Is It Normal Aging or Is It Alzheimer’s Disease?

1. Is It Normal Aging or Is It Alzheimer’s Disease?

2. “Man fools himself. He prays for a long life, yet he fears an old age.” Chinese Proverb

3. Human Life Expectancy At Birth Adapted from: Hayflick L. How and Why We Age. 1994

4. Life Expectancy Through the Ages

5. Life Expectancy at Age 65 • 1965…….5 years • <10 million Medicare beneficiaries • 2005…….20 years • 40 million Medicare beneficiaries • Worldwide over 1/2 of all humans who have ever lived to age 65 are alive today!

6. The Near Future • January 1 2011: first “Boomers” turn 65 • First “Boomers” hit age 85 beginning in 2031 • By 2030 1 in 5 Americans will be >65 • By 2030 those >85 will be nearly 9 million • By 2050 estimated to be nearly 1 million >100 • Today 96,500 persons are >100 years

8. Senile • The USA is rapidly becoming “geriatric” • Latin root, “sen” in “senile” means “pertaining to old age,” not demented! • Gerontology is the study of aging • Geriatrics is the medical care of the aged

9. The New “Age Wave” • 5.3 million persons today have dementia and this number could triple by 2050 • Death rates for heart disease, stroke and cancer are declining…….death rates for dementia are rising! • Dementia is currently the 5-6th leading cause of death and rising quickly

10. Dementia • 60-80% of long stay nursing home residents • Nearly 2/3 of Assisted Living residents • Estimated ½ million Americans have early onset Alzheimer’s Disease….defined as <65 • Only half of all dementia has been diagnosed and only half of those receive any current treatment

11. Normal Aging or Age Associated Disease? • Osteoarthritis • Osteoporosis • Diabetes mellitus • Atherosclerosis • Hypertension • Alzheimer’s

12. Commonly Asked Questions • Is memory loss a natural part of ageing? • Why can’t I remember as well as my wife? • Is it normal to write notes to myself? • Why can’t I remember names? • Is it normal to forget why I went into the kitchen? • Sometimes my mind just goes blank, normal? • Can I slow age related memory changes?

13. Brain Changes with Aging • Brain weight declines by 10% by age 80 • Normal brain weighs 3lbs at age 20 • Blood flow to the brain declines • Declines in speed of nerve conduction • Loss of neurons occurs throughout life • Brain has huge reserve capacity

15. Brain changes with Aging • Brain weight declines by 10% by age 80 • Normal brain weighs 3lbs at age 20 • Blood flow to the brain declines • Declines in speed of nerve conduction • Loss of neurons occurs throughout life • New networks of nerves created even in late life • Brain has huge reserve capacity

16. Memory Changes with Age • Information processing: • Encoding new information • Reduced efficiency and speed with aging • Short term memory declines • Storage and retrieval • Recall slows with age • Recognition changes little

17. Memory Changes with Age • Consistent theme: • Speed of performance slows with aging • “Less bandwidth” • Fear of memory loss increases • Complaints of nonspecific memory losses • Depression , alcohol and illness can adversely affect memory

18. Memory Changes with Age • Long term memory should not decline • Crystallized memory does not change • Any declines likely represents difficulty in processing new information

19. Memory Changes with Age • Intelligence should not decline with age • Speed of processing information declines • Complex ideas are more affected than simple ones • Ability to perform under stress declines • Prior experiences may aid considerably

20. Aging Changes in Cognition Reading Least change Vocabulary Long term factual memory Immediate memory span Sustained attention Serial(practice-related) learning Delayed recall Motor speed Visuo-spatial skills Most change

21. What Can Worsen Memory? • Any drug that affects the brain: • Sleeping pills, pain pills, antihistamines, incontinence meds, tranquilizers, alcohol, etc • Undiagnosed depression • Fatigue, stress, anxiety • Acute illness with Delirium(Acute confusion) • Stroke…most “TIAs” are really small strokes

22. What Can Worsen Memory? • Extensive white matter changes on Head CT scan….likely quite significant and probably not normal aging • Still somewhat controversial

24. Commonly Asked Questions • What‘s the difference between Alzheimer’s and dementia? • Is it normal and expected with age? • What causes Alzheimer’s? • Why do we hear so much about it now? • Can we postpone or avoid Alzheimer’s?

