Alzheimer’s Disease & Dementia Presented by Zanda Hilger, M.Ed., LPC representing Dallas Area Agency on Aging

What is Alzheimer’s Disease & Dementia? Dementia is a a chronic or persistent disorder of the mental processes caused by brain disease or injury & marked by memory disorders, personality changes, & impaired reasoning. Alzheimer's disease is the most common type of dementia that causes problems with memory, thinking & behavior. Symptoms usually develop slowly & get worse over time, becoming severe enough to interfere with daily tasks.

10 Warning Signs 1. Memory loss 2. Trouble planning and problem solving 3. Daily tasks are a challenge 4. Times and places are confusing? 5. Changes in vision 6. Words and conversations are frustrating 7. You lose things 8. Lapse in judgment 9. Social withdrawal 10. Mood changes

Alzheimer’s Disease Incurable, degenerative, & terminal disease. Alzheimer's disease (AD) is a slowly progressive disease of the brain, characterized by impairment of memory & eventually by disturbances in reasoning, planning, language, & perception. Many scientists believe that Alzheimer's disease results from an increase in the production or accumulation of a specific protein (beta-amyloid protein) in the brain that leads to nerve cell death. “Plaques & tangles” First described by a German psychiatrist & neuropathologist Alois Alzheimer in 1906 & was named after him.

Types of Dementia - Source Alzheimer’s Association alz.org Creutzfeldt-Jakob Disease *Dementia with Lewy Bodies Down Syndrome as the individual ages Frontotemporal Dementia Huntington's Disease Mild Cognitive Impairment Mixed Dementia Normal Pressure Hydrocephalus Posterior Cortical Atrophy *Parkinson's Disease Dementia Traumatic Brain Injury *Vascular Dementia Korsakoff Syndrome * Increasingly diagnosed or recognized

Statistics of Alzheimer’s Disease Generally, it is diagnosed in people over 65 years of age, although the less-prevalent early onset of Alzheimer’s can occur much earlier. Estimated 5.3 million in the US in 2015, mostly in those age 65 & older. Barring the development of medical breakthroughs, the number of Americans with Alzheimer's disease will rise to 13.8 million by 2050 Alzheimer’s is predicted to affect 1 in 85 people globally by 2050.

Diagnosis Usually diagnosed from the patient history, collateral history from relatives, & clinical observations, Based on the presence of characteristic neurological & neuropsychological features, ruling out other illnesses. Advanced medical imaging with computed tomography (CT) or magnetic resonance imaging (MRI), & with single photon emission computer tomography (SPECT) or positron emission tomography (PET) can be used to help exclude other cerebral pathology or subtypes of dementia. Highest accuracy from autopsy.

Normal Brain vs Brain with Alzheimer’s Disease

A split-view image showing PET scans of a normal brain (L) & a brain with Alzheimer's disease (R).

Diagnostic Tools Neuropsychological tests such as the mini-mental state examination (MMSE) are widely used to evaluate the cognitive impairments needed for diagnosis. More comprehensive test arrays are necessary for high reliability of results, particularly in the earliest stages of the disease. Psychological tests for depression are employed, since depression can either be concurrent with AD, an early sign of cognitive impairment, or even the cause. When available as a diagnostic tool, SPECT & PET neuroimaging are used to confirm a diagnosis of Alzheimer's in conjunction with evaluations involving mental status examination. In a person already having dementia, SPECT appears to be superior in differentiating Alzheimer's disease from other possible causes, compared with the usual attempts employing mental testing & medical history analysis.

Important Point If you know a person with Alzheimer’s, you know A Person (one, singular, etc) with Alzheimer’s or dementia

Stages of Alzheimer’s Disease

Early Mild Stage Symptoms of Developing A.D, This is considered as a mild/early stage & the duration period is 2-4 years. Frequent recent memory loss, particularly of recent conversations & events. Repeated questions, some problems expressing & understanding language. Writing & using objects become difficult & depression & apathy can occur. Drastic personality changes may accompany functional decline. Need reminders for daily activities & difficulties with sequencing impact driving early in this stage.

