Hello. Today we are going to discuss Alzheimer’s disease briefly, but focus on the “other” dementias. This is a brief overview rather than an in-depth study.
Many people worry about becoming more forgetful as they grow older. Our brains change as we age, just like the rest of our bodies. We all misplace our keys once in a while; we all enter a room forgetting why we went there in the first place. Does this mean we have “dementia”? Probably not. Serious memory loss, confusion, and other major changes in the way our minds work are not typical parts of aging. Many conditions can disrupt memory and mental function. If symptoms such as consistent poor judgment; inability to manage money; difficulty with keeping track of date or time; difficulty conversing; or misplacing things but unable to retrace steps are noticed – it is time to see a doctor. Symptoms that interfere with daily function should be addressed. However, keep in mind, there are many causes for symptoms, some causes can be treated. And that is why it is important to be checked out by a physician.
There is often confusion with terms. So, to begin let’s take a look at Dementia. Dementia is actually an umbrella term describing a variety of diseases and conditions that develop when nerve cells in the brain (called neurons) die or no longer function normally. The death or malfunction of neurons causes changes in one’s memory, behavior and ability to think clearly.
Physicians often define dementia based on the criteria given in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).(1) To meet DSM-IV criteria for dementia, the following are required: • Symptoms must include decline in memory and in at least one of the following cognitive abilities:1) Ability to speak coherently or understand spokenor written language.2) Ability to recognize or identify objects, assumingintact sensory function.3) Ability to perform motor activities, assumingintact motor abilities and sensory function andcomprehension of the required task.4) Ability to think abstractly, make sound judgmentsand plan and carry out complex tasks.• The decline in cognitive abilities must be severeenough to interfere with daily life.
To establish a diagnosis of dementia, a physician must determine the cause of the dementia-like symptoms. Some conditions have symptoms that mimic dementia but that, unlike dementia, can be reversed with treatment – such as those listed here. In contrast, dementia is caused by irreversible damage to brain cells.
Alzheimer’s disease, a progressive, degenerative disease of the brain, was first identified more than 100 years ago, but research into its symptoms, causes, risk factors and treatment has gained momentum only in the last 30 years. Although research has revealed a great deal about Alzheimer’s, the precise changes in the brain that trigger the development of Alzheimer’s, and the order in which they occur, largely remain unknown. The only exceptions are certain rare, inherited forms of thedisease caused by known genetic mutations.
AD IS Most common type of dementia; accounts for an estimated 60 to 80 percent of cases. Difficulty remembering names and recent events is often an early clinical symptom; apathy and depression are also often early symptoms. Later symptoms include impaired judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking. New criteria and guidelines for diagnosing Alzheimer’s were proposed in 2011. They recommend that Alzheimer’s disease be considered a disease that begins well before the development of symptoms.Hallmark brain abnormalities are deposits of the protein fragment beta-amyloid (plaques) and twisted strands of the protein tau (tangles) as well as evidence of nerve cell damage and death in the brain.
Previously known as multi-infarct or post-stroke dementia, vascular dementia is less common as a sole causeof dementia than is Alzheimer’s disease. Impaired judgment or ability to make plans is more likely to be the initial symptom, as opposed to the memoryloss often associated with the initial symptoms of Alzheimer’s. Vascular dementia occurs because of brain injuries such as microscopic bleeding and blood vessel blockage. The location of the brain injury determines how the individual’s thinking and physical functioning are affected. In the past, evidence of vascular dementia was used to exclude a diagnosis of Alzheimer’s disease (and vice versa). That practice is no longer considered consistent with pathologic evidence, which shows that the brain changes of both types of dementia can be present simultaneously. When any two or more types of dementiaare present at the same time, the individual is considered to have “mixed dementia.”
Includes dementias such as behavioral variant FTLD, primary progressive aphasia, Pick’s disease and progressive supranuclear palsy.Typical symptoms include changes in personality and behavior and difficulty with language. Nerve cells in the front and side regions of the brain are especially affected. No distinguishing microscopic abnormality is linked to all cases. The brain changes of behavioral variant FTLD may be present at the same time as the brain changes of Alzheimer’s, but people with behavioral variant FTLD generally develop symptoms at a younger age(at about age 60) and survive for fewer years than those with Alzheimer’s.
Rapidly fatal disorder that impairs memory and coordination and causes behavior changes. Results from an infectious misfolded protein (prion) that causes other proteins throughout the brain to misfold and thus malfunction. Variant Creutzfeldt-Jakob disease is believed to be caused by consumption of products from cattle affected by mad cow disease.
Mixed dementia is characterized by the hallmark abnormalities of AD and aother type of dementia – most commonly, vasuclar dementia, but, also, other types – such as dementia with lewy bodies. Recent studies suggest that mixed dementia is more common than previously thought.
