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, not a single cause. • Alzheimer's disease is the 5th leading cause of death for people ages 65&up in the US • 1 in 8 older Americans has AD • The healthy adult has 100 billion neurons, and 100 trillion synapses. • Beta-amyloid protein causes plaque buildup outside of neurons • Tau protein forms tangles inside of the actual neuron, blocking synapses • 1st identified over a century ago, but only gained momentum in research about 30 years ago • Brain cell disruption usually begins in the hippocampus (in the cortex) where new memory formation occurs, causing short term memory loss. Damage spreads, creating other difficulties Risk Factors • Apolipoprotein-E epsilon 4 abnormalities. It's the gene for the protein that carries cholesterol in blood • Mild Cognitive Impairment (MCI) • Cardiovascular disease (creates a lack of blood to the brain) -Physical inactivity • -High cholesterol • -diabetes -obesity • -smoking • Social Engagement and Diet • -Social isolation encourages loss • -Healthy diet high in vegetables discourages loss • Head trauma The 10 Warning Signs 1. Memory loss that disrupts daily life 2. Challenges in planning and problem solving 3. Difficulty completing familiar tasks 4. Confusion with time or place 5. Trouble understanding visual images and spatial relationships 6. New problems with words in speaking or writing 7. Misplacing things, inability to retrace steps 8. Decreased/poor judgment 9. Withdrawal from work or social activities 10. Mood and personality changes I'm seeing some of those symptoms, but how do I know it's not just normal aging? Typical age-related changes Could be Alzheimer's Disease Making a bad decision every once in a while Poor judgment and decision-
and especially if they are high-risk. physical and neurological examinations • MRI to identify brain changes • Soon biomarkers will be used to diagnose AD. Diagnosis • The Dr will perform a family history. psychiatric history. assuming intact sensory function Ability to execute motor activities. other tests that indicate damage to or degeneration of neurons Dementia Dementia is the loss of mental functions -..such as thinking.beta-amyloid and tau presence may be tested for in cerebrospinal fluid and blood. close family members will be involved • Cognitive tests. and comprehension of the required task. and plan and carry out complex tasks. history of cognitive and behavioral changes. AND Ability to think abstractly.making Missing a monthly payment Forgetting which day it is.. • Ideally. Dementia is not a disease itself. make sound judgements.that is severe enough to interfere with a person's daily functioning. and reasoning -. but remembering later Sometimes forgetting which word to use Losing things from time to time Inability to manage a budget Losing track of date or season Difficulty holding a conversation Misplacing things and being unable to retrace steps Sooooooo. sensory function. That's who usually diagnoses AD. DSM-IV Criteria for Dementia *Symptoms must include a decline in memory and in at least one of the following cognitive abilities: • • • • Ability to generate coherent speech or understand spoken or written language Ability to recognize objects. but rather a group of symptoms that are caused by various diseases or conditions that result in damaged neurons and or connections between neurons. it's time to see the PRIMARY CARE PHYSICIAN-PCP. assuming intact motor abilities. memory. . If you or a loved one are having experiences such as those above.
Parkinson's Disease. awareness of time and place. -additional biomarker research is needed. should determine the cause of dementia. New staging guidelines take effect this year: 1. normal pressure hydrocephalus Alzheimer's Disease is the most common type of dementia.symptoms often overlap. but it hopefully will be able to diagnose measurable changes in CSF and the brain at this phase. Mild cognitive impairment due to AD: mild but measurable changes in thinking abilities. many people with dementia have brain abnormalities associated with more than one type of dementia. and based on scores on mental-functioning tests that assess memory. they should be examined for symptom patterns and distinguishing microscopic brain abnormalities that can help differentiate different types of dementia.*The decline must be severe enough to interfere with ADLs. CreutzfeldJakob disease. 4.stroke. moderate. There are over 50 types of dementia Such as : Vascular dementia . but memory may not be as affected -Mixed Dementia. FDA has approved 5 drugs that temporarily improve symptoms. Some causes of dementia are treatable: • • • • • • Depression Delirium Drug interaction Thyroid problems Alcoholism Vitamin deficiencies If the patient isn't experiencing a treatable condition. but have no effect on person's ability to carry out every day activities. Dementia due to AD: DSM IV guidelines The old stages were mild. 60%-80% of all cases -According to long-term observational studies. THEN Dr. but no treatment is available to slow or stop AD. Preclinical Stage: begins as many as 20 years before any symptoms appear. . 3. 2. and severe.may be AD and another type -Dementia with Lewy Bodies. Treatment No treatment will alter the underlying course of the terminal disease. and reasoning. frontotemporal dementia. thinking.
4. They're indicated for different stages of the disease . Possible side effects include agitation or anxiety. antihistamines. (exercise. The final phase of the disease may last from a few months to several years.Donepezil (Aricept). Dwindling neurons eventually stop being able to produce ach. If effective treatments exist. All may cause stomach upset. cutting cholesterol. and galantamine (Razadyne).20 years after diagnosis. and tacrine (Cognex). If AD develops quickly. comorbidity. on average. omega 3 fatty acids 2-3x a week. antioxidant-rich diet. but it's associated with more serious side effects than the other three drugs in this class. Memantine (Namenda). it is more likely to worsen quickly. Death usually occurs from an infection or organ failure. and further disease progression. For later stages of the disease. vomiting.1. thought. During that time. diarrhea. and fatigue. although a patient may live anywhere from 3 . Cholinesterase Inhibitors: AD decreases acetylcholine levels in the brain. But in individuals. and we all know ach is important for alertness. early detection can lead to modification of dementia risk. . others Expectations How quickly AD gets worse is different for each person. Cognex was the first approved. sleeping pills. Prevention Three forms of prevention exist. Tertiary prevention is geared towards reducing disability. and these drugs will lose effectiveness. or dangerous behaviors. Other Treatment Other meds may be used to control aggressive. muscle cramps. rivastigmine (Exelon). cns depressants. Primary: Same preventative measures for cardiovascular health promotion. Medications that make confusion worse may need to be discontinued. memory. agitated. and judgment. the patient becomes totally disabled. one cholinesterase inhibitor may work better or produce fewer side effects than does another. Secondary prevention aims at preventing preclinical disease from progressing to clinical disease and depends on effective screening and early detection of dementia. All cholinesterase inhibitors. -painkillers. 2. Primary prevention aims at reducing disease incidence. Patients with AD often die earlier than normal. NSAID therapy) ⁃ Maintain social interactions throughout life ⁃ Stay mentally active ⁃ Some studies have found correlation between moderate red wine consumption and 50% lower incidence of disease ⁃ Vaccine in research stage: 3. They are usually given in very low doses to curb risks of side effects and death. work about equally well.
or receptor for advanced glycation endproducts. Amyloid and the way it gets there could be targets for a new vaccine. Alvin Terry. the amyloid protein can accumulate in the brain instead of being eliminated by the body’s natural defenses. Research has shown that RAGE may also contribute to the inflammation and damage that amyloid causes to the brain’s nerve cells. In Alzheimer’s. Early results have shown improved cognition and memory in animal models of Alzheimer’s. Professor of Pharmacology and Toxicology. “RAGE. according to research by a Georgia Health Sciences University graduate student. a fifth-year graduate student who is studying the disease in the lab of Dr.” said Scott Webster. nestling between the neurons and forming impassable plaques. . proteins bind to amyloid and transport it into the brain.An accomplice to the protein that causes plaque buildup in Alzheimer’s disease is the focus of a potential new treatment.
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