Moderate Second stage - can be 2-10 years Can no longer cover up problems.  Pervasive & persistent memory loss impacts life across settings. Rambling speech, unusual reasoning, confusion about current events, time, & place.  Potential to become lost in familiar settings, sleep disturbances, & mood or behavioral symptoms accelerate. Nearly 80% of patients exhibit emotional & behavioral problems which are aggravated by stress & change. Slowness, rigidity, tremors, & gait problems impact mobility & coordination.  Need structure, reminders, & assistance with activities of daily living.

Moderate stage Increased memory loss & confusion. Problems recognizing family & friends. Inability to learn new things. Difficulty carrying out tasks that involve multiple steps (such as getting dressed). Problems coping with new situations. Delusions & paranoia. Impulsive behavior. In moderate AD, damage occurs in areas of the brain that control language, reasoning, sensory processing, & conscious thought

Severe Last stage Confused about past & present. Loss of recognition of familiar people & place.s Generally incapacitated with severe to total loss of verbal skills. Unable to care for self.  Falls possible & immobility likely. Problems with swallowing, incontinence, & illness. Extreme problems with mood, behavioral problems, hallucinations, & delirium. Patients need total support & care, & often die from infections or pneumonia

Causes of Alzheimer’s Disease Scientists don’t yet fully understand cause, but clear that it develops because of a complex series of events that take place in the brain over a long period of time. As many as 20+ years. Likely causes include genetic, environmental, & lifestyle factors. Some drug therapies propose that AD is caused by reduced synthesis of the neurotransmitter acetylcholine. Alzheimer's disease is characterized by a build-up of proteins in the brain. Plaques– deposits of the protein beta-amyloid that accumulate in the spaces between nerve cells Tangles – deposits of the protein tau that accumulate inside of nerve cells

Microscopy image of a neurofibrillary tangle, conformed by tau protein.

Early Diagnosis & Treatment Identify the problem & start available treatments. See a neurologist or geriatrician specializing in dementia as soon as possible. You can explore treatments that may provide some relief of symptoms & help you maintain a level of independence longer. Identify clinical drug trials that help advance research, such as at UT Southwestern. Identify resources Call Alzheimer’s Association 24/7 Helpline: 1.800.272.3900 Dallas Area Agency on Aging – 211 for resources such as caregiver support & other services & resources.

Benefits of Early Diagnosis & Treatment, 2 Learn as much as you can Education programs & seminars, including Stress Busters for Family Caregivers. Online resources & education Alzheimer’s Association & other resources Have more time to plan for the future – A diagnosis of Alzheimer's allows an individual to take part in decisions about care, transportation, living options, financial & legal matters. Build the right care team & social support network. Update or create wills, Powers of Attorney, & address other legal & financial issues. Help for the individual & loved ones – Talk to the family about what is diagnosis, treatment, other doctors & services, financial & legal plans, & resources. Seek out support groups & education. Care & support services are available, making it easier for the individual & family members to live the best life possible with Alzheimer’s or dementia. Find support groups for family caregivers. Alz Association, churches

Medicines used to treat Symptoms Do not prevent or cure; may slow symptoms Aricept Donepezil • Loses its effect over time • Used for mild, moderate & severe AD Exelon Rivastigmine • Loses its effect over time • Used for mild to moderate AD • Can get in pill form or as a skin patch Namenda Memantine • Loses its effect over time • Used for moderate to severe AD • May be given with Aricept®, Exelon® Razadyne Galantamine • Loses its effect over time • Used for mild to moderate AD • Can get in pill form or as a skin patch

Medications to Treat Related Symptoms SSRIs Zoloft & Celexa Used to reduce depression & anxiety Sertraline & Citalopram • May take 4 to 6 weeks to work Trileptal Used to treat severe aggression Oxcarbazepine • Also used to treat depression & anxiety Tegretol Used to treat severe aggression Carbamazepine • Also used to treat depression & anxiety Remeron Used to reduce depression & anxiety Mirtazepine • May take 4 to 6 weeks to work • Sometimes used to help people get to sleep

Sources Alzheimer’s Association – www.alz.org Material by Kirmal Masih, Southern Methodist University Family Caregiver resources and education at www.familycaregiversonline.net