Dementia: How About That

1
Dementia How About That

• If you were born in 1980 you can expect to live
  26 years longer than if born in 1900
• Only five people have been documented to live to
  112 years
• One person in Japan lived to be 114
• 115-120 is expected to be the longest attainable
  age

2
Longevity

• Rugged lifestyle, low calorie, low animal fat
  diets are thought to contribute to the longevity
• There are no supercentenarians (gt120 years)
• In US oldest documented death 113 years, 124 days
  
• There are some commonalities among those very
  old
• Lived in same place all life with same extended
  family
• have good health (never or rarely sick in life).
• don't smoke
• because of good health took little if any medicine

3
What are characteristics of those who live longer
(North America)?

• Economic status -- wealthier people live longer
  (can afford medical care, good nutrition).
• Education level -- Study on 113 nuns in
  Minnesota from 1936-1980. Those with a B.A.
  lived to a mean age of 89.2 those without lived
  to be 81.4 years. It's thought that stimulated
  mental activity might prolong life it's thought
  that personality can enter in too. Why did some
  go on for a B.A. and others not?
• female -- of all animals, females usually outlive
  males -- 6-8 years in humans. 171 days in
  spiders, 150 days in rats, 51 days in beetles.
• If your parents live to an old age, you are more
  likely to

4
1971 Caleb Finch Coined The Terms Pathogenic And
Eugeric

• Eugeric is a more general phenomenon in all aging
  organisms. Production cessation, menopause,
  lipofuscin (an aging pigment that builds up in
  all mammals) -- reduced immune function, etc.
• Pathogenic -- secondary age related disease.
  e.g., cerebrovascular disease like hypertension.
  If untreated, stroke. Only 10-20 age with
  pathogenic conditions

5
Some Terms

• Senescent -- an organism of old age. There is no
  implication of dementia here.
• Senility -- a deterioration of abilities that
  were normal before, including a memory deficit,
  loss of impulse control, etc. Senility implies
  dementia, mental incompetence.
• Pre-senile Dementia -- above symptoms that occur
  in those younger than 65 years

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Presenile Dementias

• Picks Disease
• Huntington's Chorea
• Creutzfeldt-Jakob Disease
• Alzheimer's Disease

7
Picks Disease

• Pick's Disease is genetic presents itself at age
  50. More common in women, atrophy of most
  cortical areas. Personality change is the first
  symptom, then memory (frontal lobes). This makes
  sense, as the frontal lobes have long been held
  as the center for personality.

8
Huntingtons Chorea

• Huntington's Chorea -- progressive cognitive
  decline. Usually memory impairment is the first
  sign, then patients experience personality
  change, characterized by irritability, suspicion,
  etc. These patients frequently have dysarthria.
  Also inherited then chorea occurs (abrupt, jerky
  movements), followed by dementia.

9
Creutzfeldt-Jakob's Disease

• Occurs equally in male/female. Evidence of
  genetic transmission (possibly by virus,
  however). Degeneration of motor system. Mean
  age death 75 years.

10
Senile Dementia

• Senile Dementia of the Alzheimer's Type (SDAT).
  First described in 1900. Patient had loss of
  memory, followed by confusion, dementia.
• Multi-infarct Dementia (Vascular Dementia)

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Post-Death Findings in Brains of Alzheimer's
Patients

• Severe atrophy. Cortex has neurofibrillary
  tangles, neuritic plaques in neural fibers.
  Fatty tissue substance also found in brain. AD
  is a pathological development of aging, not part
  of normal aging. There is clearly a genetic
  component involved
• prevalence of SDAT among family (familial cases
  are rare)
• 8 dizygotic twins
• 42 monozygotic twins
• 7 siblings
• 3 parents

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Risk factors for SDAT

• If a family history of SDAT and history of head
  trauma chances are 1 in 4 by age 90. In general
  population, without above risk factors, chances
  are 1 in 7 by age 90.

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3 Facts about SDAT

• Neuritic plaques that are abundant in SDAT
  contain a beta protein (amyloid) common to
  chromosome 21.
• disease has been linked to chromosome 21.
• People with Down Syndrome carry an extra
  chromosome 21, and, if they live long enough,
  they all have the neuritic plaques and the
  neurofibrillary tangles.

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Not Enough Is Yet Known About SDAT Genetically

• It still influences a heterogenous group of
  people
• Because the genetic link is not so tight, other
  approaches are being studied too
• Only humans get SDAT. No other animal gets it
• There is no clear cut animal model for SDAT, but
  it's being attempted

15
Multi-Infarct Dementia (MID)

• brought on by non-noticeable strokes due to
  hypertension. Differentiated by the following
  factors from SDAT
• may be sudden onset
• focal neurological signs
• frequent association with hypertension
• step-wise noticeable decline, vs. gradual
• Highest risk are those with genetic propensity of
  HTN. It can be avoided (treating HTN, lower
  cholesterol level)

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Management Early Stages

• Providing information and support to family
  members is a large part of our role
• Memory Compensation
• reminders, notebooks, etc.
• Disorientation/Confusion
• calendars, maps, reminders
• Denial, anger, questions
• Some planning, but mostly anxiety, grief, anger

17
Management

• Middle Stages
• More difficulty in the home
• The patient probably still is aware of the
  consequences, may be angry, depressed
• Family has to do more-- e.g., bathing, dressing,
  patient may be incontinent, etc.

18
Management

• Late Stages
• Usually in a nursing home
• Some guilt associated with that are possible
• Counseling of the family at this stage may be
  very important.