1. ALZHEIMER’S DISEASE Dr. Shantel Anderson, DHEd Leadership and Organizational Management MPH 543 Jill Marshall and Tara Sheets February 18, 2014

2. Alzheimer’s Disease Alzheimer’s Disease is:  a type of dementia that causes problems with  memory,  thinking, and  Behavior. Dementia results in the loss of skills:  Intellectual, and  Social.

3. Alzheimer’s Disease Alzheimer’s Disease:  is irreversible and progressive;  slowly destroys  Memory,  Cognitive (thinking) skills, and  ability to complete activities of daily living;  causes the brain cells and the connections between them to degenerate and die; and  causes a decline in memory and mental function.

4. Risk Factors Risk Factors include:  Age  65 and older.  Risk doubles with every 5 years.  After age 85 risk increases to 50 percent.  Family History  Immediate family member with Alzheimer’s increases risk.  Risk is increased if there is more than one relative with the illness.  Genetics  Three Deterministic genes directly cause Alzheimer’s Disease including  Amyloid precursor protein (APP),  Presenilin-1 (PS-1), and  Presenilin-2 (PS-2).

5. Risk Factors Risk Factors:  Head trauma  Seat belts, safety helmets  Head-Heart connection (high blood pressure, stroke, diabetes, etc.)  Healthy eating, and exercise  Monitor heart health with a physician  General Health  Maintain a healthy weight, limit tobacco and excess alcohol  Myths  Aluminum  Aspartame (equal, nutrasweet)  Flu Shots  Silver dental fillings

6. Stages  The stages of Alzheimer’s disease include  pre-clinical (mild cognitive impairment),  mild,  moderate, and  severe.

7. Symptoms and Impact  Preclinical: No Major symptoms  toxic changes are taking place in the brain;  abnormal deposits of proteins;  Forming of plaques and tangles throughout the brain; and  neurons begin to work less efficiently.  Mild: Changes aren’t significant enough to affect work or relationships.  May be changes or issues with:  memory, personality, thinking, organizing, expressing thoughts; and  misplacing belongings, problem solving, and ability to complete complex tasks and make sound judgments  Neurons lose ability to function and communicate with each other and die.

8. Symptoms and Impact  Moderate: Increased confusion and significant changes in personality and behavior.  May need assistance with activities of daily living and self-care.  Damage spreads to a nearby structure in the brain, more neurons die, and affected brain regions begin to shrink.  Severe: Impact now includes movement and physical capabilities  Require daily assistance with  activities of daily living, and  self-care;  Loss of ability to communicate coherently;  Damage is widespread; and  Brain tissue has shrunk significantly.

9. Prevalence and Forecast  In 2013:  5.2 million people had Alzheimer’s  Someone develops Alzheimer’s every 68 seconds  One in every three seniors died with Alzheimer’s or other dementia  By 2030 it is estimated:  8.6 million will have Alzheimer’s  By 2050 it is estimated  16.0 million will have Alzheimer’s

10. Direct Costs  In 2013:  $203 billion was spent on health care, long-term care, and hospice  $142 billion of that was paid by Medicare and Medicaid  By 2050:  Those with Alzheimer’s is projected to triple  Costs are projected to increase to $1.2 trillion

11. Indirect Costs  $216 billion is spent by the 5 million family and friends that provide 17 billion hours of unpaid care every year.  Many caregivers have to travel away from their families.  Emotional stress, depression, and physical exhaustion.  $9.1 billion is spent on the health care costs of these caregivers.  65 percent of caregivers take time off, come in late, or leave early.  20 percent take leaves of absence.  13 percent switched from full-time to part-time jobs.  11 percent gave up their jobs.

12. Cholinesterase Inhibitors Benefits:  Cholinesterase inhibitors slow the progression,  Helps brain cells function better, and  May provide improvements in memory and functioning.  Common Cholinesterase inhibitors share these similar benefits to the brain:  Donepezil (Aricept)—treats mild, moderate, and severe stages  Rivastigmine (Exelon)—treats mild and moderate stages  Galantamine (Razadyne)—treats mild and moderate stages Concerns:  Improvements last 6-12 months,  Improvements found in only about half of the participants, and  No current method to identify who will respond to the medications

13. Side Effects Side Effects with medications:  nausea and vomiting,  loss of appetite,  indigestion and Increased frequency of bowel movement,  pain and headaches, and  shakiness and tremors (Rivastigmine only). Less common side effects:  Insomnia,  Fatigue,  Muscle cramps, and  Stomach ulcers (donepezil only).

14. Side Effects Uncommon but more serious side effects:  seizures,  bloody coughs, stools, or vomiting,  Painful urination,  Irregular heart rate and  Depression (Galantamine only) NOTE: Currently research has indicated that Donepezil may have less adverse effects than Rivastigmine.

15. Research Project Agenda Include Cholinesterase Inhibitors as a treatment option for upcoming five year strategic research project agenda to determine:  Long term care costs can be reduced by 30 percent over a five year period. Methodology  Treatment options are:  effective in 50 percent of participants  prolongs deterioration by approximately six months to one year  It is cost effective:  Average annual cost for long-term care $6,833/month.  Stay in long-term care for Alzheimer’s is at least 17 months.  Saves approximately or $81, 996 per year ($40,998 every six months), per person.  Dignity:  Allowing more to age in place for a longer period of time.

