Normal Aging, Brain Injury and Alzheimer’s Disease
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Normal Aging, Brain Injury and Alzheimer’s Disease Annual Conference for Professionals in Brain Injury April 11, 2013
description
Normal Aging, Brain Injury and Alzheimer’s Disease. Annual Conference for Professionals in Brain Injury April 11, 2013. Presenters. Jean Wood, Minnesota Board on Aging Mark Kinde, Minnesota Department of Health Michelle Barclay, Alzheimer’s Association. Overview of Session. - PowerPoint PPT Presentation
Transcript of Normal Aging, Brain Injury and Alzheimer’s Disease
Normal Aging, Brain Injury and Alzheimer’s Disease
Annual Conference for Professionals in Brain InjuryApril 11, 2013
Presenters
• Jean Wood, Minnesota Board on Aging
• Mark Kinde, Minnesota Department of Health
• Michelle Barclay, Alzheimer’s Association
Overview of Session
• Normal brain changes with age• Brain injuries in older adults
– Prevalence, causes and comorbidities• Alzheimer’s Disease and other dementias
– Prevalence, identification and management• Falls prevention to reduce risk for brain injury
– community interventions
Demographics of Aging
• The baby boomers started turning 60 in 2006.• According to the 2010 Census -
In 2010, there were 683,000 Minnesotans age 65 and older.in 2030, there will be 1.3 million Minnesotans age 65 and older.
• The 85+ population is the fastest growing.
Normal Brain Changes with Aging
• Brain and spinal cord lose nerve cells and weight.
• Nerve cells may transmit messages more slowly.
• Reduced or lost reflexes or sensation may occur in some people.
• Some slight slowing of thought, memory and thinking is natural.
Brain Injury Epidemiology, MN
• When & where do brain injuries happen?• To whom?• What are the leading causes?• What other illnesses or injuries occur in
conjunction with brain injury?• What do we know about outcomes?• How much do brain injuries cost?• Who pays?
ED TBI by age-group
N
Year
Hospitalized TBI by age-group
N
Year
ED TBI by gender
N
Year
Hospitalized TBI by gender
N
Year
Seasonal incidence of TBIseen in the ED
Year
N
Seasonal incidence of hospitalized TBI
What causes unintentional TBI?(ED treated)
N
Year
What causes unintentional TBI?(Hospitalized)
N
Year
Where do brain injuries happen? (ED TBI)
N
Year
Where do brain injuries happen? (Hospitalized TBI)
N
Year
Co-morbidity: ED treated TBI
Co-morbidity Hospitalized TBI
What about drugs & alcohol?
ED Treated Hospitalized
Is income related to brain injury? (Median Income by Zip)
ED Treated Hospitalized
Centers for Disease Control and Prevention , National Center for Health Statistics. Multiple Cause of Death 1999-2010 on CDC WONDER Online Database, released 2012. Data are from the Multiple Cause of Death Files, 1999-2010, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.html on Feb 13, 2013 5:58:52 PM
TBI Mortality by year, Minnesota, 55+
ALZHEIMER’S DISEASE AND RELATED DEMENTIA
Dementia is a loss of mental function in two or more areas such as
language, memory, or judgment severe enough to impact daily life.
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Alzheimer’s disease is the most common cause of dementia.
