimer’s </li></ul><ul><li>Seventy percent of people with Alzheimer’s live at home </li></ul><ul><li>Alzheimer’s is the seventh leading cause of death in U.S. </li></ul><ul><li>Alzheimer’s is the 5th leading cause of death in people over 65 years old </li></ul>
  10. 10. Risk factors <ul><li>Age </li></ul><ul><li>Type 2 diabetes </li></ul><ul><ul><li>High-blood pressure </li></ul></ul><ul><ul><li>High cholesterol </li></ul></ul><ul><ul><li>Obesity? </li></ul></ul><ul><li>Down’s Syndrome </li></ul><ul><li>Head Injury </li></ul>
  11. 11. Gender <ul><li>One in six women and one in ten men who reach age 55 can expect to develop Alzheimer’s in their remaining lifetime. </li></ul><ul><li>More women will develop Alzheimer’s because they live longer than men, on average. </li></ul>
  12. 12. Contextual Issues-Prevalence <ul><li>Education and Occupation </li></ul><ul><ul><li>Fewer years, increased risk </li></ul></ul><ul><li>Race/Ethnicity </li></ul><ul><ul><li>African-Americans </li></ul></ul><ul><ul><li>Latinos </li></ul></ul><ul><ul><li>Okinawan’s </li></ul></ul>
  13. 13. Medical treatment <ul><li>There are numerous medications to treat cognitive symptoms: </li></ul><ul><ul><li>Donepezil (Aricept) </li></ul></ul><ul><ul><li>Rivastigmine (Exelon) </li></ul></ul><ul><ul><li>Galantamine (Razadyne), </li></ul></ul><ul><li>Anti-psychotics for hallucinations and delusions: </li></ul><ul><ul><li>haloperidol (Haldol) and atypical antipsychotic agents such as risperidone </li></ul></ul><ul><li>Antidepressant medications for low mood and irritability: </li></ul><ul><ul><li>citalopram (Celexa) </li></ul></ul><ul><ul><li>fluoxetine (Prozac) </li></ul></ul><ul><ul><li>paroxeine (Paxil) </li></ul></ul><ul><ul><li>sertraline (Zoloft) </li></ul></ul>
  14. 14. Etiological Issues <ul><li>Psychological </li></ul><ul><li>Biological </li></ul><ul><li>Social </li></ul><ul><li>Familial </li></ul>
  15. 15. Implications for Tx <ul><li>Long-term counseling </li></ul><ul><ul><li>Patient </li></ul></ul><ul><ul><li>Caregivers </li></ul></ul><ul><li>Residential care </li></ul><ul><li>Adult-daycare and activity programs </li></ul><ul><li>Support groups </li></ul>
  16. 16. <ul><li>Ethics of Genetic Testing for Dementia </li></ul><ul><li>Gene Therapy </li></ul><ul><li> </li></ul><ul><li>Vaccine </li></ul><ul><li>Ginkgo biloba and vitamin E </li></ul>Gene therapy and future research
  17. 17. Warning Signs <ul><li>Memory Loss: One of the most common early signs of dementia is forgetting recently learned information. While it’s normal to forget appointments, names or telephone number, those with dementia will forget such things more often and not remember them later. </li></ul><ul><li>Difficulty Performing Familiar Tasks: People with dementia often find it hard to complete everyday tasks that are so familiar we usually do not think about how to do them. A person with Alzheimer's may not know the steps for preparing a meal, using a household appliance or participating in a lifelong hobby. </li></ul><ul><li>Problems with Language: Everyone has trouble finding the right word sometimes, but a person with Alzheimer’s often forgets simple words or substitutes unusual words, making his or her speech or writing hard to understand. If a person with Alzheimer's is unable to find his or her toothbrush, for example, the individual may ask for &quot;that thing for my mouth.&quot; </li></ul><ul><li>Disorientation to Time and Place: It's normal to forget the day of the week or where you're going. But people with Alzheimer's disease can become lost on their own street. They may forget where they are and how they got there, and may not know how to get back home. </li></ul><ul><li>Poor or Decreased Judgment: No one has perfect judgment all of the time. Those with Alzheimer's may dress without regard to the weather, wearing several shirts on a warm day or very little clothing in cold weather. </li></ul><ul><li>Problems with Abstract Thinking: Balancing a checkbook is a task that can be challenging for some. But a person with Alzheimer's may forget what the numbers represent