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DEMENTIA 1/6/16

Learn about the common symptoms, diagnostic methods, and treatment options for dementia. Discover how age, pathology, and different types of dementia impact patients. Find out which drugs can help manage the disease and what the future holds for dementia research and care.

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DEMENTIA 1/6/16

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  1. DEMENTIA 1/6/16 DR TONY O’BRIEN MD FRCP

  2. Dementia • Common – 700,000 sufferers in the UK • Prevalence increases with age • Age • 40-65 years • 65-70 years • 70-80 years • 80+ • Prevalence • 1 in 100 • 1 in 50 • 1 in 20 • 1 in 5

  3. Dementia • Chronic disorder affecting higher cortical functions, including memory, reasoning, orientation, and communication skills • Gradual loss of skills needed to carry out daily activities • Progressive Dementia UK Report 2007

  4. Dementia Deficits in Memory and Functional abilities, plus two more categories • Memory • Functional abilities • Language • Perceptual skills • Attention • Constructive abilities • Orientation • Problem solving

  5. Not all about memory • 1. Age associated memory impairment • Mild cognitive impairment • Dementia

  6. Dementia Diagnosis • Neuropsychological assessments – e.g. MMSE, ADAS-cog • Clinical examination • Collateral history • Brain scan • Blood tests

  7. Distribution pathology in typical AD (Braak and Braak 1991)

  8. Focal dementiaYOU DO NOT NEED IMAGING TO DISTINGUISH THESE CONDITIONS R L PATIENT 3 ALZHEIMERS OR FTD PATHOLOGY: LEFT POSTERIOR SUPERIOR TEMPORAL LOBE → non-fluent aphasia PATIENT 2 ALZHEIMER’S PATHOLOGY: PARIETAL LOBE → spatial sx PATIENT 1 ALZHEIMER’S PATHOLOGY: HIPPOCAMPUS → memory sx PATIENT 4 FTD PATHOLOGY: LEFT LATERAL TEMPORAL LOBE → fluent aphasia

  9. Dementia Others Dementia with Lewy Bodies Alzheimer’s Disease 5 % 55 % 15 % Vascular Dementia Frontotemporal lobe dementias 20 % 5 %

  10. Alzheimer’s • Slow insidious onset • Progressive decline • Early changes in personality – ‘depression’, agitation • Positive family history

  11. Alzheimer’s - Pathology • Loss of cholinergic neurones • Amyloid plaques • Neurofibrillary tangles of Tau proteins

  12. Vascular Dementia • Often abrupt onset • Step-wise progression • Focal neurological signs or symptoms • Evidence of cerebrovascular disease on brain scan • Emotional lability • Early presence of gait disturbance

  13. Dementia with Lewy Bodies (DLB) • Sits somewhere between Alzheimer’s and Parkinson’s • 2 out of 3 of • Spontaneous features of Parkinsonism • Visual hallucinations • Fluctuating course • Supporting features • Recurrent falls / syncope • Neuroleptic sensitivity - 70 % patients affected • Systematized delusions

  14. Treatment of Dementia • Education, support and signposting to services • Disease modifying • Symptomatic • Drugs for behavioural disturbance

  15. Dementia Treatment - Symptomatic Effects vs Slowing Disease Mild Impairment Placebo Symptomatic Diseasemodifying Severe Baseline End TreatmentPeriod (Ferris, 8/03)

  16. Alzheimer’s Disease • Cholinesterase inhibitors • Donepezil, Rivastigmine, Galantamine • Glutamate receptor antagonist • Memantine

  17. Vascular Dementia • Secondary prevention for stroke - Disease Modifying • Antiplatelet therapy or anticoagulation if AF • Statin • Perindopril +/- Indapamide • Promote healthy lifestyle with regard to diet, exercise, good diabetic control, smoking cessation, etc.

  18. Case Study Arthur has recently attended the memory clinic at the hospital and has been diagnosed with dementia of the ‘mixed type’. Arthur has a mini-mental state examination (MMSE) of 23. He has a background history of hypertension and has fallen twice in the last year. Amitryptiline 50 mg nocte, Simvastatin 20 mg nocte, Zopiclone 7.5 mg nocte, Bendroflumethiazide 2.5 mg od, Aspirin 75 mg od Suggest some possible options for management.

  19. The Future • Alzheimer’s: drugs spontaneous to disease-modifying..multidrug • Vascular: earlier recognition and aggressive treatment • Parkinsons: disease modifying drugs: single drug • Legal situation: living will, Preferred priority care / living • Societal moral legal debate for treatment of advanced dementia • Ageism

  20. Acknowledgements • Dr John Whitear Geriatrician • Dr Lucy Coward Neurologist • S/N Christine Timms • S/N Jackie Smith

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