AGEING, MEMORY LOSS AND ALZHEIMER’S DISEASE? Dr JANE HECKER Dept Internal Medicine, Royal Adelaide Hospital College Grove Hospital.

Slides:



Advertisements
Similar presentations
Cognition enhancing or neuroprotective compounds for the treatment of cognitive disorders: why? when? which? Lockhart BP, Lestage PJ. January 2003.
Advertisements

Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital, Peter James Centre, Turning Point.
APOE Genotype Effects on Alzheimer’s Disease Clinical Onset, Epidemiology, and Gompertzian Aging Functions J.Wesson Ashford, M.D., Ph.D. Stanford / VA.
Management of Early Dementia Dr Eleanor Mullan Consultant Psychiatrist Mental Health Services for Older People South Lee, Cork Feb 2011.
DEMENTIA. Outline What is Dementia? What is Dementia? Who gets it? Who gets it? What are the symptoms? What are the symptoms? How do we diagnose it? How.
Dementia & Delirium in Surgical Patients Damian Harding Department of Geriatric Medicine February 2008.
Alzheimer’s Disease Nicotine’s relationship and contribution to dementia.
Alzheimer’s Disease Find group of ~4 students ~ 10 minutes Discuss the following personal family connection to AD (if willing only) observations/experiences.
Dementia Drugs: Mainstream and Alternative Medicines Susan Kurrle.
DEMENTIA JOE BEDFORD IBRAHIM ELSAFY ESCALIN PEIRIS.
Treatment Options for Dementia Deb Bynum, MD Division of Geriatric Medicine University of North Carolina.
Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine Palmerston North Hospital.
By: Candice Carlson & Josh Edwards. What is Alzheimer’s? Alzheimer’s is a type of dementia Problems with memory, thinking, and behavior. Symptoms develop.
Dementia Produced by Wessex LMCs in partnership with: Dr Nicola Decker, GP Alzheimer’s Society.
Cognitive Enhancers. Dementia A syndrome due to disease of the brain, characterised by progressive, global deterioration in intellect including: Memory.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 22 Alzheimer’s Disease.
Treatment of Alzheimer’s Dementia with Donepezil Psych 4080 March 6, 2007.
Decision presented by the committee board members: Nicholas Mann & Katelyn Strasser FUTURE FUNDING FOR ALZHEIMER’S DISEASE October 14, 2014 MPH 543 Leadership.
ALZHEIMER’S DISEASE BY OLUFOLAKUNMI KEHINDE PRE-MD 1.
Alzheimer’s Disease Angela Singh, PharmD Associate Professor of Pharmacy Practice Florida A&M University College of Pharmacy & Pharmaceutical Sciences.
ALZHEIMER’S PART 2. AD VIDEO
ALZHEIMER’S DISEASE BY JOSEPH MOLLUSO.
DEMENTIA IS A LOSS OF INTELLECTUAL FUNCTION. IT IS A BROAD TERM USED TO DESCRIBE A CONDITION WHERE A PERSON EXHIBITS IMPAIRMENTS IN HIGHER CORTICAL FUNCTIONS.
ALZHEIMER’S DISEASE DIAGNOSIS and TREATMENT J. Wesson Ashford, M.D., Ph.D. Stanford / VA Alzheimer’s Center VAMC, Palo Alto, California Calabasas, California.
Dementia in Clinical Practice Mary Ann Forciea MD Clinical Prof of Medicine Division of Geriatric Medicine UPHS Photo: Nat Geographic.
Dementia Dr Deborah Stinson Sutton CMHT for Older People
Alzheimer’s Disease Landscape
LISA JOHNSON & SUZANNE GRIESEL MPH 543 LEADERSHIP AND ORGANIZATIONAL BEHAVIOR FEBRUARY 16, 2014 Funding Analysis of Alzheimer’s Treatment Options: Three.
How To Improve Memory Performance and Keep Your Brain Young Gary W. Small, MD Parlow-Solomon Professor on Aging Professor of Psychiatry & Biobehavioral.
Alzheimer’s Society, UK Our research programme
Grow Your Brain at Any Age Majid Fotuhi, MD PhD Howard County Office on Aging Columbia, MD March 28, 2014.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 33 Delirium and Dementia.
Six Steps to a Better Brain Majid Fotuhi, MD PhD March 6, 2014.
Introduction: Medical Psychology and Border Areas
NOW WHERE HAVE I PUT MY GLASSES? A DISCUSSION AROUND DEMENTIA Dr Marion Overton U3A SCIENCE 19TH JUNE 2015.
Why Physicians Do Not Diagnose Alzheimer’s Disease Mark A. Sager, MD Professor of Medicine and Population Health Sciences Director, Wisconsin Alzheimer’s.
Alzheimer’s Disease By: Chelcy Branon. Facts  In 2006, there were 26.6 million sufferers worldwide  Costs 100 billion dollars per year.
Medical University of Sofia, Faculty of Medicine Department of Pharmacology and Toxicology Alzheimer’s Disease Avi Gandhi (2009)
Heather Kellogg March 6, 2013 Honors Psychology, Period 1
COLUMBIA PRESBYTARIAN HOSPITAL CENTER
CONFUSION & DEMENTIA CHAPTER 35.
Do you remember what you ate for dinner two days ago?
Dementia 痴呆 Jie Ming Shen, M.D., Ph.D. Department of Neurology Ruijin Hospital, SSMU.
Alzheimer's: An Investigation into Treatment Options Dana McGuire and Jessica Scharfenberg MPH 543: Leadership and Organizational Management Concordia.
Assessment and Diagnosis of Dementia Dr Alison Haddow.
CAROLINE HARADA, M.D. ASSOCIATE PROFESSOR OF MEDICINE UAB DIVISION OF GERONTOLOGY, GERIATRICS, AND PALLIATIVE CARE NOVEMBER 2013 Dementia.
Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 44 Confusion and Dementia.
Dementia in Clinical Practice Mary Ann Forciea MD Clinical Prof of Medicine Division of Geriatric Medicine UPHS Photo: Nat Geographic.
Dementia: Alzheimer’s Disease Cyril Evbuomwan Patient Group Meeting 1 st December 2015.
Amyotrophic lateral sclerosis
Dementia Care Wendy Burnett CNS for Older People.
Cognitive Disorders Chapter 13 Nature of Cognitive Disorders: An Overview Perspectives on Cognitive Disorders Cognitive processes such as learning, memory,
Alzheimer’s Disease: Advances and Hope Trey Sunderland, M.D. Chief, Geriatric Psychiatry Branch National Institute of Mental Health Bethesda, Maryland.
Alzheimer’s disease.
BY: AMAN SINGH AND ALLY MATTINGLY Alzheimer's Disease.
Alzheimer’s Disease By:Jeorzsees Ang, Becky Carrasco, Eunice Choi, and Deborah De La Puente.
Memantine (Ebixor) Joanne Lily Wombwell Senior Memory Clinic Nurse Hartington Unit, CNDRH.
Orientation to Early Memory Loss. Let’s look for some answers… What is happening? What should I do? Where should I go?
COGNITIVE DEVELOPMENT IN LATE ADULTHOOD CHAPTER 18 Lecture Prepared by: Dr. M. Sawhney.
ALZHEIMER’S DISEASE DIAGNOSIS and TREATMENT J. Wesson Ashford, M.D., Ph.D. Stanford / VA Alzheimer’s Center VAMC, Palo Alto, California October, 2004 Slides.
Alzheimer’s Disease: 진단과 치료
DEGENERATIVE DISEASES is a disease in which the function or structure of the affected tissues or organs will progressively deteriorate over time, whether.
Dementia Dr.Mansour K. Alzahrani.  Define the dementia  Discuss the prevalence of dementia  Discuss the impact of dementia on the individual and the.
DEMENTIA 1/6/16 DR TONY O’BRIEN MD FRCP. Dementia Common – 700,000 sufferers in the UK Common – 700,000 sufferers in the UK Prevalence increases with.
Alzheimer Disease: An Overview. What is Dementia? Dementia is a set of symptoms, which includes loss of memory, understanding, and judgment.
Neurocognitive Disorders
What is Dementia? A term that describes a wide range of symptoms associated with a decline in memory or other thinking skills. Dementia may be severe.
Alzheimer’s Disease Medical University of Sofia, Faculty of Medicine
Chapter 30 Delirium and Dementia
Chapter 25 The Elderly.
Presentation transcript:

