Dementia: A Growing Epidemic

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Dementia A Growing Epidemic

• Stephanie R. Johnson Ph.D.

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What is Dementia?

• This term refers to a deterioration in mental
  capacities that goes beyond the normal changes
  expected to occur with the normal aging process.
• Dementia is both a behavioral and diagnostic
  classification.

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Dementia Characteristics

• Memory Impairment
• Language Impairment
• Visuo-spatial Impairment
• Problem Solving Impairment

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Dementia Characteristics

• Changes in functional capacity
• Changes in mood
• Changes in personality
• Changes in behavior

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Subtypes of Dementia

• Alzheimers Disease
• Vascular Dementia
• Parkinsons Disease
• Huntingtons Disease
• Picks Disease
• Substance induced persistent Dementia
• Dementia due to HIV Disease

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Dementia Subtypes

• The two most common types of Dementia include
• Alzheimers Disease
• Vascular Dementia

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Vascular Dementia

• Vascular Dementia makes up 15-25 of all
  dementia cases.
• This subtype of dementia is much more prevalent
  in people of color due to the high risk of
  cerebrovascular disease (stroke).

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Vascular Dementia Risk Factors

• Advanced Age
• Stroke
• Smoking
• Obesity
• Alcoholism
• Hypertension
• Diabetes

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Vascular Dementia Clinical and Behavioral
Features

• Motor impairment
• Memory impairment
• Language impairment
• Problem Solving
• Depression

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Alzheimers Disease

• A slow onset
• Short-term memory impairment
• Gradual deterioration of cognitive capacities

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Alzheimers Disease

• 50 of all cases of Dementia (most common subtype
  of dementia)

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Alzheimers Disease Risk Factors

• Advanced Age
• Family History of AD
• Parkinsons Disease
• Downs Syndrome
• Genetic Factors
• History of Head Injury

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Alzheimers Disease Early Stage Behavioral
Characteristics

• Memory Loss
• Confusion with familiar activities (e.g. driving
  to familiar places)
• Loss of Initiative
• Mood and Personality Changes

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Alzheimers Disease Moderate Stage Behavioral
Characteristics

• Increased memory impairment
• Begins to make repetitive statements
• Motor problems
• Difficulty recognizing family and friends
• Difficulty with everyday activities
• Needs Supervision

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Alzheimers Disease Late Stage Behavioral
Characteristics

• Weight Loss
• Cannot recognize family or ones self
• Unable to communicate
• Unable to control bowels
• Unable to care for ones self

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Diagnosis of Alzheimers Disease

• A definite diagnosis of AD is only possible after
  death during an autopsy when the brain can be
  examined for specific physiological changes that
  have occurred.

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Diagnosis of Alzheimers Disease

• Referral to one of the following
• Neurologist
• Geriatrician
• Geropsychiatrist
• Neuropsychologist

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Diagnosis of Alzheimers Disease

• Steps to Diagnosis
• Detailed Patient History
• Information from Family Members
• Neurological Exam
• Brain imaging (MRI)
• Neuropsychological Testing

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Treatment of Alzheimers Disease

• Pharmacological Intervention for Mild to Moderate
  AD
• Cognex
• Aricept
• Exelon
• Reminyl

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Treatment of Alzheimers Disease

• These drugs work by inhibiting an enzyme that
  normally breaks down acteylcholine which is a key
  neurotransmitter involved in cognitive
  functions.
• Efficacy for these drugs is 6 months to two years

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Treatment of Alzheimers Disease

• Antidepressants are used to treat behavioral
  symptoms of AD
• Zoloft
• Wellbutrin
• Celexa

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Treatment of Alzheimers Disease

• Preventive Methods
• Estrogen
• Anti-inflammatory agents (Ibuprofen, Steroids)
• Antioxidants (Vitamin E)
• These methods are still under investigation!

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Alzheimers Disease Ethnicity Issues

• National Institutes of Health estimate that by
  the year 2050 14 million older Americans are
  expected to have AD.

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Alzheimers Disease Ethnicity Issues

• A number of studies have suggested that people of
  African descent have a higher prevalence rate of
  AD even after controlling for other illnesses
  (diabetes, hypertension, cardiovascular disease)

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Alzheimers Disease Ethnicity Issues

• Changing demographic of the United States Over
  the next 50 years
• Latino elderly will have the largest increase in
  population
• Followed by People of African descent

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Alzheimers Disease Ethnicity Issues

• Why are these statistics important?
• Genetics
• Environment

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Alzheimers Disease Caregiver Issues

• AD affects the entire family structure and has
  physical and emotional consequences for the main
  caregiver
• Spouses are by far the largest group of
  caregivers and this is often problematic because
  they are usually older frail, and have
  pre-existing health problems

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Alzheimers Disease Caregiver Issues

• If I become a caregiver for someone with AD what
  can I expect
• Time commitment
• Physical Effort (Activities of Daily Living)
• Financial Costs (Adult Day Care, Stop working)

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Alzheimers Disease Caregiver Issues

• Psychological Distress
• Fatigue
• Social Isolation
• Family conflict

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Alzheimers Disease Where Do We Go From Here?

• Becoming educated about dementia
• Participate in clinical research
• Community Involvement

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Alzheimers Disease Where Do We Go From Here?

• Developing an International Foundation to support
  education and research for AD
• Special emphasis on special populations (Minority
  populations, Women)
• Faith-Based Initiative

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Alzheimers Disease Where Do We Go From Here?

• For More Information
• Alzheimers Disease Cooperative Study
• 858-622-5880 (antimony.ucsd.edu)
• Alzheimers Disease Education and Referral
• 1-800-438-4380 (www.alzheimers.org)
• Children of Aging Parents
• 1800-227-7294 (www.caps4caregivers.org)