ACT on Alzheimer’sDisease Curriculum

Module I: Disease Description

Disease Description

• These slides are based on the Module I: Disease Description text

• Please refer to the text for all citations, references and acknowledgments

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Module I: Learning Objectives

Upon completion of this module the student should:•Gain understanding of normal aging and cognitive functioning.•List potential causes of dementia and memory loss.•Identify the impact that Alzheimer’s disease and other dementias have on the human brain and functioning.•Demonstrate knowledge of Alzheimer’s disease including: stages and categories, symptoms, diagnosis, risk factors, and disease duration.

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Normal Aging

Normal Aging

• Intelligence remains intact• Principal changes in “normal” aging:

1. General slowing of cognitive performance2. Decrease in mental flexibility • Solving new problems with old solutions

3. Mild word-finding difficulties• Names of places, objects, people

4. Mild decrease in working memory • Manipulating information mentally (working a math

problem in your head)• “Senior moments”

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Normal Aging

• Independence in daily activities preserved

• Complains about memory but provides considerable detail re: instances of forgetfulness

• Patient often more concerned than close family

• Recent memory intact for important events

• Normal performance on mental status exam

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Description of Dementia

What is Dementia?

A chronic and persistent disorder caused by a brain disease or injury that produces a decline in memory and intellect from some previously higher level of functioning severe enough to

interfere with everyday life.

Dementia is NOT normal aging

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Alzheimer’s Disease

Vascular dementia

Pick’s diseaseBrain tumor

Lewy Body Disease

Dementia

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Causes of Dementia

• According to Adams (2002), the causes of dementia in people 71 years and older are:

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Alzheimer’s Disease

• Alzheimer’s disease is the most common form of dementia, accounting for 60-80% of all cases

• Symptoms of Alzheimer’s disease include:– Early stage symptoms may include difficulty

remembering names and recent events– Mid-stage symptoms may include deficits that

impact language and visuospatial function– Later stages include impaired judgment, confusion

and difficulty walking, talking and swallowing

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Vascular Dementia

• Vascular dementia (VD) was previously known as multi-infarct or post-stroke dementia

• VD is rarely the primary cause of dementia (5-10% of all cases)

• VD frequently overlaps with Alzheimer’s disease

• Clinical manifestations can be divided into cortical and subcortical syndromes

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Vascular Dementia

• For cortical syndromes, the presenting symptoms vary to the original stroke location

• For subcortical syndromes, presenting symptoms include focal motor signs, gait disturbance, and personality changes, and cognitive changes including mild memory deficit

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Other Forms of Dementia

• While Alzheimer’s disease and Vascular Dementia account for the vast majority of dementia cases, there are other forms of dementia:– Lewy Body dementia– Mixed dementia– Parkinson’s disease– Frontotemporal lobar dementia– Creutzfeldt-Jakob disease– Normal pressure Hydrocephalus

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Memory Loss

• In addition to dementia, memory loss can result from a variety of conditions:– Vascular (stroke, hypoxic injury after cardiac

arrest)– Infectious diseases (Herpes simplex, HIV)– Toxic (alcoholism, medication overdose)– Autoimmune– Metabolic (B12 deficiency, electrolyte imbalance)

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Memory Loss

• Other non-dementia conditions that may cause memory loss:– Neoplastic (brain tumor)– Traumatic (traumatic brain injury)– Endocrine (Hypothyroidism)– Episodic (seizure, migraine)– Neurodegenerative (Huntington’s Disease)

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Neuroanatomy of Memory Loss

• Memory is divided into the following memory systems:– Episodic memory: remember last minutes to

years, this type of memory is most commonly impacted by Alzheimer’s disease

– Working memory: type of memory lasting seconds, impacted by vascular dementia

– Semantic memory: consists of factual information– Procedural memory: driving a car or riding a bike

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Alzheimer’s Disease

Alzheimer’s Disease Is:

• A progressive, degenerative, neurological disease of the brain

• A steady decline in memory and cognitive functioning severe enough to interfere with everyday life

• Related to specific chemical and structural changes in the brain

• NOT reversible

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What does Alzheimer’s Look Like?

