What is Alzheimer’s What is Alzheimer’s Disease?Disease?

Alzheimer’s disease is a progressive Alzheimer’s disease is a progressive brain disorder that gradually brain disorder that gradually destroys a person’s memory and destroys a person’s memory and ability to learn, reason, make ability to learn, reason, make judgments, communicate and carry judgments, communicate and carry out daily activities.out daily activities.

Statistics on Alzheimer’s DiseaseStatistics on Alzheimer’s Disease

• More than 5 million people in the United States are affected with the disease.

• Worldwide it is estimated that 22 million people suffer from the disease.

• The prevalence of the disease doubles every five years beyond the age of 65.

• By the year 2040, 14 million people in the Unites States are expected to have Alzheimer’s Disease.

• Research suggests that the risk may be higher in African Americans and Hispanic Americans than for Caucasians.

• Incidence of the disease is higher in women than men• People with AD live an average of 8 to 10 years after the

diagnosis.

• The disease can last up to 20 years.• AD is the fourth leading cause of death in the United

States killing more than 100,000 people annually.• Alzheimer’s care is estimated to cost the United States

more than $100 billion a year• More than 7 out of 10 people with Alzheimer’s Disease

live where almost 75 Percent of the care is done by family members

• The average cost of a nursing home is $42,000 to $70,000 per year

• The average lifetime cost of care for an individual with AD is $174,000.

Statistics on Alzheimer’s Disease continued

Statistics on Alzheimer’s Disease continued

History of the diseaseHistory of the disease

First discovered in 1906 by a German Neurologist, First discovered in 1906 by a German Neurologist, Dr. Alois Alzheimer.Dr. Alois Alzheimer.

Subject was a 51 year old woman who exhibited problems with Subject was a 51 year old woman who exhibited problems with memory and disorientation.memory and disorientation.

The woman died at the age of 55 in a mental institution. An The woman died at the age of 55 in a mental institution. An autopsy revealed that the brain had cortical atrophy and autopsy revealed that the brain had cortical atrophy and abnormalities in the cerebral cortex called abnormalities in the cerebral cortex called NEUOFIBRILLARY TANGLESNEUOFIBRILLARY TANGLES and and NEURITIC NEURITIC PLAQUESPLAQUES..

Causes of the diseaseCauses of the disease

Numerous theories have been developed about the underlying causes of AD such as environmental toxins, genetics, and viruses have all been suspected.

No single cause for Alzheimer’s Disease has been identified

Numerous theories have been developed about the underlying causes of AD such as environmental toxins, genetics, and viruses have all been suspected.

No single cause for Alzheimer’s Disease has been identified

Definite risk factors for Alzheimer’s Disease.

Definite risk factors for Alzheimer’s Disease.

Advanced age Family History of AD Genetics Down’s Syndrome History of head trauma Low educational and occupational

status

Advanced age Family History of AD Genetics Down’s Syndrome History of head trauma Low educational and occupational

status

Possible risk factors for Possible risk factors for Alzheimer’s DiseaseAlzheimer’s Disease

Female genderFemale gender Small strokes of cerebral vascular Small strokes of cerebral vascular

diseasedisease Parkinson’s DiseaseParkinson’s Disease Race and EthnicityRace and Ethnicity Environmental ToxinsEnvironmental Toxins DietDiet Lack of exerciseLack of exercise StressStress Depression before onset of ADDepression before onset of AD

Theories of Alzheimer’s Theories of Alzheimer’s DiseaseDisease

• The Genetic TheoryThe Genetic Theory• Familial Alzheimer’s linked to Familial Alzheimer’s linked to

Chromosome 21Chromosome 21• APP GeneAPP Gene• ApoE GenesApoE Genes• The Viral TheoryThe Viral Theory• The Immune System TheoryThe Immune System Theory• The Aluminum TheoryThe Aluminum Theory

The Need for an Accurate DiagnosisComponents of diagnostic testing

COMMONLY USED SOMETIMES USED

History and Physical Psychological Tests

Neurological Exam Spinal Tap

Cognitive screening exam Brain scan

Blood Tests PET SPECT

Brain scan(CT MRI ) HIV blood test

Reasons for obtaining a Reasons for obtaining a DiagnosisDiagnosis

Rule out reversible forms of dementiaRule out reversible forms of dementia To provide a context and explanation for symptomsTo provide a context and explanation for symptoms To obtain appropriate medical treatmentTo obtain appropriate medical treatment To let you decide whether or not to enroll in research To let you decide whether or not to enroll in research

studiesstudies To help family understand changing roles and To help family understand changing roles and

responsibilitiesresponsibilities To ease communication for all concernedTo ease communication for all concerned To plan for the futureTo plan for the future

