1. Memory Loss, and Alzheimer’s:
Leadership Summit
Biloxi, Mississippi
October , 2018
Memory Loss, and Alzheimer’s:
What we need to know
Monica W. Parker, MD

2. Questions we will discuss today
1) Are Dementia and Alzheimer’s the same thing?
2) What Is Mild Cognitive Impairment?
3) How do we diagnose Alzheimer’s Disease?
4) Can we prevent Alzheimer’s ?
5) Is research Safe?

3. Alzheimer’s Disease is Expensive
Dementia costs more to American society than heart disease and cancer – and is now the most expensive disease in the United States –
 Average, annual, per-person Medicaid spending on seniors with Alzheimer’s disease or another dementia is 19 times higher than average per-senior Medicaid spending on those without Alzheimer’s
75% of Alzheimer’s patients end up in a nursing home by age 80
51% of AD patients rely on Medicaid
Georgia Medicaid - $2 billion just on long term nursing care for seniors in 2010
Source: HealthPayer Intelligence

4. Social and Economic Costs of AD
AD is the 4th leading cause of death for AA 65+in the US.1
Annual healthcare costs in US is $226 billion costs
$217 billion in unpaid caregiving.1
Annual costs for health care, long-term care, and hospice care for patients with AD and other dementias are expected to increase to more than $1 trillion in
AD appears to be the most costly illness in the United States, even more so than cancer and heart disease.2
Alzheimer’s Association, 2015 ( 2. Hurd MD et al. N Engl J Med. 2013;368:

5. The Alzheimer’s Disease Epidemic
US Population
> 85 years old
(in millions)
million today nearly 50% over age 85 have AD . . .
million baby boomers turning 65 – ~10,000 per day thru 2030

6. Prevalence of Dementia

7. Figure 3. Age-adjusted death rates for Alzheimer’s disease, by Hispanic origin, race for non-Hispanic population, and sex: United States, 2010
NOTE: Death rates for Hispanic origin should be interpreted with caution because of inconsistencies in reporting Hispanic origin on the death certificate as compared with censuses, surveys, and birth certificates. SOURCE: National Vital Statistics System, Mortality.

8. Medicare Beneficiaries
50% of all Medicare recipients have ADRD
92% of patients with ADRD have at least 1 chronic disease
Medicare recipients with ADRD have four or more chronic diseases
High blood pressure, Diabetes, High cholesterol, Heart Disease, Chronic Kidney Disease, Anemia, Rheumatoid Arthritis, Depression, COPD, Heart Failure

9. What Is Dementia or NCD?
Dementia or Neurocognitive Disorders(NCD), are NOT NORMAL in aging!
Two or more brain functions are affected
Symptoms and behaviors interfere with normal social or occupational function
No effective treatment
Symptoms may overlap with delirium, a treatable medical problem ( infection, dehydration, meds)

10. Neurocognitive Disorders in DSM-5: Impairment Across 6 Key Domains
Symptoms
Complex attention
Ability to attend to and process multiple stimuli
Executive function
Ability to plan, organize, and complete tasks/projects
Learning and memory
Acquiring, manipulating, and remembering items, facts, words and their meanings, events, people, procedures, skills, etc.
Perceptual-motor
Identification and manipulation of figures, maps and items; motor tasks; recognition of faces and colors
Language
Expressive and receptive language skills
Social cognition
Socially appropriate behaviors and decision-making; empathy
APA. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.
Alzheimers Summit.Los Angeles

11. What is Mild Cognitive Impairment?
An Acquired condition that may affect only ONE higher brain function.
Cognitive impairment does NOT interfere with normal activities
Symptoms are mild and persistent
Earliest detectable stage of illness
may NOT result in dementia

12. Frequency of Dementia Disorders
LB,CTE,HIV,ETOH
Frontotemporal (FTD)
Alzheimer’s Disease
52%
Parkinson’s Disease
Vascular
17%
AD + Vascular
14%

13. Dementia Symptoms Memory Loss Repetition of words, stories, phrases
Loss of bowel and bladder function
Inability to independently dress, groom, toilet, feed or manage finances or meals
Gait instability- falls
Personality Changes- belligerent, apathy
Psychoses- paranoia