People with DLB have some of the symptoms common in Alzheimer’s, but are more likely than people with Alzheimer’s to have initial or early symptoms such as sleep disturbances, well-formed visual hallucinations, and muscle rigidity or other parkinsonian movement features. Lewy bodies are abnormal aggregations (or clumps) of the protein alpha-synuclein. When they develop in a part of the brain called the cortex, dementia can result. Alpha-synuclein also aggregates in the brains of people with Parkinson’s disease, but the aggregates may appear in a pattern that is different from DLB.The brain changes of DLB alone can cause dementia, or they can be present at the same time as the brain changes of Alzheimer’s disease and/or vascular dementia, with each entity contributing to the development of dementia. When this happens, the individual is said to have “mixed dementia.”
As Parkinson’s disease progresses, it often results in a severe dementia similar to DLB or Alzheimer’s. Problems with movement are a common symptom early in the disease. Alpha-synuclein aggregates are likely to begin in an area deep in the brain called the substantianigra. The aggregates are thought to cause degeneration of the nerve cells that produce dopamine. The incidence of Parkinson’s disease is about one-tenth that of Alzheimer’s disease.
OVERVIEW OF DEMENTIA
Recommended pre-requisite presentation for
“The Other Dementias: Virtual Training and Active Learning on Non-Alzheimer’s
three-part series, which is made possible through a grant funded from
• Making a bad decision once in a while
• Missing an occasional monthly payment
• Forgetting which day it is and remembering
• Sometimes forgetting which word to use
• Losing things from time to time
• Consistent poor judgment and decision
• Loss of an ability to manage money
• Inability to keep track of the date or the
• Difficulty having a conversation
• Misplacing things and loss of the ability to
retrace steps to find them
There are many
causes of dementia
Is NOT a specific disease.
Alzheimer's disease is
the most common cause
of a progressive
Is a GROUP OF SYMPTOMS
affecting intellectual and social abilities
severely enough to interfere with daily
Memory loss generally occurs in
dementia, but memory loss alone does
not imply you have dementia.
2013 Alzheimer’s Disease Facts and Figures, Alzheimer’s
disease is more
than among whites
from 14% to
There is a greater
familial risk of
risk of dementia
among firstdegree relatives
of AfricanAmericans who
disease is 43.7%
Genetic and environmental factors may work differently
to cause Alzheimer’s disease in African-Americans
Data from a large-scale longitudinal study indicate that persons
with a history of either high blood pressure or high cholesterol
levels are twice as likely to get Alzheimer’s disease. Those with
both risk factors are four times as likely to become demented.
65% of African-American Medicare beneficiaries have
hypertension, compared to 51% of white beneficiaries.
They are also at higher risk of stroke.
(Data from the Current Medicare Beneficiary Survey)
African-Americans have a 60% higher risk of type 2 diabetes —
a condition that contributes directly to vascular disease.
African-Americans have a higher rate of vascular dementia than
ASSOCIATED RISK FACTORS:
Incidence higher in women
Diabetes (type 2)
No treatment available to slow or stop the deterioration of
brain cells in Alzheimer's disease.
US FDA has approved five drugs that temporarily slow
worsening of symptoms for about 6 - 12 months.
Effective for only about ½ of the individuals who take them.
INCIDENCE: AD more prevalent among African-Americans
Memory loss that
planning or solving
Changes in mood and
Withdrawal from work
or social activities
familiar tasks at
home, at work or at
Decreased or poor
Confusion with time
images and spatial
Misplacing things and
losing the ability to
New problems with
words in speaking or
VaD can be
Result of a
Approx. 2530% of all
from 1 to 4
the age of
• Untreated high blood pressure
• High cholesterol
• Heart disease
• Confusion and agitation; depression
• Unsteady gait
• Problems with memory
frequency, urgency, incontinence
• Night wandering
• Decline in ability to organize
thoughts/actions, difficulty planning
• Poor attention/concentration
Damage caused by infarcts cannot be
reversed. Future cerebrovascular
incidents can be controlled (control of
cardiovascular risk factors)
affects parts of the
brain that contain
made up of an
called tau protein
of nerve cells
in the F-T
areas of the
than AD, i.e.,
One form of
areas of the brain are
and language). In
of these lobes
• Possible genetic mutations.
• socially inappropriate behaviors
• loss of mental flexibility
• decline in personal hygiene
• language problems, and
• movement disorders
• difficulty with concentration and
CJD is a
Variant CJD is
linked primarily to
1 in 1 million
with CJD per
abnormal versions of a protein called a
Risk of CJD is low.
Cannot be transmitted through
coughing, sneezing, touching or sexual
• Spontaneously (majority of cases)
• Genetic mutation (family history)
• Contamination. (very low number of
exposures to infected human tissue
during a medical procedure)
changes, anxiety, depression, memory
loss, impaired thinking, blurred
difficulty swallowing, motor issues.
can exist at
half of the
of both PD
of those age
65, 5% over
(average = 6
PD is a
result of a
for < 5% of
Educational programs for
families and professionals
The Alzheimer's Association is the leading voluntary health
organization in Alzheimer’s, care, support and research.
Its mission is to eliminate Alzheimer’s disease through the
advancement of research; to provide and enhance care
and support for all affected; and to reduce the risk of
dementia through the promotion of brain health.
Information and referrals
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