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Dementia: Alzheimer’s Disease

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

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Dementia: Alzheimer’s Disease

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  1. Dementia: Alzheimer’s Disease Cyril Evbuomwan Patient Group Meeting 1stDecember 2015

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

  3. 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

  4. 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

  5. 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!

  6. 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

  7. 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

  8. 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

  9. 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

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

  11. 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/Schizophrenia • Acute confusional state • Infection: AID, Syphilis

  12. 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

  13. 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

  14. 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

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

  16. 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

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