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Dementia

Outline
• What is Dementia?
• What are risk factors?
o Can you do anything about them?
• How is dementia diagnosed?
• Treatments for Dementia
o Lifestyle
o Medications
• Living with Dementia
o Safety
o Caregivers
• Future Research
What is Dementia?
Dementia
• A group of symptoms
o Memory loss
o Problems with reasoning, judgment, language
AND
• Problems with day to day functioning
(work, driving, social relationships)
o AND
• A progressive illness
DSM Criteria

 1. Memory impairment
 2. At least one of the following:
– Aphasia
– Apraxia
– Agnosia
– Disturbance in executive functioning
 3. Disturbance in 1 and 2 interferes with daily
function
 4. Does not occur exclusively during delirium
Activities of Daily Living

 ADLs: bathing, toileting, transfer, dressing,


eating
 IADLs (executive functioning):
– Maintaining household
– Shopping
– Transportation
– Finances
Symptoms of
Dementia
• Problems with short term memory
o Appointments
o Conversations
o Events
o Repeating stories
• Difficulty remembering
names, faces
o Forgetting acquaintances
and friends
Symptoms of
Dementia
• Trouble making sense of language
• Trouble finding the right word
• Difficulty naming objects
• Understanding complicated instructions
• Trouble doing familiar things
• Driving, banking
• Cooking, cleaning, laundry
• Dressing, bathing
Symptoms of Dementia
• Confusion in
unfamiliar places
• Getting lost
• Personality changes
• Easy to anger,
emotional
• Suspicious
• Seeing or hearing
things that aren’t there
Dementia or Normal
Aging?
• Normal changes of aging
o Slower to process information
o Hearing and vision may decrease
o Motor speed decreases
• Unlike dementia, these changes
should not prevent normal day-
to-day activities
Other things that cause
memory trouble
• A recent medical illness
o Starts suddenly
o Changes between sleepy and agitated
• Depression
o Sad mood
o Decreased initiative
• Some medical conditions
o Vitamin deficiencies
o Low thyroid function
o Sleep Apnea
Mild Cognitive Impairment
• Somewhere between memory changes of
normal aging and dementia
• Can affect memory, or other domains or both
• Increases the risk of getting dementia BUT
not everyone who has MCI will go on to
develop dementia
Causes of Dementia
• Alzheimer’s Dementia
 Most common form of dementia
 10% of 65-75 year olds
 20% of 75-85 year olds
 30% of > 85 year olds

 Gradually progresses over time


 Cause not known for sure
 Genetics in some families (more
rare)
 Messenger chemicals and
inflammation in the brain
 Brain gradually losses size
(“atrophy”)
Causes of Dementia
• Vascular dementia
• Second most common type of dementia
• Caused by small strokes
• Areas of brain that have
stopped getting oxygen and
die
• The strokes might not have
other symptoms
• Strokes happen suddenly
and cause sudden
worsening of memory
Causes of Dementia
• Mixed Dementia
 Combination of Alzheimer’s
and Vascular
 Very common
 Gradual decline with
occasional sudden worsening
• Frontal Temporal Dementia
 Often has personality changes
early on
• Parkinson’s Disease related
Dementia
• Others
What Are the Risk
Factors for Dementia?
Risk Factors

• Genetic
• Vascular
• Lifestyle
Family History
• Most cases of dementia are NOT genetic,
inherited or running in the family
• Some cases of dementia
run in the family where
multiple members in
several generations have
dementia
• Often dementia comes on at
younger age
• Can come on at older age and
look like usual Alzheimer’s
disease
Cardiovascular
(Heart and Blood Vessels)
• High blood pressure
• High cholesterol
• Diabetes
• Smoking
o All of these increase the
o risk of stroke
• These are risk factors for both AD and vascular
dementia
o What can do to help with this?
 Exercise, healthy diet, quit smoking
 Managing the above medical conditions well
Lifestyle

• Potential Lifestyle factors:


 Traumatic head injuries
 Toxic exposures
 Physical activity / Diet
 Education
Diagnosing Dementia
What happens at
the doctor's office?
• Talking to the patient and family
o Memory changes
o Trouble doing day-to-day activities
• Safety concerns
o Driving
o Getting lost
o Burning pots on the stove, leaving taps on to
flood
• Other medical conditions
o Conditions that increase the risk of dementia
or stroke
o Medications that could make memory worse
 Pain medications, sleeping pills, alcohol
• Depression
• Family history of dementia
What happens at
the doctors office?
• Physical Examination
o Checking for signs of
stroke, Parkinson’s or
other conditions that cause
dementia
• Memory Testing
o The “Mini-Mental” test
o Written test of memory and
thinking
o The doctor may also do
other memory tests
What happens at
the doctors office?

