Dementia: Alzheimer’s Disease
Cyril Evbuomwan
Patient Group Meeting
1st December 2015
Dementia: Definition
• Clinical condition complex, progressive and
irreversible Characterized by deterioration in
• Intellectual function
• Behaviour
• Personality
• Presence of NORMAL level of consciousness
and perception
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
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
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!
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
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
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
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
Alzheimer’s Disease: Presentation(3)
•
•
•
•
Late Stages
Wandering, disorientation
Apathy
Psychiatric symptoms: Hallucination,
depression and delusion
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/Schizophr
enia
Acute confusional
state
Infection: AID, Syphilis
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
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
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
AD: What can we do to reduce risks?
•
•
•
•
•
Nothing
Age
Gender-females
Genetics
Learning disability
• Yes(modifying risks)
• Alcohol/smoking
• Obesity
• Hypertension/cholest
erol
• Head injury
• Education/mental
stimulation
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