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Am I Losing My Mind?Normal Aging vs. Early Signs of Dementia
Laurey Sherman, RN, BSN
Founder, Providence Senior Living
www.ProvidenceAL.com
Is It Alzheimer’s or Just Normal Aging?
• Terminology
• The Difference Between Normal Aging, Mild Cognitive Impairment, and
Dementia, Causes, Risk Factors, Diagnosis
• Progression Path of Alzheimer’s Disease
Terminology
• ADL=Activities of Daily Living (bathing, dressing, grooming, toileting)
• Normal Aging
• Mild Cognitive Impairment (MCI)• Incipient Dementia
• Isolated Memory Impairment
• Cognitive Impairment, No Dementia (CIND)
• Short Term Memory Loss (STML)
• Age-Associated Cognitive Decline (AACD)
• Alzheimer’s Disease (AD) / Dementia
Alzheimer’s Disease / Dementia
Progressive Incapacitating
Mild Cognitive Impairment
More Pronounced Mild Affect ADL
Normal Aging
Gradual Normal ADL
Normal Aging Pattern and Factors
Normal Aging Pattern
• Gradual Changes In:
• Intelligence
• Memory
• Attention
• Language
• Reasoning
• Speed of Processing
• No Changes in Day to Day Functioning
• Usually not noticeable to Friends or Family
Factors Affecting Normal Aging
• Stress
• Medications
• Sensory Changes
• Physical Decline *
• Depression or Anxiety *
* Recent Research suggests these may be precursors for Dementia
It’s Time For the MINI-MENTAL!
Mild Cognitive Impairment (MCI)
• The Intermediate Stage between Normal Aging and Dementia
• 20% over Age 65 have MCI
• More severe problems with memory, judgment, language and thinking
• Family and friends usually notice a change
• Usually doesn’t interfere with your day-to-day activities
• Sometimes worsens. Sometimes improves.
• May be Permanent or Temporary
Causes of MCI
• May or May Not be Related to Alzheimer’s Disease
• Parkinson’s Disease (Lewy Body proteins)
• Strokes or other changes in blood flow to the brain (e.g., Trauma)
• Shrinkage of the Hippocampus
• Ventricular enlargement
• Brain Plaques (beta-amyloid proteins)
• Chemotherapy or other Drugs
Risk Factors & Diagnosis of MCI
Risk Factors
• Age
• APOE-e4 gene
• Diabetes
• Smoking
• Depression
• High Blood Pressure
• High Cholesterol
• Lack of Exercise
• Lack of Mental and Social Stimulation
Diagnosis
• Medical History & Physical Exam
• Cognitive Tests (MMSE, etc)
• CT, MRI, Blood Tests
• Declining over time
• Confirmation with Family/Friend
• This diagnosis ISN’T DEMENTIA!
Alzheimer’s—the Most Common Form of
Dementia
• Short Term Memory Loss affects DAILY LIFE
• Difficulty Problem Solving
• Difficulty Completing FAMILIAR tasks
• Confusion with Time and Place
• Trouble Understanding Visual Images and Spacial Relationships
• New Problems with Words and Writing
• Misplacing/Inability to RETRACE steps
• Decreased or Poor Judgment
• Social/Work Withdrawal
• Changes in Mood/Personality
• 95%--A combination of genetic, lifestyle, and environmental factors
• 5%--Genetic
• Damage/Death of Brain Cells, specifically the hippocampus
• “Plaques and Tangles”—incapacitate the brain cells
What Causes Alzheimer’s Disease (AD)?
One of the First Signs of AD is Short Term
Memory Loss (STML)
Definition:
• “Short Term” is 30 seconds to several days, things you are currently thinking about
• “Short Term” is 5-9 items. Long Term is far more.
• Memories Travel The Brain:
Frontal LobeHippocampusCerebral Cortex
• STML—when problems occur in the Frontal Lobe
Diagnosis:
• Medical History & Physical Exam
• Cognitive Tests (MMSE, etc)
• CT, MRI, Blood Tests
Early AD Can Look Like MCI
Symptoms of Mid-Stage AD
• Repeating statements without realizing the repetition
• Forget things without remembering them later
• Misplacing things, often in illogical locations
• Disorientation—month, day, season, year
• Difficulty finding words, problems with reading and forming sentences
• Inability to keep track of bills, problems with simple math
• Repeatedly Burning things on the stove, Getting lost while driving
• Personality Changes—aggression, frustration, anger, blaming others
Disease Progression and Prognosis
• Functional Assessment Staging Test (FAST) Stages 1—7f
• Memory AttireToiletingSpeakingWalkingSittingSwallowing
• Palliative Care (“Hospice”) is Appropriate at Stage 7a (“Speaks 5-6 words per day”)
• Death is usually attributed to Heart or Respiratory Failure, Secondary to Dehydration
• Disease Progress is Usually 4-10 Years, but Can Go Longer
Resources for this Presentation
• Love in the Land of Dementia
• The 36-Hour Caregiver
• MayoClinic.org
• Alz.org
• webMD.com
• Auer S., Reisberg B, The GDS/FAST staging system. Int Psychogeriatr 9 Suppl 1:167-71, 1997