Dementia
Common UncommonAlzheimer’s DiseaseVascular Dementia
Dementia with Lewy bodiesParkinson’s Dementia
Frontotemporal dementiaCorticobasal Degeneration
Progressive Supranuclear PalsyJakob-Creutzfeldt Disease
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Causes of Dementia in People 71+
Adams, 2002
Alzheimer’s Prevalence with Age
Hebert et al 2000
85+(42%)
65-74 years (1.6%)
75-84 years (19%)
Alzheimer’s Disease Risk Factors
Age Family history
Patients with a 1st degree relative have a 10-30% increased chance of developing AD (van Duijn 1991)
Genetic factors Mild Cognitive Impairment (MCI) Vascular risk factors Head injury Amyloid in the brain (PET Scan)
TAUIST
BAPTIST
Progression of Alzheimer’s Disease
Early Stage: 2 - 4 years in duration
Middle Stage: 2 - 10 years in duration
Late Stage: 1 - 3 years in duration
Early Stage AD
Symptoms Interfere with everyday functioning Forgetfulness Trouble with time/sequence relationships More mental energy needed to process Trouble multi-tasking Writes reminders, but loses them Personality changes Shows up at the wrong time or day Changes in appearance Preference for familiar things
Middle Stage AD Fluctuating disorientation Diminished insight Learning new things becomes difficult Restricted interest in activities Declining recognition of acquaintances,
distant relatives, then more sig. relationships
Mood and behavioral changes Functional declines Alterations in sleep and appetite Wandering
Late Stage AD
Severe disorientation to time and place No short term memory Long-term memory fragments Loss of speech Difficulty walking Loss of bladder/bowel control No longer recognizes family members Inability to survive without total care
Alzheimer’s Disease: Course, Prevention, Treatment Strategies
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INTERVENTION Primary Prevention
Secondary
Prevention
Treatment
CLINICAL STATE NormalPre-
symptomatic AD
Mild Cognitive Impairme
ntAD
Numbers of people ??? 20 to 60 mil 10 to 15 mil 5.3mil
BRAIN PATHOLOGIC STATE
No diseaseNo symptoms
Early AD brain changesNo symptoms
AD brain changesMild symptoms
Mild, moderate or severe impairment
STRATEGIES
Identify at-riskPrevent AD
Prevent or delay emergence of symptoms
Stimulate memorySlow progression
Treat cognitionTreat behaviorsSlow progressionDISEASE PROGRESSION
ALZHEIMER’S DISEASE IMPACT
Nearly 90,000 Minnesotans have Alzheimer’s disease.
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5.4 million Americans have the disease.
Number of people over 65 with AD in MN38
2000 2010 2025 Change
% increa
se
88,000 94,000 110,000 22,000 25%Alzheimer’s Association Facts & Figures Report 2012
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Alzheimer’s disease is the sixth leading cause of death
in the United States.
AD is the fifth leading cause of death for those aged 65 and older.
% change in leading causes of death: 2000 - 2008
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Alzheimer’s Association Facts & Figures Report 2012
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Nearly 240,000 Minnesotans are caregivers for someone with Alzheimer’s disease.
Seventy percent of people with Alzheimer’s disease live at home.
Economic Value of Caregiving in MN42
Number of ADRD Caregive
rs
Hours of Unpaid
Care
Economic Value of Unpaid Care
237,441 270,397,947 $3,225,847,510Alzheimer’s Association Facts & Figures Report 2011
Age of Alzheimer’s Family Caregivers43
*Average age = 52 years
Alzheimer’s Association Facts & Figures Report 2012
Impact on the Caregiver’s Health
33% of Alzheimer’s family caregivers have symptoms of depression
Alzheimer’s family caregivers are more likely than non-caregivers to: Report that their health is fair to poor. Have high levels of stress hormones, reduced
immune function, slow wound healing, new hypertension and new coronary heart disease.
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People with Alzheimer’s disease are high users of healthcare
and long-term care services.
Total cost was three times higher for Medicare beneficiaries age 65+ with AD in 2004.
Average Medicare payments per person for beneficiaries age 65+ with and without ADRDs in 2008 (2011 dollars)
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Alzheimer’s Association Facts & Figures Report 2012
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More than seventy thousand Minnesota nursing home residents
have cognitive impairment.
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Current data suggests that less than 35% of people with Alzheimer’s and other dementias have a diagnosis of the condition in their medical record.
