Transcript Document

Dementia
Geriatrics Advocacy Group
UBC Internal Medicine
Disclosure
• We are happy to provide general medical
information and answer your questions
This talk is not a substitute for seeing your
doctor
o We will not be able to give you personal
medical advice
o
Outline
• What is Dementia?
• What are risk factors?
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Can you do anything about them?
• How is dementia diagnosed?
• Treatments for Dementia
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Lifestyle
Medications
• Living with Dementia
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Safety
Caregivers
• Future Research
What is Dementia?
Dementia
• A group of symptoms
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Memory loss
Problems with reasoning, judgment, language
AND
• Problems with day to day functioning
(work, driving, social relationships)
o AND
• A progressive illness
Symptoms of
Dementia
• Problems with short term memory
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Appointments
Conversations
Events
Repeating stories
• Difficulty remembering
names, faces
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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
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Slower to process information
Hearing and vision may decrease
Motor speed decreases
• Unlike dementia, these changes
should not prevent normal dayto-day activities
Other things that cause
memory trouble
• A recent medical illness
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Starts suddenly
Changes between sleepy and agitated
• Depression
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Sad mood
Decreased initiative
• Some medical conditions
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Vitamin deficiencies
Low thyroid function
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)
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High blood pressure
High cholesterol
Diabetes
Smoking
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All of these increase the
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
How is it DIAGNOSED?
• The only true way is to test a
sample of the brain
• This cannot be done in a live person!
• Doctors are researching ways to
diagnose dementia using brain scans
and other tests
• The diagnosis is made by your
doctor
• Talking to the patient and family
• Physical examination
• Brain scans and laboratory tests in
some cases
What happens at
the doctor's office?
• Talking to the patient and family
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Memory changes
Trouble doing day-to-day activities
• Safety concerns
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Driving
Getting lost
Burning pots on the stove, leaving taps on to
flood
• Other medical conditions
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Conditions that increase the risk of dementia
or stroke
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
The “Mini-Mental” test
Written test of memory and
thinking
o The doctor may also do
other memory tests
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What happens at
the doctors office?
• Investigations
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
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• Imaging
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CT or MRI scans
Not every person needs a head scan
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
How to Prevent Dementia?
Prevention - Without Drugs
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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)
Brain Training?
• Exercise for the brain
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Learning new things
helps keep the brain
healthy
• Playing games
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Cards
Ma Jong
• New hobbies
Social Engagement
- Getting Out and About
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Visiting friends and
relatives
Joining clubs
Senior centres
Volunteering
Diet
• Mediterranean diet
• Plenty of fruits and
vegetables
• Regular consumption of
fish
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Antioxidants
Healthy fats (omega 3)
Prevention – With Drugs
• May be helpful
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Omega 3 acids
• May be harmful
Vitamin E and estrogen – may increase heart attack
and stroke
o Anti-inflammatories – heart and kidney side effects
o Ginkgo biloba – may increase bleeding
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• Preventing strokes
Keep good control of blood pressure, diabetes and
cholesterol
o Baby aspirin in people with risk of stroke – ask your
doctor
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Treatment of
Dementia
Types of Treatment
• Non-medication treatment
• Medication treatment
Non-Medication Treatment
• Lifestyle
• Regular exercise and socializing
• Keep a regular routine
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Sleep
Meals
Dressing and bathing
Toileting
• Keep enjoyment in life
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Massage and aromatherapy
Pets
Music
Photo albums and happy
memories
Non-Medication Treatment
• Sleep problems
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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
Tips For Caregivers
• Patience with repetitive behaviors
• The person doesn’t realize they are doing it
• Speak slowly, using one idea at a time
• Emotional outbursts, suspicion
• Try to distract rather than argue
• Suggest a cup of tea or a walk
• If you are too frustrated, take a break
• Go for a walk
• Call a friend
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 (Aricept), Rivastigmine (Exelon),
Galantamine
• Side effects include nausea, diarrhea, slow heart beat
and dizzy spells
• Memantine (Ebixa) is also used in more severe
Alzheimer’s
• Has side effects such as dizziness, and can worsen
aggression and confusion
Living with Dementia
Planning for the Future
• Involve family and close friends and
explain:
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The diagnosis
The person’s memory will decline
The person will need more help over time
• Plan for the future while the person can
still talk about what they prefer:
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Living Arrangements
Health Care
 Substitute Decision Maker – who will make
medical decisions if the person becomes
unable
 Advance Directives – a written document
about medical preferences
Finances
• Understand their financial
situation
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Bank accounts
Income
Assets (home)
Debt
Will
• Power of Attorney
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Assigns a person to take over
finances if they become
unable to manage
Driving
• When to stop?
• Who can help?
Wandering
• Pacing around
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Can get lost or fall
• Ways to manage
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Close supervision
Provide a safe place to wander (mall)
Provide alternative activities
Environment control
 Lock doors
 Remove hazards
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Maintaining contact
 Wandering registry: Safely Home, GPS, cell phones
Tips For Caregivers:
Safety Measures at Home
• Locks on medicine cabinets
• Locks for stove
• Keep furniture in the same place to
prevent falls
• No electrical appliances in bathroom
• Keep water heater below 50 C
• Help the person with personal care
• Ask for a home therapist visit from your
doctor
• Home safety and equipment suggestions
For Caregivers
– Take Care of Yourself!
• Caregiving is consuming!
• Take time for yourself
• Preventing burnout will allow you to care for your loved one better
and longer
• Exercise and socialize
• Take care of your own medical
problems
• Consider respite care and outside
supports
• Respite through care facilities
• Home Care
• Adult Day Centers
• Connect with other caregivers
through the Alzheimer’s Society of
BC
News Flash - What is new in the
Dementia World?
Diagnosis of Dementia
• New techniques show how the brain is working
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PET, SPECT scans
• More accurate and detailed scans
Early on may predict who is at risk of developing
Alzheimer’s disease
o May help to tell different types of dementia apart
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• Mostly used in research
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Soon could be used
routinely
Diagnosis of Dementia
• “Biomarkers”
Clues from cerebrospinal fluid (CSF), fluid around
the brain
o Take a sample of the fluid
o
 Must stick a needle into the back to collect the fluid
 Invasive test with some risks
• May be able to predict who among those with
mild memory problems will eventually get
Alzheimer’s Disease
• Only used in research right now
o
Soon could be used routinely
Treatment of Dementia
• There is currently no cure for any type of
dementia
• Researchers are working hard on new
treatments and ways to prevent dementia
• Vaccines
• New medications
• New treatments may be ready as early as 5 –
10 years from now
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
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Alzheimer’s and Vascular
most common
• Not all memory problems
are dementia
Take Away Points
• Risk factors
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Cardiovascular
Genetics
• Prevention
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Healthy diet and exercise
Social activities
Controlling medical conditions
Prevent strokes
Take Away Points
• Diagnosis of dementia is done by a
doctor and involves:
Talking with a patient
and their family,
o A physical exam
o Memory testing
o In some cases blood or
imaging tests
o
Take Away Points
• Treatment of dementia
involves
Support systems for the
patient and caregivers
o Medication
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• Safety and planning for the
future are important
• The Alzheimer’s Society is
wonderful resource for
families
Take Away Points
• There’s a lot of
research going on in
dementia
• New information is
coming about
prevention, diagnosing
and treating dementia
Thank You!
• Faculty Advisor: Dr. R. Wong
• Geriatric Medicine Fellow: Dr. J. Chase
• Presentation Contributors:
o Drs. E. Dempsey, K. Gan, J. Iosfina, M.
Spencer, M. Wan, W. Wong
• To you for the invitation to speak
Questions?