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Dementia_Talk_2011_pics_PPT_v1_2

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									Dementia
Geriatrics Advocacy Group
 UBC Internal Medicine
             Disclosure
• We are happy to provide general medical
  information and answer your questions
  o This talk is not a substitute for seeing your
    doctor
  o 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   Lifestyle
  o   Medications
• Living with Dementia
  o   Safety
  o   Caregivers
• Future Research
What is Dementia?
               Dementia
• A group of symptoms
  o   Memory loss
  o   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
  o   Appointments
  o   Conversations
  o   Events
  o   Repeating stories
                          • Difficulty remembering
                            names, faces
                            o   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
       o   Slower to process information
       o   Hearing and vision may decrease
       o   Motor speed decreases
     • Unlike dementia, these changes
       should not prevent normal day-
       to-day activities
  Other things that cause
     memory trouble
• A recent medical illness
  o   Starts suddenly
  o   Changes between sleepy and agitated
• Depression
  o   Sad mood
  o   Decreased initiative
• Some medical conditions
  o   Vitamin deficiencies
  o   Low thyroid function
  o   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)
•   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
  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
       o   Memory changes
       o   Trouble doing day-to-day activities
     • Safety concerns
       o   Driving
       o   Getting lost
       o   Burning pots on the stove, leaving taps on to
           flood
     • Other medical conditions
       o   Conditions that increase the risk of dementia
           or stroke
       o   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
  o The “Mini-Mental” test
  o Written test of memory and
    thinking
  o The doctor may also do
    other memory tests
                    What happens at
                   the doctors office?




• Investigations
   o 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

• Imaging
   o   CT or MRI scans
   o   Not every person needs a head scan
   o   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 brain
          o   Learning new things
          o   helps keep the brain
          o   healthy

        • Playing games
          o   Cards
          o   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
    fish
       o   Antioxidants
       o   Healthy fats (omega 3)
         Prevention – With Drugs
• May be helpful
  o   Omega 3 acids
• May be harmful
  o Vitamin E and estrogen – may increase heart attack
    and stroke
  o Anti-inflammatories – heart and kidney side effects
  o Ginkgo biloba – may increase bleeding
• Preventing strokes
  o Keep good control of blood pressure, diabetes and
    cholesterol
  o Baby aspirin in people with risk of stroke – ask your
    doctor
Treatment of
 Dementia
        Types of Treatment


• Non-medication treatment
• Medication treatment
Non-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

• 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 decline
      o   The person will need more help over time
    • Plan for the future while the person can
      still talk about what they prefer:
      o   Living Arrangements
      o   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
  o   Bank accounts
  o   Income
  o   Assets (home)
  o   Debt
  o   Will

• Power of Attorney
  o   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 supervision
  o   Provide a safe place to wander (mall)
  o   Provide alternative activities
  o   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!
• 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
  o   PET, SPECT scans

• More accurate and detailed scans
  o 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 research
  o   Soon could be used
      routinely
          Diagnosis of Dementia

• “Biomarkers”
  o Clues from cerebrospinal fluid (CSF), fluid around
    the brain
  o 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 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
       o   Alzheimer’s and Vascular
           most common
     • Not all memory problems
       are dementia
      Take Away Points
• Risk factors
  o   Cardiovascular
  o   Genetics
• Prevention
  o   Healthy diet and exercise
  o   Social activities
  o   Controlling medical conditions
  o   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 exam
                    o Memory testing
                    o In some cases blood or
                      imaging tests
      Take Away Points
• Treatment of dementia
  involves
  o Support systems for the
    patient and caregivers
  o 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?

								
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