DementiaGeriatrics Advocacy Group

UBC Internal Medicine

Disclosure• We are happy to provide general medical

information and answer your questionso This talk is not a substitute for seeing your

doctoro 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 Lifestyleo Medications

• Living with Dementiao Safetyo Caregivers

• Future Research

What is Dementia?

Dementia

• A group of symptomso Memory losso Problems with reasoning, judgment, language

AND• Problems with day to day functioning

(work, driving, social relationships)oAND

• A progressive illness

Symptoms of Dementia

• Problems with short term memoryo Appointmentso Conversationso Eventso Repeating stories

• Difficulty remembering names, faceso Forgetting acquaintances

and friends

• 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

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 agingo Slower to process informationo Hearing and vision may decreaseo Motor speed decreases

• Unlike dementia, these changes should not prevent normal day-to-day activities

Other things that cause memory trouble

• A recent medical illnesso Starts suddenly o Changes between sleepy and agitated

• Depressiono Sad moodo Decreased initiative

• Some medical conditionso Vitamin deficiencieso Low thyroid functiono Sleep Apnea

• 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

Mild Cognitive Impairment

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”)

• Vascular dementia• Second most common type of dementia

Causes 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?

• Genetic• Vascular• Lifestyle

Risk Factors

• Most cases of dementia are NOT genetic, inherited or running in the family

Family History

• 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 dementiaoWhat can do to help with this?

Exercise, healthy diet, quit smokingManaging the above medical conditions well

Lifestyle

• Potential Lifestyle factors:Traumatic head injuriesToxic exposuresPhysical activity / DietEducation

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 familyo Memory changeso Trouble doing day-to-day activities

• Safety concernso Drivingo Getting losto Burning pots on the stove, leaving taps on to

flood

• Other medical conditionso Conditions that increase the risk of dementia

or strokeo Medications that could make memory worse

Pain medications, sleeping pills, alcohol

• Depression• Family history of dementia

What happens at the doctors office?

• Physical Examinationo Checking for signs of

stroke, Parkinson’s or other conditions that cause dementia

• Memory Testingo The “Mini-Mental” testo Written test of memory and

thinkingo The doctor may also do

other memory tests

What happens at the doctors office?

• Investigationso Usually blood work is done to make sure there isn’t a medical cause for the

memory changeo Blood work to check vitamins and thyroid levels

• Imagingo CT or MRI scanso Not every person needs a head scano 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 braino Learning new thingso helps keep the braino healthy

• Playing gameso Cardso 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

fisho Antioxidantso Healthy fats (omega 3)

Prevention – With Drugs

• May be helpfulo Omega 3 acids

• May be harmfulo Vitamin E and estrogen – may increase heart attack

and strokeo Anti-inflammatories – heart and kidney side effectso Ginkgo biloba – may increase bleeding

• Preventing strokeso Keep good control of blood pressure, diabetes and

cholesterolo Baby aspirin in people with risk of stroke – ask your

doctor

Treatment of Dementia

Types of Treatment

• Non-medication treatment• 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

Non-Medication Treatment

• 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 declineo The person will need more help over time

• Plan for the future while the person can still talk about what they prefer:o Living Arrangementso 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

situationo Bank accountso Incomeo Assets (home)o Debto Will

• Power of Attorneyo 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 supervisiono Provide a safe place to wander (mall)o Provide alternative activitieso 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!

• 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

• Caregiving is consuming!• Take time for yourself• Preventing burnout will allow you to care for your loved one better

and longer

News Flash - What is new in the Dementia World?

Diagnosis of Dementia

• New techniques show how the brain is workingo PET, SPECT scans

• More accurate and detailed scanso 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 researcho Soon could be used

routinely

• “Biomarkers”o Clues from cerebrospinal fluid (CSF), fluid around

the braino 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 nowo Soon could be used routinely

Diagnosis of Dementia

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 dementiao Alzheimer’s and Vascular

most common• Not all memory problems

are dementia

Take Away Points• Risk factors

o Cardiovascularo Genetics

• Preventiono Healthy diet and exerciseo Social activitieso Controlling medical conditionso 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 examo Memory testingo In some cases blood or

imaging tests

Take Away Points• Treatment of dementia

involveso Support systems for the

patient and caregiverso 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?