Questions/Answers on Dementia due to Alzheimer s Disease Presentation at Governor s Conference on Aging Friday, December 15, 2012 Raj C.

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1 Questions/Answers on Dementia due to Alzheimer s Disease Presentation at Governor s Conference on Aging Friday, December 15, 2012 Raj C. Shah, MD How many people are there in the United States? A little over 300 million (312.8 million at the beginning of 2012) How many people are over the age of 65? Over 30 million (13.3% of US population in 2011) What is the fastest growing population in the United States? People over age 85 What are the biggest health fears of older persons? Loss of memory, loss of mobility, pain, loss of eyesight What cognitive function changes the least with aging? Reading ability What cognitive function changes the most with aging? Visuomotor processing speed What is Mild Cognitive Impairment? Subjective and objective memory concerns in the absence of dementia What is dementia? Chronic memory loss. What changes occur with a dementia? Getting lost, behavioral difficulties, acute confusion episode (delirium) while hospitalized What are the most common primary neurodegenerative diseases causing dementia? Alzheimer s disease, vascular disease, Lewy Body disease, Frontotemporal lobar degeneration What is the typical course of Alzheimer s Gradual onset of cognitive loss usually involving short-term memory that slowly progresses over years. Rush University Medical Center. Reproduction allowed with permission of author Page 1

2 How is the typical course of vascular dementia different from dementia due to Alzheimer s Involves step-wise loss of cognitive function with each vascular episode How is the typical course of dementia due to Lewy Body disease different from dementia due to Alzheimer s Involved parkinsonism early in the process with daily fluctuation in memory and early hallucinations How is the typical course of frontal-temporal dementia different from dementia due to Alzheimer s Presents as loss of speech abilities with relatively intact memory or with significant behavior issues including disinhibition What is the most common cause of dementia in the United States? Alzheimer s disease How many individuals have dementia due to Alzheimer s disease in the United States? Over 5 million (5.4 million estimated in 2012) How many individuals have dementia due to Alzheimer s disease in Illinois? Over 200,000 (210,000 based on 2010 estimates) What is the risk of having dementia due to Alzheimer s disease at age 65? 2 to 4% What is the risk of having dementia due to Alzheimer s disease at age 85? About 50% What is the risk of having Alzheimer s disease if you have a first degree relative with the About 2-fold the general population risk What genetic risk factor is most commonly associated with Alzheimer s Apolipoprotein E e4 allele presence Rush University Medical Center. Reproduction allowed with permission of author Page 2

3 Are there medications approved for the prevention of Alzheimer s No What are lifestyle choices that may benefit older persons including individuals with memory loss? Physical activity, cognitive activity, nutrition, socialization, purpose in life, controlling depressive symptoms, controlling cardiovascular conditions, monitoring medication side effects What are the barriers for person seeking evaluation of memory loss? Denial, fear, not knowing where to seek help What is a major barrier for caregivers seeking a memory evaluation? Feeling that memory loss is part of normal aging What are barriers for healthcare providers to conduct evaluations of memory loss? Time, difficulty with separating out competing causes of memory loss What are common reasons for seeking an evaluation of memory loss? Cognitive loss, functional loss, behavioral changes. What is the average Mini-Mental State Examination score when someone is first diagnosed with dementia due to Alzheimer s 18 out of 30 How is Alzheimer s disease diagnosed? By clinical history and examination Why are blood tests ordered in a dementia evaluation? To look for conditions that can be treated that may cause memory loss What are brain scans ordered in dementia evaluation? To look for other structural causes of memory loss such as infarctions or masses Is genetic testing commonly done? Only in very rare cases with a strong familial history with young onset of memory troubles. Rush University Medical Center. Reproduction allowed with permission of author Page 3

4 What is the likelihood that a clinical diagnosis by and experienced physician will match pathology diagnosis? About 90% Who is involved in the care plan for Alzheimer s Person with the disease, caregivers, medical providers, community social service providers, legal providers. What are the goals of a treatment plan? Reduce cognitive decline, functional decline, and behavioral changes to alleviate caregiver burden and to prevent crisis What are the components of a good treatment plan? Education and lifestyle interventions, social services, and medications Are there treatments to cure Alzheimer s No. What are the medications approved for the symptomatic treatment of Alzheimer s Tacrine (not used any more), donepezil, galantamine, rivastigmine and memantine. Are there approved treatments for the behavioral symptoms of dementia due to Alzheimer s No, apart from the 5 medications approved for the symptomatic treatment of Alzheimer s disease What are some areas for which families commonly seek advice? Driver s evaluation programs, powers of attorney for health care and property, community home services, selecting medication plans, Adult Day programs, Supportive Living sites, handling visits to Emergency Room or hospital What are some good resources of information about the Alzheimer s Disease Education and Referral Center, Alzheimer s Association, The 36 Hour Day What are common reasons for nursing home placement? Incontinence, behavior, caregiver burnout Rush University Medical Center. Reproduction allowed with permission of author Page 4

5 How long does someone live with Alzheimer s About 10 years after diagnosis. Can range from 3 to 20 depending on underlying health. Do people die of Alzheimer s Yes, it is the sixth leading cause of death in the United States. What causes people to die with Alzheimer s Hip fractures and pneumonia in the moderate-to-severe stages and inability to maintain nutrition in the terminal stages. Are G-tubes helpful for people with terminal Alzheimer s No, they have not shown to increase length of life and lead to more complications such as pneumonia Are individuals with Alzheimer s disease eligible for hospice? Yes and they may stay in the program even if they survive more than 6 months How much does it cost to care for individuals with dementia due to Alzheimer s About $200 billion a year based on 2012 estimates What is the biggest cost for dementia due to Alzheimer s disease care? Loss of caregiver productivity What is the second biggest cost associated with dementia due to Alzheimer s Iatrogenic hospitalization Why do we need more research in Alzheimer s To understand how the disease occurs, to develop new diagnostic tests, to develop interventions to prevent the development of the disease in an asymptomatic phase, to slow loss of function once diagnosed, to reduce suffering for person with Alzheimer s and their caregivers. Rush University Medical Center. Reproduction allowed with permission of author Page 5

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