Alzheimer s and Dementia Third Annual Women s Health and Wellness Symposium William D. Rhoades, DO Chairman Dept. of Medicine william.rhoades@advocatehealth.com
Objectives Define the Top Ten Signs of Dementia, i.e. Warning Signs Describe the stages of Dementia Examine treatment options for Dementia and behaviors associated with Dementia Identify new areas of research
If your memory loss affects either job skills or other useful activities. Especially short-term memory loss.
If you have trouble performing familiar tasks Mom s famous recipes don t taste right Dad can no longer change the oil
If you have problems with language, like becoming quiet in group conversations
If you have disorientation to time and place Like you call at 3:00am to find Like you call at 3:00am to find when your daughter is coming over.
If you have impaired judgment like taking your pills twice when not sure
If you have problems with abstract thinking understanding parables
If you misplace items in strange locations the checkbook s in the freezer
If you have significant changes in mood or behavior new anxieties/depression
If you have developed changes in personality for better or worse
If you have a loss of initiative apathy
Differential Diagnosis of Dementia Vascular dementias Multi-infarct dementia Binswanger s disease Vascular dementias and AD Other dementias Frontal lobe dementia Creutzfeldt-Jakob disease Corticobasal degeneration Progressive supranuclear palsy Many others Dementia with Lewy bodies Parkinson s disease Diffuse Lewy body disease Lewy body variant of AD AD AD and dementia with Lewy bodies 5% 10% 65% 5% 7% 8% Small GW, et al. JAMA. 1997;278:1363-1371; American Psychiatric Association. Am J Psychiatry. 1997;154(suppl):1-39; Morris JC. Clin Geriatr Med. 1994;10:257-276. 3
Current Prevalence of AD AD is the fourth leading cause of death due to disease for people > 65 years of age in the United States 1 Approximately 5.5 million people in the United States have AD 2 1. Murphy SL. Natl Vital Stat Rep. 2000;48:1-106. 2. Evans DA et al. Milbank Quarterly. 1990;68:267-289.
Who Is More Likely to Get AD? People 65 years of age and older Women Increased risk of developing AD On average, live longer than men People with a family history of AD People with genetic factors predisposing to AD, including those with Down syndrome Andersen K et al. Neurology. 1999;53:1992-1997.
AD Stages of Cognitive Decline (GDS*) Stage 1 none Stage 2 very mild Stage 3 mild Stage 4 moderate Stage 5 moderately severe Stage 6 severe Stage 7 very severe * Global Deterioration Scale. Reisberg B et al. Am J Psychiatry. 1982;139:1136-1139.
Early Alzheimer s disease Memory impairment Word finding difficulty Difficulty with executive function and complex tasks Geographic disorientation Reasoning and judgment abilities Usually remain independent
Middle-stage Alzheimer s disease Day-night disorientation Language deterioration Difficulty with simple chores Troublesome behavior: wandering irritability paranoia Depression
Behavioral Issues Day-night disorientation Depression Wandering Irritability Paranoia Hallucinations Delusions Agitation
Advanced Alzheimer s disease Hallucinations Delusions Agitation Erosion of basic activities of daily living Total dependence on caregivers Complete loss of independence
Nonpharmacologic Therapy Early Alzheimer s Use it or lose it Safety and structure Memory aids Alleviating depression Middle-stage AD Adult day care Simplify the environment Redirect behavior Do not argue
BARRIERS TO DIAGNOSIS AND TREATMENT OF AD By Patients and Families Patient lacks insight Fear of diagnosis Denial of diagnosis Fear of loss of function Belief that there is nothing to do Fear of societal implications i.e. financial, insurance, and embarrassment of a mental illness By Physicians Drugs don t work Want to be sure of diagnosis before making it because of implications Early diagnosis difficult without family help Diagnosis and explanation take time Suspect diagnosis but no need to make it
Clinical Management of AD Goals and end-points of therapy: Social and behavioral therapy Medications to improve or maintain function and cognition Medications for certain behaviors Recognition of delirium and depression Care of caregivers
Medications Aricept (donepezil) Exelon (rivastigmine) Razadyne (galantamine) Namenda (memantine)
End-Stage Alzheimer s Disease Palliative care Hospice care Hospitalizations Feeding issues including tube feeding Resuscitation decisions
Nonpharmacologic Therapy Advanced Alzheimer s disease Special care units Structure and activities based on cognition Additional in-home care assistance Management of incontinence
Who Are the Caregivers? The overwhelming majority of patients live at home and are cared for by family and friends 77% are women 73% are over 50 years of age 33% are the sole providers 45% are children of the patient 49% are spouses Remainder are close family members or friends Consumer Health Sciences, LLC. Princeton, NJ; December 1999.
Caregiver Burden Caregivers spend from 40 100 hours per week with the patient 90% are affected emotionally (frustrated, drained) 75% report feeling depressed; 66% have significant depression Half say they do not have time for themselves and that the stress affects family relations Many experience a significant loss of income
Factors That Create Breaking Point for Caregiver Amount of time spent caring for the patient Loss of identity Patient misidentifications and clinical fluctuations Nocturnal deterioration of patient Annerstedt L et al. Scand J Public Health. 2000;28:23-31.
Alzheimer s and Dementia for the Third Annual Women s Health and Wellness Symposium William D. Rhoades, DO FACP william.rhoades@advocatehealth.com