Dementia, Parkinson s disease & dementia with Lewy bodies

Transcription

1 Dementia, Parkinson s disease & dementia with Lewy bodies K Nicholson PhD candidate The University of Melbourne

2 Research question What is the experience of caring for a person with dementia with Lewy bodies (DLB)?

3 Methodology Heuristic inquiry (Moustakas, 1990). 13 spousal carers of people with a diagnosis of DLB. 12 female and 1 male carer. Age 71 (SD±7.6) Years married 48 (SD±7.4) 6 were recruited through dementia networks, 6 through Parkinson s networks and 1 was a snowball through a carer support group. Methods: questionnaire on the phone demographics, assessment process and early signs they noticed in their spouses, in depth interview (12 face to face, 1 telephone) focus group (N=7).

4 Definitions Dementia is the term used to describe the symptoms of a large group of illnesses, which cause a progressive decline in a person s mental functioning. It is a broad term, which describes a loss of memory, intellect, rationality, social skills and normal emotional reactions. Key words in the WHO 1992 definition. Consciousness is not clouded..the primary requirement for diagnosis is evidence of a decline in both memory and thinking

5 Definitions Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR) states dementia is manifested by both (1) memory impairment and (2) one (or more) of the following cognitive disturbances.. PD is a progressive, degenerative neurological condition. It primarily involves a disturbance in the co-ordination of movement and has three main symptoms: tremor, rigidity and bradykinesia (slowness of movement). (Parkinson's Victoria, 2007)

6 Perceptions Prominent feature of dementia is memory loss Anecdotally many people equate dementia, memory loss and AD as one entity. PD is a motor disorder

7 The what and where of DLB It is a progressive, neurodegenerative disease of ageing and thought to be the 2nd most prevalent form of dementia. Guidelines first reported in Neurology in 1996 and refined through 2 further consensus meetings.

8 Dementia with Lewy bodies Representation of DLB Consortium Criteria McKeith et al: 2005 Core feature Dementia 1 or 2 of Fluctuations Parkinsonism Visual hallucinations Suggestive features REM sleep behaviour Severe neuroleptic Neuro-imaging disorder sensitivity changes Supportive features Repeated Transient Severe Systemized Hallucinations Other Depression falls & faints syncope autonomic delusions in other medical dysfunction modalities tests

9 Dementia with Lewy bodies Representation of DLB Consortium Criteria McKeith et al: 2005 Core feature Dementia Fluctuations Parkinsonism Visual hallucinations Suggestive features REM sleep behaviour Severe neuroleptic Neuro-imaging disorder sensitivity changes Supportive features Repeated Transient Severe Systemized Hallucinations Other Depression falls & faints syncope autonomic delusions in other medical dysfunction modalities tests

10 Dementia with Lewy bodies Dementia defined as progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function (McKeith, et al 2005). Memory impairment not an early feature Deficits on tests of attention, frontosubcortical and visuospatial ability

11 Dementia

12 Memory

13 Skill learning and habits This sub cortical memory involves areas of the cerebellum, the cholinergic basal nucleus of Meynert and the basal ganglia (Gabrieli, 1998; Nolte, 2001) re-entrant circuits between the cortex and the basal ganglia; the reward-guided choice behaviour circuit the executive circuit for planning and working memory the motor circuit

14 Carers reports of spouses subcortical deficits Memory deficits Expressed as retrieval deficits with preservation of recognition Executive dysfunction Concepts, problem solving and set shifting Internally cued behaviour Tasks that require planning and sequencing Attentional impairment Reaction times and vigilance Fluctuations

15 DLB where does it fit? AD / DLB DLB / PD

16 Dementia with Lewy bodies Representation of DLB Consortium Criteria McKeith et al: 2005 Core feature Dementia Fluctuations Parkinsonism Visual hallucinations Suggestive features REM sleep behaviour Severe neuroleptic Neuro-imaging disorder sensitivity changes Supportive features Repeated Transient Severe Systemized Hallucinations Other Depression falls & faints syncope autonomic delusions in other medical dysfunction modalities tests

17 Lewy bodies Lewy bodies - alpha synuclein deposits in cell bodies Can be found throughout the brain but particularly in the brain stem, basal ganglia, substantia nigra & basal cells of Meynert. Impact dopaminergic & cholinergic systems

18 History 1817 James Parkinson s essay on Shaking Palsy 1862 Charcot coined the term Parkinson s disease added cognitive impairment 1912 Fritz Heinrich Lewy ( (Frederic Henry Lewey) described and named Lewy bodies 1992 α-synuclein immunocytochemistry led to the ability to stain Lewy bodies 1995 Dementia with Lewy Bodies 1st CDLB (McKeith et al)

19 DLB/PDD Working Group Neurology 2007, 68 Lewy body disorders Dementia with Lewy bodies DLB Parkinson s disease PD Parkinson s disease dementia PDD Lewy body dementias DLB & PDD Lewy body disease PD, PDD & DLB

20 A way to increase DLB awareness Neuro degenerative diseases Dementia AD FTLD Vascular Others including Alcohol related Parkinson s DLB Parkinson s disease Neuro degenerative disease Amyloidopathy: AD Tauopathies: AD / FTLD Alphasynucleinopathies: DLB PD PDD Other NDDs:

21 I would like to acknowledge: My supervisors at the University of Melbourne: Dr P St Leger & Prof D Ames for their continuing support Scholarship support from Alzheimers_Logo_PMS_Sm The carers who gave of their time & openly shared their experiences with me.

22 References APA. (2000). The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, (4 ed.). Arlington: APPI. Gabrieli, J. D. E. (1998). Cognitive Neuroscience of Human Memory. Annual Review of Psychology, 49, Lippa, C. F. M., Duda, J. E. M., Grossman, M. M., Hurtig, H. I. M., Aarsland, D. M., Boeve, B. F. M., et al. (2007). DLB and PDD boundary issues: Diagnosis, treatment, molecular pathology, and biomarkers. Neurology, 68(11), McKeith, I. G., Galasko, D., Kosaka, K., Perry, E., Dickson, D. W., Hansen, L. A., et al. (2005). Diagnosis and management of dementia with Lewy bodies: Third report of the DLB consortium. Neurology, 65(12), Moustakas, C. (1990). Heuristic Research: Design, Methodology, Applications. Newbury Park CA: Sage Publications Inc. Nolte, J. (2001). The Human Brain: An Introduction to Its Functional Anatomy (5 ed.). St Louis: Mosby. Parkinson's Victoria. (2007). So... I've got Parkinson's...what's that?. Melbourne: PA. World Health Organisation. (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.