Dementia Geriatrics Advocacy Group UBC Internal Medicine.
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Transcript of Dementia Geriatrics Advocacy Group UBC Internal Medicine.
DementiaGeriatrics Advocacy Group
UBC Internal Medicine
Disclosure• We are happy to provide general medical
information and answer your questionso This talk is not a substitute for seeing your
doctoro We will not be able to give you personal
medical advice
Outline• What is Dementia? • What are risk factors?
o Can you do anything about them?• How is dementia diagnosed?• Treatments for Dementia
o Lifestyleo Medications
• Living with Dementiao Safetyo Caregivers
• Future Research
What is Dementia?
Dementia
• A group of symptomso Memory losso Problems with reasoning, judgment, language
AND• Problems with day to day functioning
(work, driving, social relationships)oAND
• A progressive illness
Symptoms of Dementia
• Problems with short term memoryo Appointmentso Conversationso Eventso Repeating stories
• Difficulty remembering names, faceso Forgetting acquaintances
and friends
• 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
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 agingo Slower to process informationo Hearing and vision may decreaseo Motor speed decreases
• Unlike dementia, these changes should not prevent normal day-to-day activities
Other things that cause memory trouble
• A recent medical illnesso Starts suddenly o Changes between sleepy and agitated
• Depressiono Sad moodo Decreased initiative
• Some medical conditionso Vitamin deficiencieso Low thyroid functiono Sleep Apnea
• 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
Mild Cognitive Impairment
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”)
• Vascular dementia• Second most common type of dementia
Causes 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?
• Genetic• Vascular• Lifestyle
Risk Factors
• Most cases of dementia are NOT genetic, inherited or running in the family
Family History
• 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 dementiaoWhat can do to help with this?
Exercise, healthy diet, quit smokingManaging the above medical conditions well
Lifestyle
• Potential Lifestyle factors:Traumatic head injuriesToxic exposuresPhysical activity / DietEducation
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 familyo Memory changeso Trouble doing day-to-day activities
• Safety concernso Drivingo Getting losto Burning pots on the stove, leaving taps on to
flood
• Other medical conditionso Conditions that increase the risk of dementia
or strokeo Medications that could make memory worse
Pain medications, sleeping pills, alcohol
• Depression• Family history of dementia
What happens at the doctors office?
• Physical Examinationo Checking for signs of
stroke, Parkinson’s or other conditions that cause dementia
• Memory Testingo The “Mini-Mental” testo Written test of memory and
thinkingo The doctor may also do
other memory tests
What happens at the doctors office?
• Investigationso Usually blood work is done to make sure there isn’t a medical cause for the
memory changeo Blood work to check vitamins and thyroid levels
• Imagingo CT or MRI scanso Not every person needs a head scano 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
• 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 braino Learning new thingso helps keep the braino healthy
• Playing gameso Cardso Ma Jong
• New hobbies
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
fisho Antioxidantso Healthy fats (omega 3)
Prevention – With Drugs
• May be helpfulo Omega 3 acids
• May be harmfulo Vitamin E and estrogen – may increase heart attack
and strokeo Anti-inflammatories – heart and kidney side effectso Ginkgo biloba – may increase bleeding
• Preventing strokeso Keep good control of blood pressure, diabetes and
cholesterolo Baby aspirin in people with risk of stroke – ask your
doctor
Treatment of Dementia
Types of Treatment
• Non-medication treatment• 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
Non-Medication Treatment
• 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:o The diagnosis o The person’s memory will declineo The person will need more help over time
• Plan for the future while the person can still talk about what they prefer:o Living Arrangementso 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
situationo Bank accountso Incomeo Assets (home)o Debto Will
• Power of Attorneyo Assigns a person to take over
finances if they become unable to manage
Driving
• When to stop?• Who can help?
Wandering• Pacing around
o Can get lost or fall• Ways to manage
o Close supervisiono Provide a safe place to wander (mall)o Provide alternative activitieso Environment control
Lock doors Remove hazards
o 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!
• 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
• Caregiving is consuming!• Take time for yourself• Preventing burnout will allow you to care for your loved one better
and longer
News Flash - What is new in the Dementia World?
Diagnosis of Dementia
• New techniques show how the brain is workingo PET, SPECT scans
• More accurate and detailed scanso Early on may predict who is at risk of developing
Alzheimer’s disease o May help to tell different types of dementia apart
• Mostly used in researcho Soon could be used
routinely
• “Biomarkers”o Clues from cerebrospinal fluid (CSF), fluid around
the braino Take a sample of the fluid
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 nowo Soon could be used routinely
Diagnosis of Dementia
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 dementiao Alzheimer’s and Vascular
most common• Not all memory problems
are dementia
Take Away Points• Risk factors
o Cardiovascularo Genetics
• Preventiono Healthy diet and exerciseo Social activitieso Controlling medical conditionso Prevent strokes
Take Away Points
• Diagnosis of dementia is done by a doctor and involves:
o Talking with a patient and their family,
o A physical examo Memory testingo In some cases blood or
imaging tests
Take Away Points• Treatment of dementia
involveso Support systems for the
patient and caregiverso Medication
• 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?