Normal Aging, Brain Injury and Alzheimer’s Disease

1. Normal Aging, Brain Injury and Alzheimer’s Disease Annual Conference for Professionals in Brain Injury April 11, 2013

2. Presenters • Jean Wood, Minnesota Board on Aging • Mark Kinde, Minnesota Department of Health • Michelle Barclay, Alzheimer’s Association

3. Overview of Session • Normal brain changes with age • Brain injuries in older adults • Prevalence, causes and comorbidities • Alzheimer’s Disease and other dementias • Prevalence, identification and management • Falls prevention to reduce risk for brain injury • community interventions

4. Demographics of Aging • The baby boomers started turning 60 in 2006. • According to the 2010 Census - In 2010, there were 683,000 Minnesotans age 65 and older. in 2030, there will be 1.3 million Minnesotans age 65 and older. • The 85+ population is the fastest growing.

5. Normal Brain Changes with Aging • Brain and spinal cord lose nerve cells and weight. • Nerve cells may transmit messages more slowly. • Reduced or lost reflexes or sensation may occur in some people. • Some slight slowing of thought, memory and thinking is natural.

6. Brain Injury Epidemiology, MN • When & where do brain injuries happen? • To whom? • What are the leading causes? • What other illnesses or injuries occur in conjunction with brain injury? • What do we know about outcomes? • How much do brain injuries cost? • Who pays?

7. ED TBI by age-group N Year

8. Hospitalized TBI by age-group N Year

9. ED TBI by gender N Year

10. Hospitalized TBI by gender N Year

11. Seasonal incidence of TBIseen in the ED N Year

12. Seasonal incidence of hospitalized TBI

13. What causes unintentional TBI?(ED treated) N Year

14. What causes unintentional TBI?(Hospitalized) N Year

15. Where do brain injuries happen? (ED TBI) N Year

16. Where do brain injuries happen? (Hospitalized TBI) N Year

17. Co-morbidity: ED treated TBI

18. Co-morbidity Hospitalized TBI

19. What about drugs & alcohol? Hospitalized ED Treated

20. Is income related to brain injury? (Median Income by Zip) ED Treated Hospitalized

21. TBI Mortality by year, Minnesota, 55+ Centers for Disease Control and Prevention , National Center for Health Statistics. Multiple Cause of Death 1999-2010 on CDC WONDER Online Database, released 2012. Data are from the Multiple Cause of Death Files, 1999-2010, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.html on Feb 13, 2013 5:58:52 PM

22. Alzheimer’s Disease and related dementia

23. Dementia is a loss of mental function in two or more areas such as language, memory, or judgment severe enough to impact daily life. Alzheimer’s disease is the most common cause of dementia.

24. Dementia Common Uncommon Alzheimer’s Disease Vascular Dementia Dementia with Lewy bodies Parkinson’s Dementia Frontotemporal dementia Corticobasal Degeneration Progressive Supranuclear Palsy Jakob-Creutzfeldt Disease

25. Causes of Dementia in People 71+ Adams, 2002

26. Alzheimer’s Prevalence with Age 65-74 years (1.6%) 75-84 years (19%) 85+ (42%) Hebert et al 2000

27. Alzheimer’s Disease Risk Factors • Age • Family history • Patients with a 1st degree relative have a 10-30% increased chance of developing AD (van Duijn 1991) • Genetic factors • Mild Cognitive Impairment (MCI) • Vascular risk factors • Head injury • Amyloid in the brain (PET Scan)

28. T A U I S T BAPTIST

31. Progression of Alzheimer’s Disease • Early Stage: 2 - 4 years in duration • Middle Stage: 2 - 10 years in duration • Late Stage: 1 - 3 years in duration

32. Early Stage AD • Symptoms Interfere with everyday functioning • Forgetfulness • Trouble with time/sequence relationships • More mental energy needed to process • Trouble multi-tasking • Writes reminders, but loses them • Personality changes • Shows up at the wrong time or day • Changes in appearance • Preference for familiar things

33. Middle Stage AD • Fluctuating disorientation • Diminished insight • Learning new things becomes difficult • Restricted interest in activities • Declining recognition of acquaintances, distant relatives, then more sig. relationships • Mood and behavioral changes • Functional declines • Alterations in sleep and appetite • Wandering

34. Late Stage AD • Severe disorientation to time and place • No short term memory • Long-term memory fragments • Loss of speech • Difficulty walking • Loss of bladder/bowel control • No longer recognizes family members • Inability to survive without total care

35. Alzheimer’s Disease:Course, Prevention, Treatment Strategies Treatment Primary Prevention Secondary Prevention INTERVENTION AD Mild Cognitive Impairment Normal Pre-symptomatic AD CLINICAL STATE 5.3mil 10 to 15 mil Numbers of people ??? 20 to 60 mil Mild, moderate or severe impairment AD brain changes Mild symptoms BRAIN PATHOLOGIC STATE Early AD brain changes No symptoms No disease No symptoms Treat cognition Treat behaviors Slow progression Prevent or delay emergence of symptoms Stimulate memory Slow progression Identify at-risk Prevent AD STRATEGIES DISEASE PROGRESSION

36. Alzheimer’s disease impact

37. Nearly 90,000 Minnesotans have Alzheimer’s disease. 5.4 million Americans have the disease.

38. Number of people over 65 with AD in MN Alzheimer’s Association Facts & Figures Report 2012

39. Alzheimer’s disease is the sixth leading cause of death in the United States. AD is the fifth leading cause of death for those aged 65 and older.

40. % change in leading causes of death: 2000 - 2008 Alzheimer’s Association Facts & Figures Report 2012

41. Nearly 240,000 Minnesotans are caregivers for someone with Alzheimer’s disease. Seventy percent of people with Alzheimer’s disease live at home.

42. Economic Value of Caregiving in MN Alzheimer’s Association Facts & Figures Report 2011

43. Age of Alzheimer’s Family Caregivers *Average age = 52 years Alzheimer’s Association Facts & Figures Report 2012

44. Impact on the Caregiver’s Health • 33% of Alzheimer’s family caregivers have symptoms of depression • Alzheimer’s family caregivers are more likely than non-caregivers to: • Report that their health is fair to poor. • Have high levels of stress hormones, reduced immune function, slow wound healing, new hypertension and new coronary heart disease.

45. People with Alzheimer’s disease are high users of healthcareand long-term care services. Total cost was three times higher for Medicare beneficiaries age 65+ with AD in 2004.

46. Average Medicare payments per person for beneficiaries age 65+ with and without ADRDs in 2008 (2011 dollars) Alzheimer’s Association Facts & Figures Report 2012

47. More than seventy thousand Minnesota nursing home residents have cognitive impairment.

48. Current data suggests that less than 35% of people with Alzheimer’s and other dementias have a diagnosis of the condition in their medical record. Boise et al., 2004, Boustani et al., 2005, Ganguli et al., 2004, Valcour et al., 2000

49. Impact of Co-Existing Medical Conditions:Percentage of Medicare beneficiaries 65+ with ADRD and a co-existing medical condition in 2009 Alzheimer’s Association Facts & Figures Report 2012

50. Community interventions to improve identification & management of AD