AGEING, MEMORY LOSS AND ALZHEIMER’S DISEASE? Dr JANE HECKER Dept Internal Medicine, Royal Adelaide Hospital College Grove Hospital

MEMORY Age health (chronic pain, exercise, diet, alcohol,) attitudes(anxiety, poor self- confidence) lifestyle (participation in cognitive activities) lifestyle (stress, workload, fatigue, relationship problems)

DIFFERENTIAL DIAGNOSIS DEMENTIA Depression Delirium Drugs Decline in memory

DEMENTIA Alzheimer’s disease 60% Vascular dementia 20% Dementia with Lewy bodies 10-15% Fronto-temporal dementia 10% Dementia associated with other neurological conditions e.g. Parkinson’s disease Mixed dementia

Prevalence of Alzheimer’s disease Kurz A. Eur J Neurol 1998; 5(Suppl 4): S1-8 Wimo A et al. Int J Geriatr Psychiatry 1997; 12: % 2% 4% 8% 16% 30% 50%

Ref: Doraiswamy et al, Advantages of an early diagnosis of AD –Enables early treatment - cognitive enhancers –Future planning for patient and caregiver –Early provision of community support and healthcare resources can decrease stress –May provide cost savings and delay institutionalisation

HISTORICAL POINTERS Forgetting recent events despite prompting Failure to attend appointments Frequent repetition of statements, stories or questions Frequent lost or misplaced items Losing track in conversation, word-finding difficulty Difficulty understanding conversation or following the story in a book or on TV Confusion with time eg. day, date, time of day Becoming lost, unable to find the way

