1. The Alzheimer’s Disease Challenge: Take Your Knowledge Further ALZHEIMER’S DISEASE AND ITS MANAGEMENT: AN OVERVIEW

2. Agenda  What is the prevalence of Alzheimer’s disease (AD) in the United States?  What are early warning signs of AD?  How do normal aging and dementia differ?  Why is AD often underdiagnosed?  What are the benefits of early detection in AD?  Who should be evaluated for AD?  What steps are important to make an accurate AD diagnosis? Alzheimer’s Disease and Its Management: An Overview

3. What is the Prevalence of AD in the United States? The Alzheimer’s Disease Challenge:

4. What Is the Prevalence of AD in the United States?  13% of persons 65 years of age and older have AD 1  43 % of persons older than 85 have AD 1  Approximately every 69 seconds, someone in America develops AD; by midcentury, it is estimated that there will a new case of AD every 33 seconds 1 1. Alzheimer’s Association. Alzheimer’s & Dementia. 2011;7()2:208-244. 2. Hebert LE et al. Arch Neurol. 2003;60:1119-1122. Projected Number of Persons ≥65 Years of Age With AD in the United States (in Millions) 2 0 2 4 6 8 10 12 14 20102020203020402050

5. What Are Early Warning Signs of Alzheimer's Disease? The Alzheimer’s Disease Challenge:

6. What Are Early Warning Signs of AD?  Approximately 5.4 million Americans have AD 1  The course of dementia is slow and progressive 2  Early signs of AD may include 3 :  Memory loss  Getting lost  Trouble handling money and paying bills  Repeating questions  Difficulty completing normal daily tasks  Poor judgment  Changes in mood or personality  AD is a disease that requires periodic reassessment 4 1. Alzheimer’s Association. Alzheimer’s & Dementia. 2011;7()2:208-244. 2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Text Revision. (DSM-IV-TR ® ). American Psychiatric Association; 2000. 3. National Institutes of Health. Alzheimer’s disease fact sheet. NIH Publication No. 08-6423. November 2008. 4. Geldmacher DS Prim Care Companion J Clin Psychiatry. 2007;9:113-121.

7. How Do Normal Aging and Dementia Differ? The Alzheimer’s Disease Challenge:

8. How Do Normal Aging and Dementia Differ? Normal Aging 1 Dementia 1 Low level of memory complaintsVariable general complaints or no awareness of memory loss Memory complaints do not interfere with daily functioning Memory complaints interfere with daily functioning Cognition normal on testingCognition impaired on testing and declines over time No mood changesMay be associated with labile or blunted mood Anstey KJ, Low LF. Aust Fam Physician. 2004;33:783-787.

9. Why Is AD Often Underdiagnosed? The Alzheimer’s Disease Challenge:

10. Why Is AD Often Underdiagnosed?  Early AD has subtle signs that are easily overlooked 1-3  Often misidentified as “normal aging”  Social skills often maintained in early disease 1  Lack of definitive screening and diagnostic tests 1,2  Concerns regarding time and reimbursement issues 3  Ethnic and cultural issues 1  Patients and caregivers often reluctant to acknowledge signs and symptoms 3  Social stigma associated with diagnosis 1. Cefalu C et al. An American Family Physician Monograph, No. 2. American Academy of Family Physicians; 2001. 2. Boustani M et al. Ann Intern Med. 2003;138:927-937. 3. Solomon PR, Murphy CA. Geriatrics. 2005;60:26-31.

11. Who Should Be Evaluated for AD? The Alzheimer’s Disease Challenge:

12. Who Should Be Evaluated for AD?  Risk increases with age (13% at ≥65 years and 43% at ≥85 years have); therefore, older adults are an obvious choice for screening 1,2  Persons with identified risk factors (eg, older age, hypertension, head injury, hypercholesterolemia, family history of AD) 2,3  Persons with memory or cognitive impairment, with or without functional impairment 3  Persons brought to the physician’s attention through a complaint, with or without patient concurrence 3 1. Alzheimer’s Association. Alzheimer’s & Dementia. 2011;7()2:208-244. 2. Boustani M et al. Ann Intern Med. 2003;138:927-937. 3. Solomon PR et al. Geriatrics. 2005;60:26-31.

13. Who Should Be Evaluated for AD? (cont)  Depressed or anxious patients, with or without cognitive complaints, apathy 1  Any older adult with cognitive, intellectual, or behavioral symptoms as reported by themselves or a reliable informant 1  Evidence suggests that risk factors for cardiovascular disease may also contribute to the development of AD 2,3 1. Solomon PR. Geriatrics. 2005;60:26-31. 2. Boustani M et al. Ann Intern Med. 2003;138:927-937. 3. Solfrizzi V et al. Neurology. 2004;63:1882-1891.

14. What Steps Are Important to Make an Accurate AD Diagnosis? The Alzheimer’s Disease Challenge:

15. What Steps Are Important to Make an Accurate AD Diagnosis?  Complete medical history  Physical examination  Neurologic examination, including mental status  Laboratory tests  Imaging test (computed tomography [CT], magnetic resonance imaging [MRI], positron emission tomography [PET]), as indicated  Utilize valid and reliable standardized clinical diagnostic criteria (eg, DSM-IV-TR) Cefalu C et al. An American Family Physician Monograph, No. 2. American Academy of Family Physicians; 2001.

16. Summary The course of dementia is slow and progressive 1 The characteristics that distinguish normal aging from dementia can be quite subtle 2 Early detection of AD offers benefits to both physicians and patients 3  Because the risk of AD increases with age, consider screening patients ≥65 years of age if clinical presentation suggests possibility of dementia 4,5  With standard criteria, the sensitivity of an AD diagnosis approaches 90% 6 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Text Revision. (DSM-IV-TR ® ). American Psychiatric Association; 2000. 2. Anstey KJ, Low LF. Aust Fam Physician. 2004;33:783-787. 3. Doraiswamy PM et al. The Alzheimer’s Action Plan. New York: St. Martin’s Press; 2008. 4. Evans DA et al. JAMA. 1989;262:2551-2556. 5. Boustani M et al. Ann Intern Med. 2003;138:927-937. 6. Cefalu C et al. An American Family Physician Monograph, No. 2. American Academy of Family Physicians; 2001.

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