14. Dementia Behaviors Wandering Personality Changes- irritability
Paranoia- fear, suspicion
Hallucinations
Unusual Spending/Buying
Compulsive Behaviors
Driving Difficulties-accidents, getting lost

15. How do you Address Behaviors?
See a Doctor!
A careful medical evaluation is required to look for treatable causes
Address problems with a trained professional ( MD, elder attorney, Occupational therapist) to manage finance, health, behavior problems
Enroll in caregiving training classes and support groups

16. Risk Factors for Brain Dysfunction
Advanced Age
Medication Interactions
Genetics/Gender
Chemotherapy
Stroke and CVD
benzodiazepines
Atrial Fibrillation
Sleep Disorders
Heart Failure
Diabetes
Hypertension
High Cholesterol
Thyroid Disease
Mood Disorders
Head Trauma
Depression
Substance Abuse
B, D, Folate
ETOH, tobacco
Vitamin Deficiencies

17. Factors that Protect the Brain
Education
Formal training, music, language
Exercise
Moderate aerobic
Anti-inflammatory drugs
Aspirin, ibuprofen, antioxidants
Statins-protect against CVD risk
Red wines
Social Engagement
Preventing Hearing Loss
Treating Depression
Managing chronic diseases: HTn; T2DM;CVD
Getting enough Sleep
Maintaining Healthy Body Weight
Mediteranean or Heart Heathy Diet

18. Alzheimer’s Pathology

19. Brain Autopsy Specimens

20. Stages of Dementia Diseases
End-stage cognition
Dependent
Poor quality of life
Profound loss of abilities
Behavioral problems
Increasing burden
Worsening memory
Functional limitations
Needing more support
Isolated memory
Independent
Excellent quality of life
Cognition
Preclinical Stage
Mild
Dementia
Moderate
Severe
Age
Mild Cognitive Impairment

21. Annual Wellness Visit (AWV)
Age 65 and annually (
No CO-PAY
Allows review of preventive health measures
Immunizations
Preventive examination review
Vision
Cancer( mammograms, lung,colonoscopy)
Hearing
Diabetes, cholesterol,anemia screening
Dementia/depression screening

22. How is dementia diagnosed?
Comprehensive Medical Exam
Medication review
medical history and diagnoses
Thyroid, diabetes, syphilis, diabetes, vitamin tests
Brain Imaging – MRI, Amyloid Pet Scan
Neuropsychologic Testing
Spinal Fluid examination via Lumbar Puncture for AB and tau protein precursors

23. Treatment
There is no known cure for brain degenerative disease.

24. Medications for Symptoms
Cholinesterase inhibitors
Aricept –donepezil
Razadyne (galantamine)
Exelon(rivastigmine)
NMDA Antagonists
Namenda- Memantine
Antidepressants to manage mood/sleep
Zoloft, Citalopram, Lexapro, Trazodone, Mirtazepine
Antipsychotics to manage psychosis
Risperdal; Seroquel; Geodon
Exelon

25. Alzheimer’s Research
The NINDS reports US volunteers for Alzheimer’s and NCD research studies are:
70% European American
12% African American
8% Asian American
10% Hispanic
53% Female 44% Male

26. Research Inclusion is a Civil Right
The Revitalization Act of 1993 requires that women and minorities be included in all clinical research studies funded by NIH because:
-Disease prevalence varies by population - -Treatment for chronic diseases may not be as effective for minority persons as for those of European descent

27. Institutional Review Boards
Are regulatory agencies at each institution that reviews studies before they are allowed to proceed. They ensure
safety
ethical conduct of research investigation
Protection of personal privacy
Informed consent for voluntary participation

28. Summary Dementia is NOT a normal part of aging
Persons 65+ need an Annual Wellness Visit (AWV)
Allows yearly screen for memory and mood
Medications, chronic diseases, mood disorders may cause symptoms of dementia
There is no drug available to cure dementia
Lifestyle changes and control of chronic disease can prevent brain dysfunction
Research is ongoing. Effective treatments require the participation of all people

29. Websites www.alzu.org Tutorial about the disease
Resources forcaregivers
resources for care, diagnosis, caregiving, education and training, research trials