HISTORICAL POINTERS Difficulty handling money or paying bills Difficulty working gadgets, planning or preparing meals, performing handyman tasks Neglect of personal care, home maintenance or nutrition Withdrawal from previous community and social activities (poor work performance if employed) Difficulty coping with new events or change to routine Personality and behaviour change

Clinical features of AD Loss of cognition –short-term memory –language –visuospatial functions Loss of daily function –instrumental activities of daily living (ADL) –self-maintenance skills Behaviour and personality change

Brain atrophy Senile plaques Neurofibrillary tangles Katzman, 1986; Cummings and Khachaturian, 1996 AD: a progressive CNS disorder with a characteristic pathology

Natural history of Alzheimer’s disease Time (years) Symptoms Diagnosis Loss of functional independence Behavioural problems Nursing home placement Death Mini-Mental State Examination (MMSE) Early diagnosisMild-to-moderate Severe Feldman and Gracon. The Natural History of Alzheimer’s Disease. London: Martin Dunitz, 1996

Cholinergic deficit –progressive loss of cholinergic neurones –progressive decrease in available ACh –impairment in ADL, behaviour and cognition Hippocampus Cortex N. basalis Meynert Bartus et al., 1982; Cummings and Back, 1998, Perry et al., 1978 Cholinergic Deficit underlies clinical symptoms

Treating Alzheimer’s Disease

Post synaptic Acetyl CoA + Choline + Acetate AChE ACh ChAT Central Cholinergic Synapse X Cholinesterase Inhibitors (-) M2 Muscarinic 1 receptor (+)

Cholinesterase inhibitors: a rational therapeutic approach in AD NH 2 N Mechanism: AChE/BuChE-I Inhibition: reversible Tacrine O O O N Mechanism: AChE-I Inhibition: reversible Donepezil N O O N N H Mechanism: AChE/BuChE-I Inhibition: pseudo-irreversible Physostigmine O O O OH P Cl O O O O P Mechanism: AChE/BuChE-I Inhibition: irreversible Metrifonate O O H H N OH Mechanism: AChE-I Inhibition: reversible Galantamine O O N N Mechanism: AChE/BuChE-I Inhibition: pseudo-irreversible Rivastigmine Weinstock, 1999

CHOLINESTERASE INHIBITORS -Second Generation Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Reminyl)

A.D. CLINICAL TRIALS 9204 patients in 21 clinical trials  modest benefit in mild-mod AD Donepezil :- 8 trials, 2664 patients Rivastigmine :- 7 trials, 3370 patients Galantamine :- 6 trials, 3170 patients

C ognition A ctivities of daily living B ehaviour ABC: the key symptom domains affected in AD

AAN Guidelines CONCLUSIONS ‘Significant treatment effects have been demonstrated with several different cholinesterase inhibitors (tacrine, donepezil, rivastigmine, galantamine) indicating that the class of agents is consistently better than placebo. The disease eventually continues to progress despite treatment and the average “effect size” is modest. Global changes in cognition, behaviour, and functioning have been detected by both physicians and caregivers, indicating that even small measurable differences may be clinically significant.’

Change from baseline in daily time spent assisting with ADL (min) * p < 0.05 vs baseline Placebo Galantamine 24 mg/day * Mean change in daily time spent by caregiver assisting with ADL at 6 months: GAL-INT-1

NICE RECOMMENDATIONS: COST EFFECTIVENESS cost savings on institutional care not well established quality of life (QALY) not easily measured Oscar Wilde “knowing the price of everything and the value of nothing”

Therapeutic Dilemmas: Alzheimer’s Disease Which drug? Who to treat? When to start treatment? How long to treat? By whom? Whether to treat?

Memantine (Ebixa) NMDA receptor antagonist trialled predominantly in moderately severe to severe dementia modest benefit in cognition, function, behaviour expensive ~ $180 per month, no PBS subsidy

PREVENTION? AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE Benjamin Franklin

Protective Factors? NSAID’s (anti-inflammatories) statins (cholesterol lowering) moderate alcohol consumption higher education ongoing intellectual stimulation physical and leisure / social activities diet - fruit and vegetables, low in saturated fat

The pathological cascade of AD Clinical symptoms Neurodegeneration Neurofibrillary tangles  -amyloid Environmental risk factors Genetic risk factors Apo-E Pathogenetic mutations APP PS1,2 Cholinergic dysfunction TAU hypophosphorylation

Post and Whitehouse - “Guidelines on Ethics of Care of People with Alzheimer’s Disease” “As the 20th century draws to a close, it is the decline of the mind contained in a still viable body that raises some of the most urgent concerns for medical ethics and society. The emphasis on technical reason and productivity that characterizes our modern industrial cultures may create a bias against people with dementia. It is important to realize that emotional and relational well-being can be enhanced despite dementia and to insist that human dignity can still be respected. In severe dementia, the finest expression of this respect may be through the touch of a hand rather than through technology.”