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  • 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.
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  • 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.
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    1. 1. Recommended pre-requisite presentation for “The Other Dementias: Virtual Training and Active Learning on Non-Alzheimer’s Dementias” three-part series, which is made possible through a grant funded from
    2. 2. TYPICAL CHANGES • Making a bad decision once in a while • Missing an occasional monthly payment • Forgetting which day it is and remembering later • Sometimes forgetting which word to use • Losing things from time to time A-TYPICAL CHANGES • Consistent poor judgment and decision making • Loss of an ability to manage money • Inability to keep track of the date or the season • Difficulty having a conversation • Misplacing things and loss of the ability to retrace steps to find them
    3. 3. There are many causes of dementia symptoms. Is NOT a specific disease. Alzheimer's disease is the most common cause of a progressive dementia. Is a GROUP OF SYMPTOMS affecting intellectual and social abilities severely enough to interfere with daily functioning. Memory loss generally occurs in dementia, but memory loss alone does not imply you have dementia.
    4. 4. memory language Dementia causes changes in: thought navigation behavior personality/ mood
    5. 5. • Depression/delirium • Medication sideeffects • Excess alcohol use • Thyroid problems • Poor diet • Vitamin deficiencies • Certain infections Reversible DEMENTIAS • • • • Alzheimer’s disease Parkinson’s Lewy-body dementia Etc. Irreversible
    6. 6. 2013 Alzheimer’s Disease Facts and Figures, Alzheimer’s Association
    7. 7. Alzheimer’s disease is more prevalent among African-Americans than among whites Estimates range from 14% to almost 100% higher; There is a greater familial risk of Alzheimer’s in African-Americans The cumulative risk of dementia among firstdegree relatives of AfricanAmericans who have Alzheimer’s 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 white Americans. http://www.alz.org/national/documents/report_africanamericanssilentepidem
    8. 8. Brain disorder, most common form of dementia Affects 5% of people at age 65 Affects 50% of people age 85+ ASSOCIATED RISK FACTORS: • • • • • • • • • • TREATMENT: • • Late-onset (65+) is most common, s lowestprogressin g Average course of DAT: 6-20 years Age Family history Down syndrome Incidence higher in women Alcohol use Atherosclerosis Blood pressure Cholesterol Depression 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. Inconclusive research: Vitamin E Anti-inflammatory drugs Estrogen Vaccine Diet INCIDENCE: AD more prevalent among African-Americans and Hispanics
    9. 9. Plaques Acethylcholine Deficiency Tangles
    10. 10. Memory loss that disrupts daily functioning Challenges in planning or solving problems Changes in mood and personality Withdrawal from work or social activities Difficulty completing familiar tasks at home, at work or at leisure Decreased or poor judgment Confusion with time or place Trouble understanding visual images and spatial relationships Misplacing things and losing the ability to retrace steps New problems with words in speaking or writing
    11. 11. VaD can be cortical and subcortical 2nd most common dementia after Alzheimer's disease Result of a damage to the brain caused by problems with the arteries serving the brain or heart. Approx. 2530% of all dementias are VaD Prevalence of VaD ranges from 1 to 4 percent in people over the age of 65. CAUSES: • Untreated high blood pressure • Diabetes • High cholesterol • Heart disease ASSOCIATED SYMPTOMS: • Confusion and agitation; depression • Unsteady gait • Problems with memory • Urinary frequency, urgency, incontinence • Night wandering • Decline in ability to organize thoughts/actions, difficulty planning • Poor attention/concentration TREATMENT: Damage caused by infarcts cannot be reversed. Future cerebrovascular incidents can be controlled (control of cardiovascular risk factors)
    12. 12. Pick's disease affects parts of the brain that contain fibrous tangles made up of an abnormal protein called tau protein Group of diseases characterized by the degeneration of nerve cells in the F-T areas of the brain Begins earlier and progresses faster than AD Occurs at ages younger than AD, i.e., 40-70. One form of this condition is Pick's disease. (Fronto-temporal areas of the brain are generally associated with personality, behavior and language). In these dementias, portions of these lobes atrophy. CAUSES: • Unknown • Possible genetic mutations. ASSOCIATED SYMPTOMS: • socially inappropriate behaviors • loss of mental flexibility • decline in personal hygiene • language problems, and • movement disorders • difficulty with concentration and thinking.
    13. 13. CJD is a degenerative brain disorder that leads to dementia and, ultimately, death. (rapid progression) Variant CJD is linked primarily to eating beef infected with bovine spongiform encephalopathy (mad cow disease. The "classic" CreutzfeldtJakob disease has not been linked to contaminated beef. 1 in 1 million people are diagnosed with CJD per year (usually older adults). CAUSES: abnormal versions of a protein called a prion. TRANSMISSION Risk of CJD is low. Cannot be transmitted through coughing, sneezing, touching or sexual contact. CJD DEVELOPS: • Spontaneously (majority of cases) • Genetic mutation (family history) • Contamination. (very low number of exposures to infected human tissue during a medical procedure) ASSOCIATED SYMPTOMS: personality changes, anxiety, depression, memory loss, impaired thinking, blurred vision, insomnia difficulty swallowing, motor issues.
    14. 14. Dementia Multifactorial AD and another type of dementia can exist at the same time MD: nearly half of the cases where AD is present
    15. 15. Deposition of Lewy bodies in both, cortical and subcortical Has features of both PD and AD Affects 1% of those age 65, 5% over age 85 Usually progresses more rapidly than DAT (average = 6 years)
    16. 16. PD is a progressi ve disorder of the CNS Results from a deficiency in the neurotran smitter DOPAMIN E Affects more than 1.5 million people in the US 20-40% have more severe symptom s/ dementia 50%+ of people with PD have MCI.
    17. 17. Sometimes referred to as WernickeKorsakoff’s syndrome A dementia syndrome caused by many years of heavy drinking Usually the result of a combo: malnutrition + brain damage directly caused by alcohol Accounts for < 5% of all dementias
    18. 18. Dementia of the Alzheimer’s type Mixed Dementias Vascular Dementia Huntington’s Disease Dementia Frontotemporal Dementia Normal Pressure Hydrocephalus Lewy Body Dementia Parkinson’s Disease Dementia Alcoholinduced Dementia CJD
    19. 19. Educational programs for families and professionals 1-800 272-3900 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. • • • • • • 24-hour Helpline Information and referrals Care consultation Support groups Online community Safety services www.alz.org
    20. 20. www.vda.virginia.gov
    21. 21. Virginia Easy Access is a FREE resource providing a simple method to search for specific services anywhere in Virginia. Virginia Easy Access is a gateway to VirginiaNavigator (which lists over 21,000 programs and services throughout the Commonwealth) and to the 2-1-1 Virginia Call Center. easyaccess.virginia.gov
    22. 22. seniornavigator.org
    23. 23. www.sahp.vcu.edu/gerontology/