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Memory Loss and Alzheimer's: Understanding the Facts

Join us at the Leadership Summit in Biloxi, Mississippi to learn more about memory loss and Alzheimer's disease. Discover the difference between dementia and Alzheimer's, the diagnosis process, prevention strategies, and the economic impact of Alzheimer's. Expert speaker, Monica W. Parker, MD, will answer common questions and provide valuable insights.

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Memory Loss and Alzheimer's: Understanding the Facts

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  1. Leadership Summit Biloxi, Mississippi October 11 -13, 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 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 2050.1 • 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 (www.alz.org/facts/downloads/facts_figures_2015.pdf). 2. Hurd MD et al. N Engl J Med. 2013;368:1326-1334.

  5. US Population > 85 years old (in millions) The Alzheimer’s Disease Epidemic . . . 5.5 million today . . . nearly 50% over age 85 have AD . . . . . . 70 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 http://www.cdc.gov/nchs/data/databriefs/db116_fig3.png) 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 APA. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.

  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 Alzheimer’s Disease 52% Frontotemporal (FTD) 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 • Genetics/Gender • Stroke and CVD • Atrial Fibrillation • Heart Failure • Hypertension • High Cholesterol • Mood Disorders • Depression • Substance Abuse • ETOH, tobacco • Vitamin Deficiencies • Medication Interactions • Chemotherapy • benzodiazepines • Sleep Disorders • Diabetes • Thyroid Disease • Head Trauma • Vitamin Deficiencies • B, D, Folate

  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 Isolated memory Independent Excellent quality of life Mild Cognitive Impairment Worsening memory Functional limitations Needing more support Mild Dementia Preclinical Stage Profound loss of abilities Behavioral problems Increasing burden Cognition Moderate Dementia End-stage cognition Dependent Poor quality of life Severe Dementia 45 50 55 60 65 70 75 80 85 Age

  21. Annual Wellness Visit (AWV) • Age 65 and annually (www.medicare.gov) • 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 • 0 • 0 • 0 • 0 • 0 • 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 • www.alz.org Resources forcaregivers • www.alzheimers.gov resources for care, diagnosis, caregiving, education and training, research trials

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