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Dementia An in-depth Update. Juergen H. Bludau, M.D. Executive Medical Director of Geriatrics Medical Director of Home Health Elliot Health System. Objectives. Know the reason for a accurate diagnosis Recognize the importance of a careful history
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DementiaAn in-depth Update Juergen H. Bludau, M.D. Executive Medical Director of Geriatrics Medical Director of Home Health Elliot Health System
Objectives Know the reason for a accurate diagnosis Recognize the importance of a careful history Understand the different types of dementia and the evolving techniques to help in the diagnosis
Dementia /
StatisticsDementia 2010 Report http://news.bbc.co.uk/2/hi/health/8493248.stm
StatisticsDementia 2010 Report http://news.bbc.co.uk/2/hi/health/8493248.stm
StatisticsWorld Alzheimer Report from ADIhttp://www.tutor2u.net/blog/index.php/economics/comments/the-social-cost-of-dementia
The dementia challenge in primary care Who in the medical community is most challenged by these issues? Most older adults receive their health care “solely” from a primary care physician More than 80% of all medical care for dementia occurs in primary care settings Ganguli et al., Ann Intern Med 2003; 138: 927-937. Borson, S. “Should Older Adults Be Screened for Cognitive Impairment?: Underdetection of Dementia in Primary Care Practice.” Medscape General Medicine, 2004-03-12. Accessed October 26, 2009. Boustani M, Peterson B, Hanson L, Harris R, Lohr KN; US Preventive Services Task Force. Screening for dementia in primary care: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2003;138:927-937
The dementia challenge in primary care Under-diagnosis Although we can now quite accurately diagnose AD and other dementia, with autopsy results supporting the clinical diagnosis in 86-90% of cases... …fewer than 35% of people with AD or other dementia have the diagnosis in their medical record. Galasco et al., Arch Neurol 1994; 51:888-895. Boise et al., 2004; Boustani et al., 2005; Ganguli et al., 2004; Valcour et al., 2000.
The dementia challenge in primary care Why these issues challenge primary care Time constraints Reimbursement constraints Skepticism about effectiveness of medications No regular screening used Structured nature of PCP interview —Yes/no answers
The dementia challenge in primary care Why(cont.) 6.Time consuming diagnosis (By means of careful history-taking from patient/ caregiver with no one specific, universal complaint) 7.No user-friendly guidelines available (Guidelines from 1990s not updated12,13,14or have focused on treatment more than on diagnosis15) 8.No clear cut physical exam signs 9.No current specific lab or imaging test easily available
The dementia challenge in primary care Why(cont.) Dementia diagnosis opens “Pandora’s box” Difficulties in communicating with patient and caregiver16,17 12.Depression may also delay early recognition 13.Lack of knowledge about available community support services Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 1994; 44:2203-6. Practice guideline for the treatment of patients with Alzheimer’s disease and other dementias of late life, American Psychiatric Association. Am J Psychiatry 1997; 157 (5Suppl): 1-39. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer’s Association, and the American Geriatrics Society, JAMA 1997; 278:1363-71. Practice guideline for the treatment of patients with Alzheimer’s disease and other dementias, Second edition, 2007
Historical Auguste Deter
Alzheimer’s Disease Coronal T1WI of the hippocampus demonstrating progressive atrophy in familial AD http://www.radiologyassistant.nl/en/p43dbf6d16f98d/dementia-role-of-mri.html
Alzheimer’s Disease http://www.alz.org/brain/10.asp
Alzheimer’s Disease The findings are consistent with the diagnosis of end stage AD, because there is: Extreme hippocampal and medial temporal lobe atrophy (MTA score: 4) Severe global atrophy (GCA scale: 3)
Alzheimer’s Disease Specimen in end stage AD demonstrating severe global atrophy. Courtesy Webpath (11).
Alzheimer’s Disease Photomicrograph of the temporal cortex of a patient with Alzheimer's disease (modified Bielschowski stain; original magnification, 40×). Numerous senile (neuritic) plaques (black arrow) and neurofibrillary tangles (red arrow) are shown.
Alzheimer’s Disease http://www.alz.org/brain/10.asp
Parkinson’s Diseasehttp://www.webmd.com/parkinsons-disease/ss/slideshow-parkinsons-overview
