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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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