1

Dementia

Definition

Chronic, progressive deterioration of:

Intellect
Memory
Personality
Communication functions
Ten warning signs...what is not a senior moment (USC Health 2006)

Memory loss
Diculty performing familiar tasks
Problems with language
Disorientation to time and place
Poor or decreased judgment
Ten warning signs, cont.

Problems with abstract thinking

Misplacing things
Changes in mood
Changes in personality
Loss of initiative
Definition, cont.

Etiology of dementia
Reversible causes include (10%)
Depression
Drug toxicity
Alcohol abuse
Brain tumor
Strokes

Hypoglycemia
Head trauma
Vitamin B12 deficiency

Vitamin B12 deficiency

Irreversible causes
Alzheimers disease (AD)
Parkinsons disease
AIDS
1/2 of all dementia is caused by Alzheimers disease
Alzheimers
disease
Progressive deterioration of key areas of the cerebral cortex of the brain (specifically hippocampus)
Abnormalities include senile plaques and tangles
Until recently, only confirmed with autopsy diagnosis
Suspected genetic link?
Genetic link has been found in some cases

9
10

Process of degeneration

11

Depositing of amyloid
Something happens to tau
Process of neural degeneration begins
Everyone with Alzheimers has amyloid, but not everyone with amyloid has Alzheimers
Treatment

12

There is no cure
Great need for more research, especially on early onset Alzheimers
Drugs are marginally eective
200 drugs have been tested since 2000
Alzheimer pill? We have cured Alzheimers in mice. Why cant we move that success to people?
Question: when should treatment begin?
Incidence
Truly a disease of old age (90% of cases after age 65)
Aects 1 out of 10 people over 65 in U.S.
1/3 of those over 80
Fourth leading overall cause of death in the U.S.

13

1/3 of those over 80

Fourth leading overall cause of death in the U.S.
Globally, expected to double every 20 years
Characteristics

14

Mild:
Mild forgetfulness, but not a functional problem
diculty with higher-order abstract skills
Language: aphasia and agraphia
Orientation in complex environments
Supervision and cueing may be needed for ADL/IADLs
Characteristics, cont.

15

Moderate:
assistance needed for ADLs
Constant supervision needed for safety
Increasingly severe diculties in judgment, problem solving, attention span, following instructions, sequencing
Communication problems: expressive and receptive language
Moderate, cont.

16

Catastrophic reactions:
Triggered by an event that seems innocent to an observer
Even hunger and thirst can trigger such an event
Activities in this stage: can follow simple directions and activities that are highly familiar and repetitive
Notebook: Catastrophic reaction

17

Characteristics, cont.

18

Severe:
all self-help care must be done for them
Incontinence
Movement is impaired
Functional speech unlikely
Focus is on maintaining physical health and nutrition
Care for care-givers essential!
Caregivers

18

Caregivers

19

Who provides care?

Emotional reactions may include:
mixed feelings, anger, embarrassment, helplessness, guilt, grief, worry, depression
Study on emotional impact of memories even when memories are gone (NPR)

20

Encouraging words about the power of emotions

Role of hippocampus
Good reason to visit grandparents...
NPR segment
Images
http://news.injuryboard.com/uploadedImages/InjuryBoardcom_Content/Blogs/News_Blog/News/Senior%20and
%20son%20i%20stock%20lisafx%20500.jpg
http://i.telegraph.co.uk/telegraph/multimedia/archive/00641/news-graphics-2007-_641731a.jpg
http://images.google.com/imgres?imgurl=http://www.ahaf.org/alzdis/about/AD_2003.jpg&imgrefurl=http://
www.ahaf.org/alzdis/about/
Brain_Neurons_AD_Normal.htm&h=518&w=700&sz=70&tbnid=hgqaOP33B_sJ:&tbnh=102&tbnw=138&hl=en&start
=1&prev=/images%3Fq%3Dalzheimer%2527s%26svnum%3D10%26hl%3Den%26lr%3D
http://4.bp.blogspot.com/_2NVidvH-nOw/RhwI_UsgTkI/AAAAAAAAAE8/4wQTcEu-7gc/s320/1.jpg
http://www.eatingdisorderexpert.co.uk/images/15808.jpg
http://lgimages.s3.amazonaws.com/data/imagemanager/5547/caregiver.jpg
http://www.caringnews.com/UserFiles/Image/iCooking_Seniors.jpg
http://www.f-secure.com/weblog/archives/iPhone_in_Freezer.jpg
http://www.accesshollywood.com/content/images/61/originals/61695_video-191982-access-exclusive-michael-jfox-part-ii.jpg
http://lolwithgod.files.wordpress.com/2011/08/grandma_working.jpg?w=490
http://cnnlarrykinglive.files.wordpress.com/2010/11/lzmom3a1.jpg
http://talk-doctor.com/wp-content/uploads/2013/03/Screen-Shot-2013-03-05-at-5.23.20-PM1.png