Dementia

1. Dementia Ashlie S. Morrissey, DNP, AGNP-C Jordyn L. Parker, MMS, PA-C

2. Normal Changes of Aging versus Dementia • What is Typical versus Pathological? • Different Types of Dementia May Present with Different Symptoms. • How prevalent are dementias in general? • Ways to lower the risk of developing dementia. • How is dementia treated? • Tips for caregivers

3. My Memory isn’t what it used to be? Should I be concerned?

4. The Alzheimer's Association’s 10 SignsEarly Detection Matters • Memory loss that disrupts daily life • Challenges in planning or solving problems • Difficulty completing familiar tasks at home, at work, or at leisure • Confusion with time or place • Trouble understanding visual images and spatial relationships • New problems with word in speaking or writing • Misplacing things and losing the ability to retrace steps • Decreased or poor judgement • Withdrawal from work or social activities • Changes in mood or personality

5. Different Types of Dementia • Alzheimer’s Disease • Vascular Dementia • Dementia with Lewy Bodies • Parkinson’s Dementia • Frontotemporal Dementia • Wernicke-Korsakoff Syndrome • Mixed Dementias • Creutzfeldt-Jakob disease • Normal pressure hydrocephalus • Huntington’s disease • Multiple Sclerosis related Dementia • HIV/AIDS related Dementia

6. Alzheimer’s Dementia • Most Common Type of Dementia – accounts for about 70% of all dementia diagnoses • Fragments of a protein called amyloid form abnormal clusters (plaques) between brain cells and a protein called tau forms tangles inside nerve cells. • Most prominent and first noticed symptom is usually memory loss. Progresses with greater memory loss and other cognitive difficulties. Problems may develop with wandering and getting lost, trouble handling money and paying bills, repeating questions, taking longer to complete normal daily tasks, and personality and behavior changes.

7. Vascular Dementia • Second most common type of dementia • Often occurs in conjunction with other types leading to a diagnosis of “Mixed dementia” • Can be due to a major cerebrovascular event, e.g. a stroke; or can be due to multiple small prior strokes which were asymptomatic at the time they occurred; or diffuse changes that occur within the white matter of the brain due to microvascular ischemic disease • Symptoms usually present more with problems planning, organization, making decisions, attention, slowed thinking, and problem solving as opposed to memory loss as in Alzheimer’s.

8. Dementia with Lewy Bodies • Lewy Bodies are named for Dr. Friederich Lewy, a German neurologist, who discovered these abnormal protein deposits in the brain’s of people with Parkinson’s disease. • These Lewy Bodies play an important role in Parkinson’s disease dementia also. • Symptoms that distinguish this type of dementia from others include: • Visual hallucinations early in the course of dementia • Fluctuations in cognitive ability, attention, and alertness • Slowness of movement, tremor, difficulty walking, or rigiditiy • Sensitivity to medications used to treat hallucinations • REM sleep behavior disorder, in which people physically act out their dreams by yelling, punching bed partners, and/or falling out of bed • More trouble with complex mental activities, such as multitasking, problem solving, and analytical thinking, than with memory

9. Brain Healthy Lifestyle • 1. Break a Sweat • 2. Be Social • 3. Healthy Heart = Healthy Brain • 4. Feed Your Brain • 5. Avoid Cigarettes And Alcohol • 6. Learn Something New • 7. Challenge Your Brain • 8. Don’t Forget To Sleep • 9. Mental Health Is A Part of Brain Health • 10. Protect Your Brain

10. Common Medications Used in Dementia • Aricept – donepezil – cholinesterase inhibitor • Namenda – memantine – N-methyl D-aspartate (NMDA) antagonist • Namzaric – memantine and donepezil – combination of previous two • Exelon – rivastigmine – Cholinesterase inhibitor • Razadyne – galantamine – Cholinesterase inhibitor

11. What to expect with medications • Medications slow progression. They are preventive, not restorative. • Most common side effects: • Cholinesterase Inhibitors: nausea, vomiting, diarrhea, vivid dreams • NMDA

12. Mechanisms of Action (for non-nerds just put your fingers in your ears.) • Acetylcholine is a neurotransmitter and acetylcholinesterase is the chemical which breaks this neurotransmitter down. By inhibiting the breakdown of Acetylcholine the hope is that disease progression is slowed. The primary symptoms affected are neuropsychiatric symptoms (particularly apathy) and memory and cognitive symptoms (memory and learning deficits primarily). • Neuronal excitotoxicity, as a manifestation of glutamatergic neurotransmission dysfunction, is hypothesized to be involved in dementias. Memantine is a low-affinity, voltage dependent, noncompetitive antagonist at glutamatergic NMDA receptors. So, memantine binds to these receptors with a higher affinity than other ions (like magnesium) and blocks influx of other ions and prevents neuronal excitotoxicity. The low affinity, uncompetitive nature, and rapid off-rate kinetics of memantine at the level of the NMDA receptor-channel, however, preserves the function of the receptor at synapses ]The interaction of memantine with NMDA receptors plays a major role in the symptomatic improvement that the drug produces in dementia.

13. Tips for Caregivers • Start with legal, financial and medical planning • Living will, POA, DNR • Use adult day programs/respite care programs • Contact a local home health agency or visit assisted living facilities • Find a support group

14. Questions?