Alzheimer’s disease: Warning Signs, Risk Factors, and More Presented by

Alzheimer’s Texas A privately funded voluntary health organization formed in 1982 to serve Central Texans with Alzheimer’s disease and their caregivers. MISSION To eliminate Alzheimer's disease and related disorders through the advancement of research and to enhance care and support for individuals, their families, and caregivers. VISION To create and sustain a dementia capable Texas in which persons with Alzheimer’s and related disorders, and their families, receive quality care, effective treatments, and meaningful support.

Defining Terms Dementia vs. Alzheimer’s Dementia vs. Normal Aging Dementia vs. Mild Cognitive Impairment “Dementia” refers to changes in cognition significant enough to interfere with daily life. People with normal age-related impairments can still enjoy their hobbies, work, & social life despite slower mental processing. People with Mild Cognitive Impairment have problems with cognitive function serious enough to be detected by tests and noticeable by loved ones, but not so severe that they interfere with daily life. Alzheimer’s is a progressive neurological disease that causes damage to neurons throughout the brain. Dementia is a term for the condition of cognitive impairment that is caused by Alzheimer’s and other disorders.

What is dementia? Dementia Reversible dementias Vascular dementia Alzheimer’s disease Lewy Body disease Frontotemporal dementia

Reversible causes of dementia Depression Adverse drug reactions Metabolic changes (thyroid) Nutritional deficiencies (vitamin B12) Enlargement of fluid cavities in brain Tumors Infections Sleep disorders

Alzheimer’s Statistics Most common form of dementia (50-70% of cases) 340,000 Texans have Alzheimer’s, over 5 million Americans 1.3 million Texans provide care for a person with Alzheimer’s 6 th leading cause of death in the state People over 65 are at greatest risk Typical duration is 4-10 years depending on when the person is diagnosed No disease-modifying treatments exist. Some risk factors for Alzheimer’s can be controlled, but it can’t be definitively prevented.

Memory changes – Complaints, even joking, about difficulty remembering – Being unable to recall names of people or places – Frequently misplacing things, asking where items are kept – Repeating questions, stories, or phrases – Problems performing familiar tasks Forgetting to use dish soap when washing dishes Difficulty remembering the ingredients of a favorite dish Uncharacteristic difficulty organizing a trip or holiday party Early Warning Signs  Difficulty learning and retaining new information It’s normal to take longer to learn something, not normal to forget something after it’s been learned.

Language problems – Consistent difficulty finding the right word to express their thoughts Substituting descriptions or similar sounding words – Struggling to communicate without halting – Retreating from social situations due to anxiety about publicly speaking Early Warning Signs

Orientation problems – Geographical disorientation – Temporal disorientation Early Warning Signs Visuospatial problems – Difficulty visually interpreting the relationship between two objects dimensionally or in their environment

Executive dysfunction – Poor judgment and reasoning ability Social judgment impaired – Diminished capacity for abstract thinking – Struggles with planning and organization – Difficulty regulating emotional responses – Trouble initiating and maintaining focus on a task – Insufficient problems solving ability to cope with change or disruptions Early Warning Signs

Behavioral Changes – Becoming more withdrawn or distant, especially in social settings. – Becoming suspicious, accusing others of infidelity or trying to cheat or steal from them – Becoming more fearful or anxious, especially in absence of caregiver and in unfamiliar situations – Hoarding unnecessary objects – Increased irritability or angry outbursts – Depression, loss of energy, tearfulness – General apathy Early Warning Signs

Changes by Stage Cognitive SkillEarlyMiddleLate MemoryNeeds reminders, short term memory loss May not recognize loved ones May not recognize self. Lives moment to moment LanguageWord-finding problems, withdraws in conversation Invents words, repeats phrases, trouble with receptive language Can’t communicate using words Executive FunctionComplex tasks will require supervision Needs coaching and prompting, caregiver must provide structure Activities must be done for the person NavigationMay become lost driving home May become lost in own home Mostly bed-bound Self-careNeeds help staying organized, managing medications Has difficulty bathing, grooming, maintaining hygiene, accidents Difficulty eating and swallowing, maintaining weight Visual-spatial perception Problems with depth perception Trouble distinguishing colors, textures Doesn’t recognize or relate to objects Mood and personalityMore easily frustrated than before May become suspicious & paranoid Mood at mercy of environmental factors

Risk factors for Alzheimer’s Advancing age Genetic predisposition Risk genes – ApoE 4 Deterministic genes – less than 10% of cases Gender and ethnicity Diabetes Head injury Lifestyle Heart disease, high blood pressure, diabetes and stroke

Treatments for Alzheimer’s Medications for symptoms – Cholinesterase inhibitors for mild to moderate symptoms Donepezil (Aricept®) Rivastigmine (Exelon®) Galantamine (Razadyne®) – Glutamate regulator for moderate to severe symptoms Memantine (Namenda®) Most effective in early stages Family education, counseling, and planning Environmental modifications Creative arts therapies Structuring the day Behavior modification techniques

Alzheimer’s Timeline : Alzheimer’s disease discovered 1976: Robert Katzman identifies Alzheimer’s as major public health concern 1984: Beta-amyloid identified (tau identified 1986) 1993: First Alzheimer’s drug approved by FDA 2006: Donepezil (Aricept) approved (Exelon in 2007) 2011: NAPA becomes law, annual cognitive assessment implemented as part of Medicare Wellness visits

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