Memory Loss: It s Not Always Alzheimers. Andrew Massey, M.D. Department of Internal Medicine University of Kansas School of Medicine--Wichita

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1 Memory Loss: It s Not Always Alzheimers Andrew Massey, M.D. Department of Internal Medicine University of Kansas School of Medicine--Wichita

2 Hendrikjje van Andel Schipperr Age 115 Don t smoke and don t drink too much alcohol except on sundays & holidays. And you must remain active... Eat a herring every day & drink orange juice.

3 Human Intelligence... or Cognition The ability of the brain 1. to choose to either ignore or focus attention 2. to learn and remember 3. to form ideas, & communicate thoughts The process of perception, memory, judgement, reasoning, and decision making

4 In our civilization & under our form of government, intelligence is so highly honored that it is rewarded by exemption from the cares of office. The essence of intelligence is skill in extracting meaning from everyday life. --Ambrose Bierce ( ) --unknown

5 Sometimes I think the surest sign that intelligent life exists elsewhere in the Knowing a great deal universe is that none of it has tried to is not the same as being contact us. smart. Intelligence is --Bill Waterson not information alone but also judgement... the manner in which information is collected & used. --Carl Sagan

6 Facts Predominantly a disease of the elderly, but affects young, too Prevalance for Alzheimer s >65 y.o., 5% >85 y.o., 50% 2 nd most feared disease among the elderly 5 million affected in U.S. Estimate 20 million by 2050

7 Myths It is irreversible It is untreatable There are no effective means to prevent it

8

9 Dementia Loss of memory or other cognitive functions Can be caused by numerous untreatable, but also treatable diseases Sometimes mistaken for other symptoms Normal aging Benign forgetfulness Aprosexia

10 10 Warning Signs 1. Memory loss 2. Difficulty performing familiar tasks 3. Misusing words 4. Confusion about time 5. Confusion about place 6. Problems with judgement & reasoning 7. Difficulty with abstract concepts 8. Personality change 9. Mood changes 10. Loss of initiative

11 Causes Most common untreatable cause is: Neurodegenerative disease such as Alzheimers Common treatable causes: stroke pseudo-dementia (depression) medications metabolic disorders infections

12 Diagnosis: Step 1 Discuss your symptoms with your doctor Physical Examination General physical exam Depression screening Neurological exam Mental status exam Orientation Attention & concentration Memory Learning Language Visual-spatial skills Executive functions

13 Folstein Mini- Mental State Examination (MMSE)

14 Montreal Cognitive Assessment (MoCA)

15 Alzheimers Disease Assessment Scale (ADAS)

16 "AOCCDRNIG TO RSCHEEARCH AT CMABRIGDE UINERVTISY, IT DEOSN'T MTTAER IN WAHT OREDR THE LTTEERS IN A WROD ARE, THE OLNY IPRMOETNT TIHNG IS TAHT THE FRIST AND LSAT LTTEER BE AT THE RGHIT PCLAE." Theory and History of the Technology of Civilization by Barry B. Powell c2009

17 Diagnosis: Step 2 Routine laboratory tests Electrolytes, blood sugar, liver, & kidney Blood count Thyroid test Vitamin B 12 level Urinalysis

18 Diagnosis: Step 3 Brain scan (routine) CT (or MRI)

19 Step 4: Special Evaluations (not routinely performed) Neurology Consult Psychiatry Consult Neuropsychometric testing Spinal Tap EEG (electroencephalogram) Cerebral arteriogram

20

21 Step 5: Pay the Bill

22 Learning Pearl Though most UNTREATABLE causes of dementia can only be definitely diagnosed by AUTOPSY OR BRAIN BIOPSY, reasonable certainty can be made by a detailed history, physical exam, & laboratory tests or x-rays that EXCLUDE TREATABLE causes

23 Treatment Specific treatment for reversible causes: B 12, antibiotics, modify medications, prevent stroke, treat depression, thyroid supplement, remove/treat brain tumor, shunt for hydrocephalous, etc.

24 Treatment 1. Cures 2. Delays or reverse the damage or stop progression of the disease 3. Symptomatic 4. Provide Hope Replace neurotransmitters Decrease inflammation Decrease toxic substances Vaccine

25 Effect of physical activity on cognitive function in older adults at risk for Alzheimer Disease Conclusion A 6 month program of physical activity provided a modest improvement in cognition over an 18 month follow-up period Journal of the American Medical Association. Sept 3, 2008, vol 300(9), pg 1027

26 Healthy diet, exercise, and socialization may protect against dementia. Healthy diet to avoid obesity may decrease risk for dementia Physically active adults have lower risk for Alzheimer s disease than inactive adults Social disengagement may be a risk factor for cognitive impairment among older persons (Neurology Reviews, Aug 2008, pg 37)

27 Prevention Take care of your hardware Invest Prevent in software head injuries (or stroke) Take Learn care a Wear new of the protective skill brain s or hobby headgear vessel Make Eat healthy new Wear friends seat belts... socialize Keep Do Exercise not informed endorse. risky.. read behavior Keep Get enough actively Drug abuse sleep engaged... participate See your Alcoholism doctor & listen Stop smoking

28 Anyone who stops learning is old, whether 20 or 80. Anyone who keeps learning is young. The greatest thing in life is to keep your mind young. --Henry Ford

29

30 The Alzheimer s Project May 10, Part Documentary, HBO

31 Neurology, 2000;54:

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