Boise et al., 2004, Boustani et al., 2005, Ganguli et al., 2004, Valcour et al., 2000
Impact of Co-Existing Medical Conditions:Percentage of Medicare beneficiaries 65+ with ADRD and a co-existing medical condition in 2009
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Alzheimer’s Association Facts & Figures Report 2012
COMMUNITY INTERVENTIONS TO IMPROVE IDENTIFICATION & MANAGEMENT OF AD
Benefits of Early Identification
Rule out other causes of cognitive impairment Start treatment early Better manage co-existing conditions Understand the symptoms and how to manage them Make decisions and future plans Build a support system Lower anxiety Avoid crisis-driven care Participate in clinical trials or other research
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Provider Practice Tools
Cognitive Impairment ID Flow Chart
Dementia Work-Up / Provider Checklist
Intervention Checklist
www.alz.org/documents/mndak/pagetrifold.pdf
Early Intervention Goal 1: Educate about medications Goal 2: Reduce excess disability
Treat conditions that worsen symptoms or lead to poor outcomes (depression, uncontrolled diabetes or blood pressure, etc.)
Make safety part of the plan Goal 3: Educate about the disease, common pitfalls,
and actions that lead to success Taking Action Workbook
Goal 4: Encourage lifestyle changes that may reduce disease symptoms or slow symptom progression Living Well Workbook
Medical Interventions: Cognitive & Behavioral Symptoms Cholinesterase Inhibitors (early- late) -
Cognex®, Aricept®/ Donepezil, Exelon®, Razadyne®
Side Effects: nausea, vomiting, increased bowel frequency
Glutomate blocker (NMDA receptor antagonist: mid/late) - Namenda®
Goal: to maintain function and reduce impact of symptoms
Medical Treatment – Co-morbid Conditions and Behavioral Symptoms Co-morbid medical conditions
Diabetes, cholesterol, blood pressure, sleep dysregulation
Psychiatric / Behavioral Symptoms Depression Anxiety Aggression / Agitation Hyper-sexuality
Reducing Excess Disability Treat conditions that worsen symptoms or lead to poor outcomes
Depression Co-existing medical conditions (diabetes, blood pressure, sleep
dysregulation) Stop smoking, limit alcohol
Address Safety Issues Medication management Fall risk Home modification / simplification Driving assessment Gun safety Financial safety Medical emergency Employment Issues, when applicable
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Early Stage
Current Services in Minnesota
Medical Evaluation / Diagnosis / Pharmacological Treatment*Research / Clinical Trials*Care Coaching / ConsultationInformation / Education Early Stage Support Groups* Engagement Programs (arts, social, creativity)*Exercise / Nutrition / Cognitive Habilitation* Home Care / Companion Services* Assisted LivingMedic Alert Safe Return® * limited
availability
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Middle Stage
Current Services in Minnesota
Medical Evaluation / Diagnosis / Pharmacological TreatmentResearch / Clinical Trials*Care Coaching / Consultation / CounselingInformation / Education Caregiver Support Groups* Adult Day Services* Meals on Wheels*Home Care / Home Health Care / Respite Services*Medic Alert Safe Return®
Assisted Living / Nursing Facility * limited availability
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Late Stage
Current Services in Minnesota
Medical Evaluation / Diagnosis / Pharmacological TreatmentCare Coaching / Consultation / CounselingInformation / Education Caregiver Support Groups* Adult Day Services* Meals on Wheels*Home Care / Home Health Care / Respite Services*Medic Alert Safe Return®
Assisted Living / Nursing FacilityHospice* * limited
availability
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Minnesota Resources
Telephone / Internet Resources Alzheimer’s Association 800.272.3900 alz.org/mnndSenior LinkAge Line 800.333.2433 MinnesotaHelp.infoACT on Alzheimer’s ACTonAlz.org
Falls in Older Adults
• Falls are the leading cause of injury for children and for adults 35-years and older.
• Falls and fall-related injuries among adults over age 65 are on the rise.
• MN ranks 5th among states in number of fall-related deaths.
Proven Steps to Reduce Fall Risk• Ask fall risk screening questions of the adults
you work with.• Refer individuals at risk for falls to their
physician for a comprehensive assessment.• Know your community resources. Connect
individuals to the resources that can help them take steps to reduce their risks.
www.mnfallsprevention.orgwww.minnesotahelp.info
Contact Information
Jean Wood, Minnesota Board on Aging651-431-2563, [email protected]
Mark Kinde, Minnesota Department of Health651-201-5447, [email protected]
Michelle Barclay, Alzheimer’s Association952-857-0524, [email protected]
