Dementia: Alzheimer’s Disease Cyril Evbuomwan Patient Group Meeting 1 st December 2015

Dementia: Definition Clinical condition complex, progressive and irreversible Characterized by deterioration in Intellectual function Behaviour Personality Presence of NORMAL level of consciousness and perception

Dementia: Types/Causes Alzheimer’s Disease(AD)Most common 60% Vascular Dementia(VaD) Dementia with Lewy Bodies(DLB) Mixed type-has feature of any 2 of above

Dementia: Alzheimer’s Disease Most common type of Dementia. Gradual loss of memory Affects approximately 496,000 in UK 5.4% of population over 65yrs

Dementia: Alzheimer’s Risk Factors Ageing Caucasian Family History Gender: Females(67%) > Males(55%) Genetic Head injury Vascular Disease Alcohol- Wine appears to be protective!

Alzheimer’s Disease: Diagnosis Guideline by NICE Dementia Screening, tests and referral Probable AD:- Established dementia Insidious onset over months to years. Progressive worsening of memory &cognitive function Onset 40-90yrs Absence of other systemic or Brain disease

Alzheimer’s Disease: Diagnosis Possible Alzheimer’s Disease Dementia Atypical onset or Presentation Mild cognitive impairment due to AD Pre-dementia stage of Alzheimer’s disease Concern about change in cognitive function Impairment in one or more cognitive domain Preservation of independence in functional abilities

Alzheimer’s Disease: Presentation(1) Insidious-progressive over 7-10yrs Early stage symptoms Memory Lapses: forgetting names of people/places Difficulty finding words for things Inability to remember recent events Forgetting appointments

Alzheimer’s Disease: Presentation(2) As Disease Progresses Difficulty with language Apraxia-difficulty with planning to use muscle Difficulty with planning and decision making Confusion

Alzheimer’s Disease: Presentation(3) Late Stages Wandering, disorientation Apathy Psychiatric symptoms: Hallucination, depression and delusion

AD: What else can it be? Other Dementia- stroke, vascular problem Normal ageing Brain disorder hydrocephalus Parkinson Disease Hypothyroidism Medication:Diazepam Vit B12 deficiency Psychiatric Depression/Schizophr enia Acute confusional state Infection: AID, Syphilis

Alzheimer’s Disease: Management(1) Non Pharmacological Patient centered care plan Nutritional support/CBT Memory assessment and referral Support for carers- registration vaccination Valid consent for assessment and treatment Advanced directive, Power of lasting attorney Use of Advocates, Voluntary services, A society

Alzheimer’s Disease: Management(2) Pharmacological Management Few drugs approved for mild to moderate AD Donepezil, Galantamine and Rivastigmine Memantine- second line drug Treatment only to continue for as long as there is improvement or delay in symptoms Regular review

Alzheimer’s Disease: Prognosis Progressive illness. Need for care plan Disease course varies individually:4-20yrs In mild case symptoms may improve or delayed with treatment Common cause of death- infections: chest/urine Palliative and End of life care: Nutritional support, Decision on resuscitation, Advance directive, Power of Attorney

AD: What can we do to reduce risks? Nothing Age Gender-females Genetics Learning disability Yes(modifying risks) Alcohol/smoking Obesity Hypertension/cholest erol Head injury Education/mental stimulation

Dementia: CEMC Programme Screening group at risk-Chronic Disease patients Investigations blood and MRI, Referral Provision of care plans Regular reviews Support for carers: Registration, vaccinations Provision of information: Community support services, Advocates, Voluntary groups