1. GERIATRIC EDUCATION SERIES Presented in partnership by Funded in part by a grant from the EJC Foundation

2. dhs.unr.edu/aging Geriatric Education Series DEMENTIA: TO KNOW OR NOT TO KNOW Steven L. Phillips, MD Medical Director Sanford Center for Aging

3. Dementia is a condition that includes a wide range of symptoms linked to declining memory or thinking skills. These symptoms are severe enough to interfere with daily living and worsen over time.

4. The United States Preventive Services Task Force (USPSTF) concluded there is not enough data to recommend for or against screening. However, the Affordable Care Act of 2010 calls for screening as part of the annual wellness visit for Medicare patients. The International Association of Gerontology and Geriatrics (IAGG) recently published a consensus recommendation for cognitive screening.

5. Objectives Objective 1 Describe those factors linked to an increased risk of dementia. Objective 2 Provide an overview of treatable and untreatable causes of dementia. Objective 3 Review components of a dementia diagnostic workup.

6. Dementia Risk Factors Age >65 Alcohol abuse Head trauma Diabetes Tobacco abuse Depression Never married Increased cholesterol Hypertension Down syndrome Physical frailty Low education level Low social support Family history Increased cholesterol*Hypertension*Downs syndrome*Physical frailty*Low education level*Low social support*Never marriedIncreased cholesterol*Hypertension*Downs syndrome*Physical frailty*Low education level*Low social support*Never married

7. Possible Factors that Reduce Risk of Dementia Adequate folate intake Diet rich in fruits and vegetables Physical activity Stimulating mental activity Mediterranean diet High education level Low or moderate alcohol intake Adequate omega-3 fatty acid Low saturated fat intake

8. Treatable Causes of Dementia Prescription drug combinations Folate deficiency Hypothyroidism Severe depression Kidney, liver and lung diseases Drug and/or alcohol abuse Hypoglycemia Normal pressure hydrocephalus Subdural hematoma Vitamin B 12 deficiency

9. Untreatable Causes of Dementia Alzheimer’s disease Multi-infarct dementia Frontotemporal dementia AIDS dementia complex Creutzfeldt-Jakob disease Lewy body dementia Huntington’s disease Parkinson’s disease

10. Diagnostic Workup Behavioral/Psychological review Activities Daily Living Comprehensive metabolic panel Complete blood count B 12 and Folate levels Thyroid stimulating hormone Clinical history Medication review Neurological Exam Assess cognitive function Neuroimaging (Structural vs Functional).

11. Sanford Center for Aging Geriatric Specialty Clinic Steven L. Phillips, MD slphillips@unr.edu (775) 784-1808