• Neurofibrillary tangles

• Amyloid plaques

• Decrease in chemicals that facilitate memory

• Cell death

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Impact of Alzheimer’s on Brain Size

Image appears courtesy of Dr. Richard E. Powers, Director of

the Alabama Bureau of Geriatric Psychiatry,

alzbrain.org

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Symptoms of Alzheimer’s Disease

• Memory loss that disrupts daily life• Challenges in planning or solving problems• Difficulty completing familiar tasks• Confusion with time or place• Trouble understanding visual images or spatial

relationships

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Symptoms of Alzheimer’s Disease

• New problems with words in speaking or writing

• Misplacing things or losing the ability to retrace steps

• Decreased or poor judgment• Withdrawal from work or social activities• Changes in mood and personality

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Categories of Alzheimer’s Disease

• The severity of Alzheimer’s disease can be broken down into three categories:– Mild cognitive decline– Moderate cognitive decline– Severe cognitive decline

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Categories of Alzheimer’s Disease

• Mild cognitive decline includes three stages:– Stage 1: no impairment, normal function– Stage 2: very mild cognitive decline, occasional

memory lapses; may be normal aging or the earliest signs of Alzheimer’s disease

– Stage 3: mild cognitive decline, early-stage Alzheimer’s may be diagnosed at this stage; family and friends may begin to notice changes

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Categories of Alzheimer’s Disease

• Moderate cognitive decline includes two stages:– Stage 4: moderate cognitive decline (mild or

early-stage Alzheimer’s disease); careful medical interview should discover clear-cut symptoms

– Stage 5: moderately severe cognitive decline (moderate or mid-stage Alzheimer’s disease); individuals begin to need help with day-to-day activities

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Categories of Alzheimer’s Disease

• Severe cognitive decline includes two stages:– Stage 6: Severe cognitive decline (moderately-

severe or mid-stage Alzheimer’s disease), memory loss worsens, changes in personality and individuals may need help with daily activities

– Stage 7: Very severe cognitive decline (severe or late-stage Alzheimer’s disease), individuals lose the ability to respond to their environment and need help with much of daily personal care

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Diagnosis of Alzheimer’s Disease

• Diagnosis of Alzheimer’s disease is commonly made by an individual’s primary care physician or neurologist. Steps in the diagnosis process include:– Getting a family and medical history– Family members provide input– Conducts cognitive test and physical and

neurologic exams– May include MRI or CT scans to detect changes in

the brain

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A Modern Diagnosis of Alzheimer’s

• In 2011, the National Institute on Aging (NIA) recommended new diagnostic criteria and guidelines for Alzheimer’s disease

• The new criteria and guidelines update, refine and broaden the guidelines published in 1984

• Three new stages of Alzheimer’s disease were proposed in 2011 to replace the prior stages that were developed in 1984

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Three Stages of Alzheimer’s

• Preclinical Alzheimer’s disease

• Mild Cognitive Impairment (MCI) due to Alzheimer’s disease

• Dementia due to Alzheimer’s disease

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Preclinical Alzheimer’s Disease

• Measurable changes in the brain that indicate signs of disease, but no development of symptoms

• Alzheimer’s disease changes in the brain 20 years before symptoms occur

• Additional biomarker research is needed before this stage of Alzheimer’s disease can be diagnosed

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MCI due to Alzheimer’s disease

• Individuals with MCI have mild but measurable changes in thinking abilities

• 10-20% of people over 65 years of age have MCI

• We do not know why some people with MCI develop dementia and others do not

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Dementia due to Alzheimer’s Disease

• This stage encompasses all stages of Alzheimer’s disease as they are listed in the previous stage descriptions from mild / early stage to severe / late-stage

• This stage is characterized by memory, thinking and behavioral symptoms that impair a person’s ability to function in daily life

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Causes of Alzheimer’s Disease• The cause or causes of Alzheimer’s disease are

not yet known• Experts believe that Alzheimer’s develops as a

result of multiple factors, rather than a single cause

• These factors include a variety of changes in the brain– Accumulation of the protein-amyloid outside neurons– Accumulation of the protein tau inside neurons

• Genetic mutation is a known cause of Alzheimer’s disease

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Risk factors for Alzheimer’s

• Most people with Alzheimer’s are over the age of 65. In addition to advancing age, other risk factors include:– Family history– Apolipoprotein E-ε4 (APOE-ε4)– Mild Cognitive Impairment (MCI)– Cardiovascular disease risk factors– Social engagement and diet– Head trauma and traumatic brain injury (TBI)– Lack of education

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Alzheimer’s Disease Duration

• Studies indicate that people age 65 and older with Alzheimer’s disease survive a median of three to eight years after a diagnosis, yet some live as long as 20 years

• On average a person with Alzheimer’s will spend more years (40% of the total number of years with Alzheimer’s) in the most severe stage of the disease than in any other stage

• Alzheimer’s disease is the sixth leading cause of death in the United States

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