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Understanding Dementia in Surgical Patients: Challenges and Implications

Learn about dementia in surgical patients, including definitions, epidemiology, types, and clinical features. Gain insights into managing cognitive decline in surgical settings.

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Understanding Dementia in Surgical Patients: Challenges and Implications

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  1. Dementia & Delirium in Surgical Patients Damian Harding Department of Geriatric Medicine February 2008

  2. Introduction Surgical patient population has changed..

  3. Introduction Surgical patient population has changed.. • More older patients • Patients have more co-morbidities.. • More likely to experience patients with dementia, and to encounter delirium/ acute confusion in surgical patients.

  4. DementiaDefinitions and Epidemiology • Dementia

  5. DementiaDefinitions and Epidemiology • Dementia: “acquired loss of cognitive function due to an abnormal brain condition”

  6. DementiaDefinitions and Epidemiology • Dementia: “acquired loss of cognitive function due to an abnormal brain condition” • Usually progressive • Includes functional decline

  7. DementiaDefinitions and Epidemiology • Dementia: “acquired loss of cognitive function due to an abnormal brain condition” • Usually progressive • Includes functional decline • Memory loss and cognitive impairment are NOT features of normal aging!

  8. DementiaDefinitions and Epidemiology • Prevalence of all dementias in the >65 yr population is 6-8%

  9. DementiaDefinitions and Epidemiology • Prevalence of all dementias in the >65 yr population is 6-8% • Prevalence in >85yr population is 30%

  10. DementiaDefinitions and Epidemiology • Prevalence of all dementias in the >65 yr population is 6-8% • Prevalence in >85yr population is 30% • Estimated annual cost reaches US$100 billion (2001) • Direct care to individual • Lost wages by caregivers

  11. DementiaDefinitions and Epidemiology • Prevalence of all dementias in the >65 yr population is 6-8% • Prevalence in >85yr population is 30% • Estimated annual cost reaches US$100 billion (2001) • Direct care to individual • Lost wages by caregivers • Significant emotional and personal costs

  12. Types of Dementia • At least 50-60% of people with dementia have Alzheimer’s Disease

  13. Types of Dementia • At least 50-60% of people with dementia have Alzheimer’s Disease • Commonest types of dementia include:

  14. Types of Dementia • At least 50-60% of people with dementia have Alzheimer’s Disease • Commonest types of dementia include: • Alzheimer’s Disease • Vascular (multi-infarct) dementia • Lewy body Dementia • Alcoholic dementia • (depression and pseudo-dementia)

  15. Alzheimer’s Disease Neurodegenerative disease associated with:

  16. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits

  17. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss)

  18. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss) • Functional impairment

  19. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss) • Functional impairment • Clear consciousness*

  20. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss) • Functional impairment • Clear consciousness* • Change from previous level (>6 months duration)

  21. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss) • Functional impairment • Clear consciousness* • Change from previous level (>6 months duration) • Median survival from diagnosis: 5-6 years

  22. Alzheimer’s Disease is associated with specific changes in brain anatomy, chemistry and physiology

  23. Alzheimer’s Disease is associated with specific changes in brain anatomy, chemistry and physiology • Neurofibrillary tangles* • Amyloid plaques • Loss of cortical choline acetyltransferase activity and of cholinergic projection neurons in Nucleus basalis of Meynert*

  24. Alzheimer’s Disease is associated with specific changes in brain anatomy, chemistry and physiology • Neurofibrillary tangles* • Amyloid plaques • Loss of cortical choline acetyltransferase activity and of cholinergic projection neurons in Nucleus basalis of Meynert* • Multifactorial genetic component

  25. Alzheimer’s Disease is associated with specific changes in brain anatomy, chemistry and physiology • Neurofibrillary tangles* • Amyloid plaques • Loss of cortical choline acetyltransferase activity and of cholinergic projection neurons in Nucleus basalis of Meynert* • Multifactorial genetic component CT/MRI may be normal or show generalized atrophy/ focal atrophy in medial temporal lobe *correlates with disease severity

  26. Alzheimer’s Disease Clinical Features:

  27. Alzheimer’s Disease Clinical Features: Cognitive

  28. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia

  29. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question.

  30. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia

  31. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties

  32. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia

  33. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair

  34. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair • Agnosia

  35. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair • Agnosia • Failure to recognise objects/ familiar faces

  36. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair • Agnosia • Failure to recognise objects/ familiar faces • Frontal executive dysfunction

  37. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair • Agnosia • Failure to recognise objects/ familiar faces • Frontal executive dysfunction • (Capacity to consent for treatment)

  38. Alzheimer’s Disease Clinical Features: Non-Cognitive

  39. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms

  40. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations

  41. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems

  42. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes

  43. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes • Apathy • Overactivity/ agitation (wandering) • Aggression • Personality changes

  44. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes • Apathy • Overactivity/ agitation (wandering) • Aggression • Personality changes • Abnormal sleep

  45. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes • Apathy • Overactivity/ agitation (wandering) • Aggression • Personality changes • Abnormal sleep • Reduced appetite

  46. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes • Apathy • Overactivity/ agitation (wandering) • Aggression • Personality changes • Abnormal sleep • Reduced appetite • Incontinence

  47. Management of Alzheimer’s Disease and Dementias

  48. Management of Alzheimer’s Disease and Dementias • Biological

  49. Management of Alzheimer’s Disease and Dementias • Biological • Social

  50. Management of Alzheimer’s Disease and Dementias • Biological • Social • Psychological

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