Memory Disorders and Dementia: Overview and Updates

Cheryl L Brandi, DNSc, APRN, NP-C, CADDCT

Nurse Practitioner, Roskamp Institute Neurology Clinic,

Sarasota, Florida

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Why is this discussion

important?

• Dementia: 1/5 of Medicare dollars

• Eighty-one percent of patients who meet dementia criteria have no diagnosis

• 1 in 3 seniors dies with dementia

• Prediction: By 2050, 13.2 million older Americans with Alzheimer’s Disease

• Parkinson’s Disease patients can develop dementia

Neurological disorder care:

It takes a village…

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Two ways of thinking

about memory disorders

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How severe is the disorder?

What is the likely disease pathology?

Normal brain aging

• Parts of the brain shrink, especially the prefrontal area and hippocampus, areas responsible for memory, learning, planning

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Memory, learning, planning

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Path of normal aging and dementia

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What is mild cognitive impairment?

• A medical diagnosis

• An abnormal condition of memory and/or thinking and not normal for age

• Sometimes called pre-dementia, but may not lead to dementia

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Normal aging and dementia

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Dementia

• A broad term for a number of chronic brain diseases involving irreversible changes in memory, thinking and/or behavior

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Dementia types and incidence

• Alzheimer’s Dementia, 55 - 65%

• Vascular Dementia, 10 - 15%

• Mixed

• Dementia with Lewy Bodies, probably 15 –20%

• Parkinson’s Dementia (40 % of PD patients)

• Frontotemporal Dementia, 5 – 8 %

• Less common

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Mild cognitive impairment and dementia

• Mild cognitive impairment--little change in daily life

• Dementia: Symptoms more obvious and person has trouble doing everyday normal activities

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Alzheimer’s Disease

• -First discovered by Alois Alzheimer in 1906

• -Usually starts some inability to remember recent events

• -Can lead to changes in language, disorientation, mood and decreased motivation but each case is different

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Pathology of Alzheimer’s Disease

• 1. Amyloid plaques

• 2. Neurofibrillary tangles—Tau protein

• 3. Loss of cell to cell connections-> cell death

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Amyloid plaques in brains have been found as early as age 20

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Nerve to nerve transmission

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By derivative work: Garrondo (talk) SEVERESLICE_HIGH.JPG: ADEAR: "Alzheimer's Disease Education and Referral Center, a service of the National Institute on Aging." PRECLINICALSLICE_HIGH.JPG: ADEAR: "Alzheimer's Disease Education and Referral Center, a service of the National Institute on Aging." (SEVERESLICE_HIGH.JPG PRECLINICALSLICE_HIGH.JPG) [Public domain], via Wikimedia Commons

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Normal brain and AD brain

Vascular dementia

• May be difficult to distinguish from AD

• May involve less significant memory impairment than AD

• Behavioral and mood disturbances more likely

• Movement disorders—gait and balance issues more common

• More trouble with spatial abilities

• Pattern--more episodic and stepwise

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Vascular dementia

• Risk factors: heart disease, hypertension, diabetes, obesity, smoking, age, male sex, possibly high homocysteine levels

Leucoaraiosis (Periventricular white matter

disease)

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Lewy Body Disease (LBD)

• Lewy bodies in the brain (alpha synuclein deposits)

• Lewy bodies deplete the neurotransmitter dopamine (movement and mood) and also acetylcholine (thinking, cognition)

• Discovered by Frederich Lewy, in the early 1900s

• Parkinson’s Disease and Lewy Body Disease are the same according to some experts

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Lewy body disease

• Progressive, often under-recognized

• Similar to Parkinson’s Disease, but in Lewy Body Disease, memory decline precedes the movement disorder

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Lewy Body

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Lewy Body Disease

characteristics

• Episodes of illogical thinking or incoherent random thoughts

• Staring spells or blank looks

• Visual hallucinations

• Acting out dreams

• BP drops with position changes

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Lewy Body Disease

characteristics

• Movement—slowed

• Movement—rigidity

• Postural stability less

• Tremor at rest

• Excessive daytime sleepiness

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Comparing Alzheimer’s and Lewy Body Disease

• Memory issues earlier in AD

• Movement issues earlier in LBD

• REM sleep disorder in LBD

• Autonomic nervous system disruption in LBD

• Certain medications might be more harmful in cases of LBD

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Frontotemporal Dementia

• A group of brain disorders characterized by behavior and language problems, and sometimes movement troubles

• Involves a progressive loss of neurons in the frontal and temporal lobes of the brain

• Several subtypes

• Also known as Pick’s Disease

• Ages 50 to 65 most common age group

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So what can I do to stabilize or prevent?

• No known cure for memory disorders or Parkinson’s disease

• We cannot change our genetic profile or our gender

• Even when there is a cure, lifestyle will be important

• Science supports even small lifestyle changes

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Evidence shows lifestyle factors do make difference!

• The Lancet Commission on Dementia Prevention, Intervention and Care, 2017

• Belief: A delay in the onset of dementia would benefit even the oldest adults

• Focus: Need to promote resilience and cognitive reserve

• Less cognitive reserve leads to earlier development of dementia

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Lancet Commission review results

• Data from 10,000 UK community-dwelling adults

• Dementia, might be the terminal stage of disease processes beginning 10 or 20 years before diagnosis

• About 35% of dementia--associated with nine risk factors

• Lifestyle changes could prevent more than a third of dementia cases.

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Nine important risk factors

• Low education level• Midlife hypertension• Midlife obesity• Hearing loss• Late life depression• Diabetes• Physical inactivity• Smoking• Social isolation

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Multi-intervention FINGERS study

• Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability

• Treatment group: 4 intensive lifestyle interventions to over 600 people 60 years and older at high risk

• Interventions: diet, exercise, cognitive training, and vascular management

• Intervention group: mean improvement in executive functioning and processing speed

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Other risk factors

• Traumatic brain injury—solid evidence to link to increased risk of dementia

• History of depression—moderate link to increased risk of cognitive decline

• Poor sleep

• Caregiving to family members with dementia

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Take-home points

• Stop smoking

• Physical activity—even mild activity is linked to decreased risk of memory decline

• Diet—combined Mediterranean/Dash diet probably has most evidence among diets for reducing risk

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Healthy nutrition

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Summary

• MCI and dementia are 2 different stages of a disease process

• MCI is a pre-dementia stage, but does not have to progress

• Most common types of dementia in seniors—Alzheimer’s Disease, Vascular dementia, Lewy Body disease and Parkinson’s dementia

• Lifestyle changes have scientific evidence to show they do make a positive difference in people with memory disorders

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