25. Dementia Facts • A very common problem in US: • 1 in 10 persons have a relative in the family • 1 in 4 knows someone who has the disease • Diagnosed every 70 sec in the US Source: Alzheimer’s Association

26. Alzheimer’s and Dementia • 60% of all dementias in US are probably related to Alzheimer’s Disease • One can have Alzheimer’s Disease and not be demented….yet • Dementia is a diagnosis not a disease

30. The Diagnosis of Dementia • Memory impairment: • Inability to learn new information • Memory abilities that decline from a prior baseline • Education, high intelligence, cultural factors, Source: Diagnostic and Statistical Manual of Mental Disorders. DSM-IV

31. The Diagnosis of Dementia • At least one of the following deficits • Language difficulties (aphasia) • Difficulty with common tasks (apraxia) • Unable to identify common objects (agnosia) • Disturbance in executive functioning • Planning, judgment, decision making Source: Diagnostic and Statistical Manual of Mental Disorders. DSM-IV

32. The Diagnosis of Dementia • A disease course that is progressive • Cognitive problems sufficient to impair a person’s ability to keep a job, live independently or represents a significant decline from previous level of functioning • No other illness or systemic condition is responsible for cognitive decline Source: Diagnostic and Statistical Manual of Mental Disorders. DSM-IV

33. Diagnosis of Dementia: Testing • History that is consistent • Physical exam that rules out significant neurologic or other disease • Evaluation of mental status • Mini-mental status exam(30 pt screening test) • Clock drawing test, current events, serial 7’s • Formal neuropsychologic testing

34. Diagnosis of Dementia: Testing • Laboratory testing • Excludes other possible causes of memory loss • Radiology is optional • Head CT or MRI, & rarely PET scanning • The diagnosis is correctly made 85-90% of the time: • Sometimes serial testing is required

35. When is it Alzheimer’s? • Definite: typical clinical history and tissue confirmation(biopsy or autopsy) • Probable: typical clinical history, insidious onset, progressive course,and no other obvious cause of dementia • Possible: patients with a second systemic or brain disorder sufficient to cause dementia but not thought to be the primary cause

36. You Know it’s Alzheimer’s When... • Insidious onset • Loss of memory is a prominent feature • No disturbance of consciousness • No other disease or manifestation exists that could explain cognitive and functional decline

37. First Symptom Noticed • Trouble remembering 46% new information • Difficulty with 27%complicated tasks • Trouble responding 14%to problems • Frequently getting lost 18%or trouble staying oriented

38. First Symptom Noticed • Trouble expressing 21%thoughts ideas, orfollowing conversations • Change in personality 25%or behavior CHS Alzheimer’s Disease Caregiver Project: Wave 6, 2000

39. Alzheimer’s Disease • First described by Alois Alzheimer in 1906 • Initially termed pre-senile dementia • A.D. is not “hardening of the arteries” • Awareness is greatly increased due to the greater numbers of persons allowed to age

40. Alzheimer’s Dementia Facts • Life expectancy: 3 to 20 years after diagnosis • Average is about 8 years • Dementia affects 6-8% of all those over 65 • Incidence doubles every 5 years >60 • Estimated 1/3 of those 85 years or over • 47% of >85yo have Alzheimer’s pathology in their brains at autopsy

41. Alzheimer’s Facts • No single test exists to make the diagnosis • Plaques and tangles are the lesions seen in the brain at autopsy • Certain areas of the brain are more affected than others (hippocampus for example) • Marked decline in acetylcholine in the brain (neurotransmitter), high levels of amyloid

43. Progression of Alzheimer’s Disease Symptoms Diagnosis Loss of independence Behavioral problems Nursing home placement Death Feldman H and Gracon S inClinical Diagnosis and Management of Alzheimer’s Disease 1996

44. Stages of Alzheimer’s Dementia • Early (2-4years) • Often not recognized by friends and family • Repeat themselves • Frequently misplace items • Gets lost easily • Personality changes; passivity and withdrawal • Word finding problems begin • Lose interest in previously enjoyable activities

45. Stages of Alzheimer’s Dementia • Middle or moderate stage(2-10 years) • Usually obvious to family and others • Wandering, pacing, disruptive behaviors • Delusions(often paranoid) and hallucinations • Require constant supervision • Sleep cycles disturbed • Sun downing and radical mood swings common • Require help with basic care activities

46. Stages of Alzheimer’s Dementia • Late stage(1-3years) • Little or no self care abilities • Cannot speak or understand language • Bedbound, chair bound, unable to walk • Cannot recognize even closest relatives • Difficulty swallowing, pneumonia is common • Brain loses the ability to control the body

47. FDA Approved Treatments • Acetyl cholinesterase inhibitors • Aricept, Exelon, Exelon Patch, Razadyne • NMDA receptor inhibitor • Namenda

49. Other Causes of Dementia • Mixed Alzheimer’s and vascular disease • Lewy body disease • Fronto-temporal dementia(Pick’s Disease) • Parkinson’s disease • Pure multi-infarct disease • HIV disease • Many, many more!

50. 10 Warning Signs of Dementia • Memory changes that disrupt daily life • Challenges in planning or solving problems • Difficulty completing familiar tasks • Confusion with time or place • Trouble understanding visual images and spatial relationships Source: The Alzheimer’s Association, www.alz.org