• Investigations
o Usually blood work is done to make sure there isn’t a medical cause for the
memory change
o Blood work to check vitamins and thyroid levels

• Imaging
o CT or MRI scans
o Not every person needs a head scan
o Scans are only done if there are signs of stroke, bleeding in the brain or other
worrisome signs
Diagnosis of Dementia

• No one test can diagnose dementia


• Memory tests or brain scans alone are not
enough
• Diagnosis is made after combining the
medical assessment and memory tests
“Modifiable” Causes of Dementia
• Medications
• Alcohol
• Metabolic (b12, thyroid, hyponatremia,
hypercalcemia, hepatic and renal dysfunction)
• Depression? (likely marker though…)
• CNS neoplasms, chronic subdural
• NPH
Normal Pressure Hydrocephalus

• Triad:
– Gait disturbance
– Urinary incontinence
– Cognitive dysfunction
NPH

• Diagnosis: initially on neuroimaging


• Miller Fisher test: objective gait assessment
before and after removal of 30 cc CSF
• Radioisotope diffusion studies of CSF
How to Prevent Dementia?
Prevention - Without Drugs
• Exercise the brain
• Exercise the body
• Keep socially active
• Quit smoking
• Alcohol in moderation
• Wear a helmet and avoid hitting your head
(sports)
• Healthy diet
• Omega fatty acids (fish oil)
Social Engagement
- Getting Out and About

• Visiting friends and


• relatives
• Joining clubs
• Senior centres
• Volunteering
Diet
• Mediterranean diet
• Plenty of fruits and
vegetables
• Regular consumption of
fish
o Antioxidants
o Healthy fats (omega 3)
Prevention – With Drugs
• May be helpful
o Omega 3 acids
• May be harmful
o Vitamin E and estrogen – may increase heart attack
and stroke
o Anti-inflammatories – heart and kidney side effects
o Ginkgo biloba – may increase bleeding
• Preventing strokes
o Keep good control of blood pressure, diabetes and
cholesterol
o Baby aspirin in people with risk of stroke – ask your
doctor
Treatment of
Dementia
Types of Treatment

• Non-medication treatment
• Medication treatment
Non-Medication Treatment
• Lifestyle
• Regular exercise and socializing
• Keep a regular routine
• Sleep
• Meals
• Dressing and bathing
• Toileting
• Keep enjoyment in life
• Massage and aromatherapy
• Pets
• Music
• Photo albums and happy
memories
Non-Medication Treatment
• Sleep problems
• Limit daytime naps
• Encourage physical activity in the day (not night)
• No alcohol or caffeine in the evenings
• Keep a night light in the bedroom or hall
• Keep a calm and regular night-time routine
• Hot milk and an evening snack

• Sleeping medicine
• Use if cannot sleep even with a
good routine
• Side effects like increasing
confusion
Medical treatment
• No medication can CURE dementia
• Medication may slow down the dementia
• In some people medication does not work at all
• Some people cannot take medication because of side
effects
• Medication is started when memory changes
interfere with day-to-day activities
• What medication can do:
• Make people a little more organized and able to function
day-to-day
• May not actually improve memory
Medical treatment
• Cholinesterase Inhibitors
• Approved for Alzheimer’s, Vascular, Mixed and
Parkinson’s Dementias
• Donepezil, Rivastigmine, Galantamine
• Side effects include nausea, diarrhea, slow heart
beat and dizzy spells
• Memantine is also used in more severe
Alzheimer’s
• Has side effects such as dizziness, and can worsen
aggression and confusion
Take Away Points
• Dementia is common
• Dementia is a memory
problem that interferes with
day-to-day activities
• There are many different
causes of dementia
o Alzheimer’s and Vascular
most common
• Not all memory problems
are dementia
Take Away Points
• Risk factors
o Cardiovascular
o Genetics
• Prevention
o Healthy diet and exercise
o Social activities
o Controlling medical conditions
o Prevent strokes
Take Away Points
• Treatment of dementia
involves
o Support systems for the
patient and caregivers
o Medication
• Safety and planning for the
future are important
• The Alzheimer’s Society is
wonderful resource for
families