Learn the basics of Dementia

1. Decontee “Dr. Dee”Jimmeh, MD
Norwood Clinic/ Brookwood Medical Center
September 30, 2014

2.  Epidemiology
 Definition/Criteria
 Clinical Staging
 Evaluation
 Associated Symptoms
 Management

3. Forgetting has become part of who Daddy is,
so I decide to try to honor his forgetfulness. I
try to love it. It defines his being these days,
and sometimes I feel that to see him I have to
look through it, a shuttered window.
Underneath the forgetting lie a few
remembered things, shoelaces, the way to
hold a razor to shave, song-lyrics he recalls,
like cockles and mussels- but you have to
catch them at the right moment of the day,
when they shine through the slats. Daddy is
Daddy now because he forgets.
-ELIZABETH COHEN
The House on Beartown Road: A Memoir of Learning and
Forgetting London (p.196-7)

4. www.alz.org
www.youtube.com/watch?v=waeuks1-
3Z4#action=share

5.  6th leading cause of death in the US
 More than 5,000,000 are currently living with
the disease.
 Every 67 seconds, someone develops
dementia in the US.
 Dementia costs in the US: $220 billion

6.  Dementia: a progressive, NON-reversible
decline in cognitive function that
significantly impacts daily activities and
social interaction

8.  Memory loss that interrupts daily life
 Challenges in problem-solving and planning
 Difficulty completing tasks
 Confusion with time or place
 Trouble understanding visual images and spatial
relationship
 New problems with words in speaking or writing
 Misplacing things and inability to retrace steps
 Decreased or poor judgment
 Withdrawal from work or social activities
 Changes in mood and personality

9.  Stage 1 (No impairment)
 Normal
 Stage 2 (Very mild)
 Person notices memory lapses
 No symptoms noticed by family, friends or doctor
 Stage 3 (Mild)
 Family and friends start to observe problem
 MMSE picks up deficits
 Stage 4 (Moderate)
 Difficulty with calculation, forgetting one’s own
personal history, social withdrawal begins

10.  Stage 5 (Moderate severe)
 Begin needing help with day to day activities
 Remain independent with eating and toileting
 Stage 6 (Severe)
 Lose awareness of surroundings and need with
most ADLs
 Major personality issues; Tend to wander and get
lost
 Stage 7 (Very Severe)
 Little to no speech production, rigid muscles,
impaired swallowing; Loss of interaction with the
environment

11.  Alzheimer’s (AD)
Vascular dementia
 Mixed dementia
Frontotemporal
dementia
Dementia with
Lewy bodies
Subcortical
dementias

12. http://farmagain.com/braininjury.html

13.  Most common type
 Onset age: >60 years of age
 Accumulation of abnormal proteins
(neurofibrillary tangles/ amyloid plaques)
 Temporal and parietal lobes heavily affected
 Early onset disease associated with
chromosome 21

14.  Also known as multi-infarct dementia
 “Step-wise” progression
 Diverse clinical presentation
 Risk factors: diabetes, hypertension, and
high cholesterol

15.  History & Physical
 Mini Mental Status Exam
 Labs: B12, thyroid function, liver enzymes,
ammonia, RPR, glucose
 Neuropsychological testing
 CT head or brain MRI

18.  History & Physical
 Mini Mental Status Exam
 Labs: B12, thyroid function, liver enzymes,
ammonia, RPR, glucose
 Neuropsychological testing
 CT head or brain MRI

21.  There is NO cure for dementia.
 Medication options seek to slow disease
progression
 Cholinesterase inhibitors (Donezepil,
Galantamine, Rivastigmine)
 NMDA receptor antagonist (Memantine)
 Other agents
 E.g. Fish oil, ginkgo biloba, vitamin E
 No definite improvement in clinical trials

22.  The mainstay of treatment is symptom
management
 Examples of symptoms:
 Depression
 Sleep disorder
 Agitation
 Sexually inappropriate behavior
 Wandering
 Falls

23.  A dementia mimic
 Co-morbid illness
 SSRIs
 Citalopram and Sertraline are good choices
 Paroxetine not ideal (most anticholinergic)
 Fluoxetine (long ½ life; drug-drug interactions
 Start low and titrate slowly
 Atypicals may be of some utility
 Effexor, Wellbutrin, Remeron

24.  Multifactorial
 Sleep-wake cycle alterations, decreased daytime
physical activity, anxiety/depression, nocturia,
and medication side effects
 Treatment
 Avoid daytime naps
 Daytime activity/exercise program
 Limiting evening liquid intake
 Go to bed and wake at the same time daily
 Medications: Melatonin, Trazadone, Remeron

25.  Typically is a response or reactions to
misperceptions of the environment
 Precipitating factors:
 Confusion because of cognitive, memory,
language deficits
 Frightening, paranoid delusions or hallucinations
 Pain or discomfort
 Depression
 Sleep disorder
 Other medical illness (e.g. UTI, pneumonia)
 New medications

26.  Keep a daily routine
 Avoid sudden changes in environment
 Frequent re-orientation
 Encourage good sleep hygiene
 Avoid physical restraints
 Redirection/distraction
 Use short, clear statements
 Use calm reassurance; Avoid reprimanding
 Music therapy
 Aromatherapy

27.  Drugs to uses:
 SSRIs (citalopram)
 Atypical antipsychotics (quetiapine, olanzapine,
risperidone)
 Drugs to avoid:
 Anti-cholinergic medications
 Anti-histamine medications
 Benzodiazepines
 Paradoxical effect

28.  All patients are at risk
 Common in stage 4 and beyond
 Alarms on doors; Noisy garments; proofing
locks on cabinets with dangerous or
flammable items
 SAFE RETURN program
 www.alz.org/Services/SafeReturn.asp
 1.800.625.3780

29.  Major safety issue in the elderly, especially
the demented
 Visuo-spatial deficits, muscle stiffness, lossof
postural reflexes, and impulsivity increases
risk
 Avoid clutter in walkways, use of handrails,
nonslip mats and other assistive devices
 Physical and Occupational Therapy

30.  ABC News Report
 www.youtube.com/watch?v=LL_Gq7Shc-Y
 Caregivers’ Support
 Resource referral
 End of life planning (legal and financial)
 Personal respite
 Counseling for grief and guilt

31.  Dementia is a slowly progressive condition that
affects cognition and has NO cure.
 Alzheimer’s and vascular dementia are the two most
common types.
 Patients present differently and progress through the
various stages at various rates
 Mainstay treatment includes non-pharmacologic
therapies, along with medicines, that impede
progression along with symptom management.
 Caregiver support and patient empathy are essential
to better outcomes.

33.  Follow Dr. Dee
 Twitter: @drdeejimmeh
 Facebook: Decontee “Dr. Dee” Jimmeh, MD
 Contact Dr. Dee
 Brookwood Medical Center, Professional Office
Building, Suite 301
 Phone 205-250-6940 Fax 205-250-6942
 www.norwoodclinic.com