and what needs to be done with them. </li></ul><ul><li>Misplacing Things: Anyone can temporarily misplace a wallet or key. A person with Alzheimer's disease may put things in unusual place like an iron in the freezer or a wristwatch in the sugar bowl. </li></ul><ul><li>Changes in Mood or Behavior: Everyone can become sad or moody from time to time. Someone with Alzheimer's disease can show rapid mood swings - from calm to tears to anger - for no apparent reason. </li></ul><ul><li>Changes in Personality: Personalities ordinarily changes somewhat with age. But a person with Alzheimer's can change dramatically, becoming extremely confused, suspicious, fearful or dependent on a family member. </li></ul><ul><li>Loss of Initiative: It's normal to tire of housework, business activities or social obligations at times. The person with Alzheimer's disease may become very passive. </li></ul><ul><li>If you recognize any warning signs in yourself or a loved one, the Alzheimer's Association recommends consulting a physician. Early diagnosis of Alzheimer's disease or other disorders causing dementia is an important step to getting appropriate treatment, care and support services. </li></ul>
  18. 18. Prevention <ul><li>1. Head first </li></ul><ul><li>Good health starts with your brain. It’s one of the most vital </li></ul><ul><li>body organs, and it needs care and maintenance. </li></ul><ul><li>2. Take brain health to heart </li></ul><ul><li>What’s good for the heart is good for the brain. Do </li></ul><ul><li>something every day to prevent heart disease, high blood </li></ul><ul><li>pressure, diabetes and stroke – all of which can increase </li></ul><ul><li>your risk of Alzheimer’s. </li></ul><ul><li>3. Your numbers count </li></ul><ul><li>Keep your body weight, blood pressure, cholesterol and blood </li></ul><ul><li>sugar levels within recommended ranges. </li></ul><ul><li>4. Feed your brain </li></ul><ul><li>Eat less fat and more antioxidant-rich foods. </li></ul><ul><li>5. Work your body </li></ul><ul><li>Physical exercise keeps the blood flowing and may encourage </li></ul><ul><li>new brain cells. Do what you can – like walking 30 minutes </li></ul><ul><li>a day – to keep both body and mind active. </li></ul><ul><li>6. Jog your mind </li></ul><ul><li>Keeping your brain active and engaged increases its vitality </li></ul><ul><li>and builds reserves of brain cells and connections. </li></ul><ul><li>Read, </li></ul><ul><li>write, play games, learn new things, do crossword puzzles. </li></ul><ul><li>7. Connect with others </li></ul><ul><li>Leisure activities that combine physical, mental and social </li></ul><ul><li>elements may be most likely to prevent dementia. Be social, </li></ul><ul><li>converse, volunteer, join a club or take a class. </li></ul><ul><li>8. Heads up! Protect your brain </li></ul><ul><li>Take precautions against head injuries. Use your car seat belts; </li></ul><ul><li>unclutter your house to avoid falls; and wear a helmet when </li></ul><ul><li>cycling or in-line skating. </li></ul><ul><li>9. Use your head </li></ul><ul><li>Avoid unhealthy habits. Don’t smoke, drink excessive alcohol </li></ul><ul><li>or use street drugs. </li></ul><ul><li>10. Think ahead - start today! </li></ul><ul><li>You can do something today to protect your tomorrow. </li></ul>
  19. 19. Final Thoughts and ? <ul><li>Practicum </li></ul><ul><li>100 years </li></ul><ul><li>Questions? </li></ul>
  20. 20. References <ul><li>Alzheimer’s Disease . (n.d.). Retrieved March 31, 2008, from </li></ul><ul><li>Alzheimer’s Disease . (n.d.). Retrieved March 31, 2008, from </li></ul><ul><li>Alzheimer’s Disease . (n.d.). Retrieved March 31, 2008, from </li></ul><ul><li>American Psychiatric Association. (2000). (DSM-IV-TR) Diagnostic and statistical manual of mental disorders-text revision , (4th ed.). Washington, DC: American Psychiatric Press, Inc. </li></ul><ul><li>Seligman, L. & Reichenberg, L. W. (2007). Selecting effective treatments: A comprehensive, systematic guide to treating mental disorders (Rev. Ed.). San Francisco: Jossey-Bass. </li></ul>