16. References Alzheimer’s Association (2014a). What is Alzheimer’s? Retrieved February 9, 2014 from http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp Alzheimer’s Association (2014b). Alzheimer’s Disease: Risk Factors. Retrieved February 9, 2014 from https://www.alz.org/alzheimers_disease_causes_risk_factors.asp https://www.alz.org/alzheimers_disease_causes_risk_factors.asp Alzheimer’s Association (2014c). Alzheimer’s Disease: Alzheimer’s Facts and Figures. Retrieved February 9, 2014 from https://www.alz.org/alzheimers_disease_facts_and_figures.asp https://www.alz.org/alzheimers_disease_facts_and_figures.asp Alzheimer’s Association (2014d). Alzheimer’s Disease: Treatments: Medications for Memory Loss. Retrieved February 10, 2014 from http://www.alz.org/alzheimers_disease_standard_prescriptions.asp http://www.alz.org/alzheimers_disease_standard_prescriptions.asp Ammons Scientific LTD. (2013). Image. Retrieved February 16, 2014 from http://www.amsci.com/abouthttp://www.amsci.com/about Birks, J (2006, Jan 25). Cholinesterase inhibitors for Alzheimer's disease. The Cochrane Library, DOI: 10.1002/14651858.CD005593. Retrieved February 10, 2014 from http://www.ncbi.nlm.nih.gov/pubmed/16437532http://www.ncbi.nlm.nih.gov/pubmed/16437532 Health Media Ventures (2014). 25 Signs and Symptoms of Alzheimer’s Disease. Image. Retrieved February 15, 2014 from http://www.health.com/health/gallery/0,,20416288_4,00.html HMBD Insurance Services. (n.d.). Long-term care is the assistance your employees will need for an extended period of time if they develop a chronic illness, disability, or cognitive impairment, such as Alzheimer's disease. Image. Retrieved February 11, 2014 from http://www.hmbd.com/group-long-term-care.html http://www.hmbd.com/group-long-term-care.html Centers for Disease Control and Prevention (CDC). (2010). Cholinesterase Inhibitors. Agency for Toxic Substances and Diseases Registry. Image. Retrieved February 16, 2014 from http://www.atsdr.cdc.gov/csem/csem.asp?csem=11&po=5http://www.atsdr.cdc.gov/csem/csem.asp?csem=11&po=5 Mayo Clinic (2013). Diseases and Conditions. Alzheimer’s Disease. Retrieved February 9, 2014 From http://www.mayoclinic.org/diseases- conditions/alzheimers-disease/basics/definition/con-20023871http://www.mayoclinic.org/diseases- conditions/alzheimers-disease/basics/definition/con-20023871

17. References Medical Care Corporation. (2014). Education: Progression of Alzheimer’s Disease. Image. Retrieved February 9, 2014 from https://www.mccare.com/education/alzprogression.html https://www.mccare.com/education/alzprogression.html MedicineNet.com. Donepezil, Aricept, Aricept ODT. Retrieved February 12, 2014 from http://www.medicinenet.com/donepezil/article.htmhttp://www.medicinenet.com/donepezil/article.htm MedicineNet.com. Galantamine, Razadyne, Razadyne ER. Retrieved February 12, 2014 from http://www.medicinenet.com/galantamine/article.htm http://www.medicinenet.com/galantamine/article.htm MedicineNet.com. Rivastigmine - oral, Exelon (cont.). Retrieved February 12, 2014 from http://www.medicinenet.com/rivastigmine- oral/page2.htm#SideEffectshttp://www.medicinenet.com/rivastigmine- oral/page2.htm#SideEffects National Institute on Aging (n.d.). Alzheimer’s Disease Education and Referral Center. Retrieved February 13, 2014 From http://www.nia.nih.gov/alzheimers/topics/alzheimers-basics http://www.nia.nih.gov/alzheimers/topics/alzheimers-basics National Institutes of Health (NIH). (2013). Science-Based Health And Wellness Resources for your Community. Image. Retrieved February 15, 2014 from http://www.nih.gov/health/wellness/http://www.nih.gov/health/wellness/ National Institutes of Health (NIH). (n.d.). Alzheimer’s Disease: Symptoms and Diagnosis. Senior Health. Image. Retrieved February 16, 2014 from http://nihseniorhealth.gov/alzheimersdisease/symptomsanddiagnosis/meal_bed_popup.htmlhttp://nihseniorhealth.gov/alzheimersdisease/symptomsanddiagnosis/meal_bed_popup.html Orestis, C. (2013). Life Expectancy Compression: The Impact of moving into a long term care facility on length of life. Life Care funding. White Papers. Retrieved February 17, 2014 from http://www.lifecarefunding.com/white-papers/moving-into-long-term-care-facilityhttp://www.lifecarefunding.com/white-papers/moving-into-long-term-care-facility Park, Alice (2012, March 8). Cost of Alzheimer's Care in the U.S. in 2012: $200 Billion. Time: Health and Family. Retrieved February 12, 2014 February 9, 2014 from http://healthland.time.com/2012/03/08/cost-of-alzheimers-care-in-the-u-s-in-2012-200-billion/http://healthland.time.com/2012/03/08/cost-of-alzheimers-care-in-the-u-s-in-2012-200-billion/ Puiu, T. (2012). Synthetic DNA and RNA that mimics chemistry of live can encode genetic information and evolve. ZME Science. Image. Retrieved February 10, 2014 from http://www.zmescience.com/medicine/genetic/xna-synthetic-dna-rna-nucleic-acids-20042012/http://www.zmescience.com/medicine/genetic/xna-synthetic-dna-rna-nucleic-acids-20042012/

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