Upload
hillary-johns
View
217
Download
1
Tags:
Embed Size (px)
Citation preview
Martha Stearn, MD
Institute for Cognitive Health
St John’s Medical Center
Jackson, Wyoming
An Overview of the Dementias
Regions of the Human Brain
2% of the total body weight
Uses 20% of the body’s blood supply
Achieves it’s maximum weight at age 20
Most of brain’s oxygen use goes to grey matter
Interesting Facts
Infancy communicationChildhood language and spatial
Young Adult brain growth peaks
Middle Age memory, learning, more difficult
Old Age continued slowing, more memories and wisdom
The Life Cycle of the Brain
The CerebrumThe Cortex
The frontal lobe – executive function, socialization, language
The parietal lobe – memory, visuospatial
The temporal lobe – short-term memory
The occipital lobe - vision
Parts of the Brain and their Function
The Limbic System
The Hippocampus
The Basal Ganglia
The Amygdala
Brain StemCerebellum
The Old Brain
100 billion cellsOne trillion
connections
The Cortical Neuron
SEROTONIN low levels in depression
DOPAMINE low levels in DLB
ACETYLCHOLINE low levels in AD, TBI, DLB, Vascular dementia
NOREPINEPHRINE
GLUTAMATE high levels in AD
Neurotransmitters
What happens to those short term memories?
Loss of intellectual abilities of sufficient severity to interfere with occupational or social functioning
to the point that one cannot function independently successfully
The Memory ContinuumPRECLINICAL the stage is being setCLINICAL Mild Cognitive ImpairmentDEMENTIA Conversion to dementia
Definition of Dementia
All involve abnormal deposition of specific proteins in the brain (amyloid and tau) that is a progressive process gradually damaging more neurons over timeClinical significance
These proteins can be biomarkers for identifying those at riskCertain lifestyle changes have been shown to
reduce that rate of protein depositionResearch geared toward drugs that will eliminate,
prevent or dissolve these proteins
Neuropathology of the dementias
Alzheimer’s Disease
Vascular Dementia
Dementia with Lewy Bodies
FrontoTemporal Dementia
Dementia of Parkinson’s DiseaseNPH
The Dementias
Most common cause of dementia
Characterized by short term memory loss and, usually later, visuospatial deficits
6th leading cause of death in the United States
Risk increases starting at age 65; nearly 50% chance of having the disease by age 85
Alzheimer’s Disease
Short term memory loss
(AMNESIA) and at least one of the following domain dysfunctions:
APHASIAAGNOSIAABSTRACTIONAPRAXIA
Definition of Probable Alzheimer’s
Also known as multi-infarct dementiaOften presents as a mix with ADRisk factors similar to those for heart disease:
HyperlipidemiaHTNSmokingDiabetesFamily history for vascular disease
Onset may appear more rapidly than ADMay not be progressive if risk factors controlled
VASCULAR DEMENTIA
VISUAL-SPATIAL PROBLEMS OFTEN MORE PROMINENT FROM THE START
HALLUCINATIONS COMMON
MENTAL STATUS TENDS TO FLUCTUATE UNPREDICTABLY
DIFFICULTY WITH CIRCADIAN RHYTHM
PARKINSONISM ON PHYSICAL EXAM
DEMENTIA WITH LEWY BODIES
More common than AD in the 50-65 age group
Memory loss less likely to be presenting symptom
Behavioral issues, change in personality, disinhibition are presenting hallmarks
Language difficulties
FRONTOTEMPORAL DEMENTIA
Cholinesterase inhibitorsDonepezil Rivastigmine GalantamineGlutamate inhibitor Memantine Atypical antipsychotics
QuetiapineMirtazapineRisperidoneHaloperidol—can be deadly for pts with dlb
Important Dementia Drugs
• Bad drugs: • antihistamines, haloperidol, hypnotics,
benzodiazepines; narcotics
• Anticholinergics: • bladder control meds; diarrhea control meds;
some asthma drugs, eg tiotropium, ipratropium
Dangers Of Polypharmacy
Behavioral issuesInsomniaDepressionNot eatingAnxietyHallucinationsParanoia
Common Symptoms
Falling
Driving
Wandering
Malnutrition
Aspiration
Why People Die From AD
Making a diagnosisMedications
Lifestyle Team approach
Dealing with caregiver burden
How we can make a difference
Neuropsychological testingPhysical therapy for balance and fall
preventionSpeech therapyOccupational therapy for home safety
evaluation and driving evaluationSupport groupsExercise classesBrain ImagingBlood work: TSH, B12, Lipids, complete
metabolic profile, CBC
Treatment and Diagnostic Modalities