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ALZHEIMERS AND DEMENTIA UPDATE TOMA 2006 G. BARRY ROBBINS, D.O., FACN Associate Professor and Chair Department of Neurobehavioral Sciences KCOM a college of ATSU
 
Goals ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Number of People Age 65 and Over, by Age Group,  Selected Years 1990-2000 and Projected 2010-2050 Federal Interagency Forum on Aging-Related Statistics 2004 , Older Americans
Future Demographics ,[object Object],[object Object],[object Object],[object Object]
Epidemiology of Dementia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Prevalence  of Dementia  in USA ,[object Object],[object Object],[object Object],[object Object]
Alzheimer’s Disease Prevalence and Incidence ,[object Object],[object Object],[object Object],[object Object]
Dementia World Prevalence   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Memory in typical aging ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pseudo-Dementia   ,[object Object],[object Object],[object Object],[object Object]
Clinical Definition of Dementia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Psychometric Definition of Dementia ,[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Criteria for Dementia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mild cognitive impairment ,[object Object],[object Object]
Pathogenesis of Mild Cognitive Impairment
Mild cognitive impairment (MCI) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MCI (Amnesic type) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pittsburg Compound-B (PiB) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J. NeuroSci, Aug 24, 2005
Dementia Syndromes   ,[object Object],[object Object],[object Object],[object Object],Not All Dementing Illnesses Are Alike Syndrome overlap is common
Differential Diagnosis of Dementia 5% 10% 65% 5% 7% 8% Dementia with Lewy bodies   Parkinson’s disease   Diffuse Lewy body disease   Lewy body variant of AD Vascular dementias and AD Other dementias   Frontal lobe dementia   Creutzfeldt-Jakob disease   Corticobasal degeneration Progressive supranuclear palsy   Many others AD and dementia with Lewy bodies Vascular dementias Multi-infarct dementia Binswanger’s disease AD Small et al, 1997; APA, 1997; Morris, 1994.
Genetics of Alzheimer’s Disease
AD Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neurological Disease: Alzheimer’s Disease The Burden of Neurological Disease – The Human Burden ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neurological Disease: Alzheimer’s Disease The Burden of Neurological Disease – The Economic Burden ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alzheimer’s Disease The Future Cost of Neurological Disease ,[object Object],[object Object]
Diagnostic Criteria for the Anterograde Amnesic Syndrome of Alzheimer’s Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Criteria  (cont’) ,[object Object],[object Object],[object Object],[object Object]
Amnesic Syndrome of AD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alzheimer’s Disease Spect Scan
Diagnostic Criteria for Dementia with Cerebrovascular Disease ,[object Object],[object Object],[object Object],[object Object]
Dementia Due to Cerebrovascular Disease (VaD) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VaD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vascular Dementia
Vascular Dementia Spect Scan
Dementia Associated with Parkinsonism: Dementia with Lewy Bodies (DLB) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DLB ,[object Object],[object Object],[object Object],[object Object],[object Object]
DBL Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Progressive Supranuclear Palsy (PSP) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Progressive Supranuclear Palsy Facial appearance “ Poker face”
Progressive  Supranuclear Palsy Retrocollis (neck extension)
Progressive  Supranuclear Palsy Paresis of vertical gaze (Downward paresis)
Cognitive-Behavioral Syndrome of Frontotemporal Dementia (FTD) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
FTD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neuropathology of FTD ,[object Object],[object Object],[object Object],[object Object]
Fronto-Temporal  Dementia Spect scan
Rapidly Progressive Dementias ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical CJD – 80%  occurrence   between 50-70 yrs. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1/3 1/3 1/3 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Major Clinical Signs in Sporadic Creutzfeldt-Jakob Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],New England Journal of Medicine , vol. 339, Nov.-Dec. 1998 Sign Frequency %
Comparison of New-Variant and Sporadic Creutzfeldt-Jakob Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],New England Journal of Medicine , vol. 339, Nov.-Dec. 1998 Characteristic New Variant Sporadic
Mental Status and functional Assessments ,[object Object],[object Object],[object Object],[object Object]
Assessment of Daily Activities ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mental Status Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mini-Cog Assessment for Dementia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Scoring of the CDT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Int J Geriatr Psychiatry 2000 15(11): 1021-1027
Diagnosing AD in primary care cognitive assessment The Clock Draw Test  Cognitive Assessment Time: 5.00  Score: 7 (normal)  Time: 'no real time'  Score: 2 (demented)  Thalmann et al 1996.  Time: .10.30  Score: 3 (demented)  Time: 1/4 past 25  Score: 3 (demented)
Laboratory Evaluation of Dementia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hierarchical Approach to Diagnosing Dementia
Neurological Disease: Alzheimer’s Disease The Human Value ,[object Object],[object Object],[object Object],[object Object]
Neurological Disease: Alzheimer’s Disease The Economic Value ,[object Object],[object Object],[object Object],[object Object]
Functional Features of the Cholinergic System
Progress and Future Direction in the Diagnosis of Dementia ,[object Object],[object Object],[object Object],[object Object]
Alzheimer’s Disease Senile Plaque
Plaques and Tangles In Alzheimer’s Disease
Neurotrophins   ,[object Object],[object Object]
Reduction of A   burden in entorhinal cortex In PDAPP mice following A   injection
Healthy Longevity Plan   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cardiovascular Disease: Heart Disease and Stroke The Human Value Death Rates for Coronary Heart Disease, 1950-1998 National Center for Chronic Disease Prevention and Health Promotion 2003,  The Burden of Chronic Disease and the Future of Public Health

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Editor's Notes

  1. This lecture which has been developed to provide you with the latest information about the diagnosis and treatment of Alzheimer's disease. Alzheimer's disease was ignored by the research and medical communities for many years and was felt to be an untreatable condition with an inexorable and relentless declining course. This has changed. Funding for Alzheimer's disease research is now the third largest item in the NIH budget . As a result, new discoveries are occurring every day and our knowledge of this disease and our ability to treat it are increasing rapidly. This module is designed to provide you with an update on some of that new knowledge. We will first discuss the epidemiology and pathogenesis of Alzheimer's disease. Then, we will talk about the diagnosis and treatment of this condition.