Differential diagnosis between dementia and psychiatric disorders
Memory Disorders and Dementia: Overview and Updates · Memory Disorders and Dementia: Overview and...
Transcript of Memory Disorders and Dementia: Overview and Updates · Memory Disorders and Dementia: Overview and...
Memory Disorders and Dementia: Overview and Updates
Cheryl L Brandi, DNSc, APRN, NP-C, CADDCT
Nurse Practitioner, Roskamp Institute Neurology Clinic,
Sarasota, Florida
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Why is this discussion
important?
• Dementia: 1/5 of Medicare dollars
• Eighty-one percent of patients who meet dementia criteria have no diagnosis
• 1 in 3 seniors dies with dementia
• Prediction: By 2050, 13.2 million older Americans with Alzheimer’s Disease
• Parkinson’s Disease patients can develop dementia
Neurological disorder care:
It takes a village…
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Two ways of thinking
about memory disorders
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How severe is the disorder?
What is the likely disease pathology?
Normal brain aging
• Parts of the brain shrink, especially the prefrontal area and hippocampus, areas responsible for memory, learning, planning
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Memory, learning, planning
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Path of normal aging and dementia
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What is mild cognitive impairment?
• A medical diagnosis
• An abnormal condition of memory and/or thinking and not normal for age
• Sometimes called pre-dementia, but may not lead to dementia
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Normal aging and dementia
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Dementia
• A broad term for a number of chronic brain diseases involving irreversible changes in memory, thinking and/or behavior
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Dementia types and incidence
• Alzheimer’s Dementia, 55 - 65%
• Vascular Dementia, 10 - 15%
• Mixed
• Dementia with Lewy Bodies, probably 15 –20%
• Parkinson’s Dementia (40 % of PD patients)
• Frontotemporal Dementia, 5 – 8 %
• Less common
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Mild cognitive impairment and dementia
• Mild cognitive impairment--little change in daily life
• Dementia: Symptoms more obvious and person has trouble doing everyday normal activities
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Alzheimer’s Disease
• -First discovered by Alois Alzheimer in 1906
• -Usually starts some inability to remember recent events
• -Can lead to changes in language, disorientation, mood and decreased motivation but each case is different
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Pathology of Alzheimer’s Disease
• 1. Amyloid plaques
• 2. Neurofibrillary tangles—Tau protein
• 3. Loss of cell to cell connections-> cell death
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Amyloid plaques in brains have been found as early as age 20
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Nerve to nerve transmission
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By derivative work: Garrondo (talk) SEVERESLICE_HIGH.JPG: ADEAR: "Alzheimer's Disease Education and Referral Center, a service of the National Institute on Aging." PRECLINICALSLICE_HIGH.JPG: ADEAR: "Alzheimer's Disease Education and Referral Center, a service of the National Institute on Aging." (SEVERESLICE_HIGH.JPG PRECLINICALSLICE_HIGH.JPG) [Public domain], via Wikimedia Commons
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Normal brain and AD brain
Vascular dementia
• May be difficult to distinguish from AD
• May involve less significant memory impairment than AD
• Behavioral and mood disturbances more likely
• Movement disorders—gait and balance issues more common
• More trouble with spatial abilities
• Pattern--more episodic and stepwise
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Vascular dementia
• Risk factors: heart disease, hypertension, diabetes, obesity, smoking, age, male sex, possibly high homocysteine levels
Leucoaraiosis (Periventricular white matter
disease)
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Lewy Body Disease (LBD)
• Lewy bodies in the brain (alpha synuclein deposits)
• Lewy bodies deplete the neurotransmitter dopamine (movement and mood) and also acetylcholine (thinking, cognition)
• Discovered by Frederich Lewy, in the early 1900s
• Parkinson’s Disease and Lewy Body Disease are the same according to some experts
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Lewy body disease
• Progressive, often under-recognized
• Similar to Parkinson’s Disease, but in Lewy Body Disease, memory decline precedes the movement disorder
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Lewy Body
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Lewy Body Disease
characteristics
• Episodes of illogical thinking or incoherent random thoughts
• Staring spells or blank looks
• Visual hallucinations
• Acting out dreams
• BP drops with position changes
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Lewy Body Disease
characteristics
• Movement—slowed
• Movement—rigidity
• Postural stability less
• Tremor at rest
• Excessive daytime sleepiness
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Comparing Alzheimer’s and Lewy Body Disease
• Memory issues earlier in AD
• Movement issues earlier in LBD
• REM sleep disorder in LBD
• Autonomic nervous system disruption in LBD
• Certain medications might be more harmful in cases of LBD
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Frontotemporal Dementia
• A group of brain disorders characterized by behavior and language problems, and sometimes movement troubles
• Involves a progressive loss of neurons in the frontal and temporal lobes of the brain
• Several subtypes
• Also known as Pick’s Disease
• Ages 50 to 65 most common age group
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So what can I do to stabilize or prevent?
• No known cure for memory disorders or Parkinson’s disease
• We cannot change our genetic profile or our gender
• Even when there is a cure, lifestyle will be important
• Science supports even small lifestyle changes
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Evidence shows lifestyle factors do make difference!
• The Lancet Commission on Dementia Prevention, Intervention and Care, 2017
• Belief: A delay in the onset of dementia would benefit even the oldest adults
• Focus: Need to promote resilience and cognitive reserve
• Less cognitive reserve leads to earlier development of dementia
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Lancet Commission review results
• Data from 10,000 UK community-dwelling adults
• Dementia, might be the terminal stage of disease processes beginning 10 or 20 years before diagnosis
• About 35% of dementia--associated with nine risk factors
• Lifestyle changes could prevent more than a third of dementia cases.
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Nine important risk factors
• Low education level• Midlife hypertension• Midlife obesity• Hearing loss• Late life depression• Diabetes• Physical inactivity• Smoking• Social isolation
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Multi-intervention FINGERS study
• Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability
• Treatment group: 4 intensive lifestyle interventions to over 600 people 60 years and older at high risk
• Interventions: diet, exercise, cognitive training, and vascular management
• Intervention group: mean improvement in executive functioning and processing speed
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Other risk factors
• Traumatic brain injury—solid evidence to link to increased risk of dementia
• History of depression—moderate link to increased risk of cognitive decline
• Poor sleep
• Caregiving to family members with dementia
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Take-home points
• Stop smoking
• Physical activity—even mild activity is linked to decreased risk of memory decline
• Diet—combined Mediterranean/Dash diet probably has most evidence among diets for reducing risk
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Healthy nutrition
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Summary
• MCI and dementia are 2 different stages of a disease process
• MCI is a pre-dementia stage, but does not have to progress
• Most common types of dementia in seniors—Alzheimer’s Disease, Vascular dementia, Lewy Body disease and Parkinson’s dementia
• Lifestyle changes have scientific evidence to show they do make a positive difference in people with memory disorders
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