The Mini Mental ExamThe Mini Mental Exam

The most commonly used test for memory The most commonly used test for memory problems, not just a test for ADproblems, not just a test for AD

Developed in l970 by Dr. Marshall FolsteinDeveloped in l970 by Dr. Marshall Folstein

The test screens the presence of cognitive The test screens the presence of cognitive impairment over a number of areasimpairment over a number of areas

Cognition is defined as mental activity such as Cognition is defined as mental activity such as memory, thinking, attention, reasoning, decision memory, thinking, attention, reasoning, decision making and dealing with conceptsmaking and dealing with concepts

Based on a series of questions and tests, points Based on a series of questions and tests, points are achieved on MMSE when answered correctly. are achieved on MMSE when answered correctly. Maximum of 30. Scores 26 or less reported with Maximum of 30. Scores 26 or less reported with people with ADpeople with AD

Areas Tested by MMSEAreas Tested by MMSE

OrientationOrientation MemoryMemory Attention and CalculationAttention and Calculation Language,Writing and Language,Writing and

DrawingDrawing

OrientationOrientation

What is the day of the week?What is the day of the week?

What year was last year?What year was last year?

What building are we in?What building are we in?

Ten points can be scored for Ten points can be scored for answering questions about date answering questions about date and locationand location

MemoryMemory

This tests recall. This tests recall.

Immediate memory scores 3 points. Immediate memory scores 3 points. (One point for each of the three (One point for each of the three objects: pen, ball, ring.) objects: pen, ball, ring.)

People are asked to remember each People are asked to remember each one and will be asked later in the testone and will be asked later in the test

Attention and CalculationAttention and Calculation

Tests the ability to concentrate.Tests the ability to concentrate.

One test, scoring a maximum of 5 points, One test, scoring a maximum of 5 points, requires the person to subtract 7 from requires the person to subtract 7 from 100 and continue.100 and continue.

The person may also be asked to spell a The person may also be asked to spell a 5 letter word backwards.5 letter word backwards.

The best of the two scores is included in The best of the two scores is included in the final scorethe final score

Language, Writing and Language, Writing and DrawingDrawing The final 9 points of the MMSE test spoken and The final 9 points of the MMSE test spoken and

written language, the ability to write, copy, and written language, the ability to write, copy, and remember named objectsremember named objects

This includes naming objects, e.g. a brush and a This includes naming objects, e.g. a brush and a pen. One point for each correct answerpen. One point for each correct answer

Carry out a three step process- 3 pointsCarry out a three step process- 3 points

Repeat a sentence- 1 pointRepeat a sentence- 1 point

Copy a figure of shape- 1 pointCopy a figure of shape- 1 point

Write a sentence on a piece of paper- I pointWrite a sentence on a piece of paper- I point

Scoring the MMSEScoring the MMSE

Score results of the MMSE are used in the Score results of the MMSE are used in the diagnosis of ADdiagnosis of AD

The scores indicate the areas of difficulty in a The scores indicate the areas of difficulty in a person presenting with cognitive problems person presenting with cognitive problems such as memory, thinking, attention, such as memory, thinking, attention, reasoning, decision making and dealing with reasoning, decision making and dealing with conceptsconcepts

Scores Indicating DementiaScores Indicating Dementia

27 and above are considered normal27 and above are considered normal

23 to 26 indicate a borderline condition23 to 26 indicate a borderline condition

22 and below are abnormal22 and below are abnormal

Scoring and people with Alzheimer’s Scoring and people with Alzheimer’s DiseaseDisease

20 to 2620 to 26 Mild Alzheimer’s Disease Mild Alzheimer’s Disease

10 to 1910 to 19 Moderate AD Moderate AD

Below 10Below 10 Severe ADSevere AD

Limitations of the MMSELimitations of the MMSE

Education levelsEducation levels

The MMSE cannot take into account very well The MMSE cannot take into account very well educated people who have mild dementia. They educated people who have mild dementia. They may score well within normal range because they may score well within normal range because they find the questions easy.find the questions easy.

Poorly educated people may score badly because Poorly educated people may score badly because they find the questions difficult. Their scoring may they find the questions difficult. Their scoring may indicate dementia when none is presentindicate dementia when none is present

Ten warning signs of Alzheimer’s Disease1. MEMORY LOSS

2. DIFFICULTY PERFORMING FAMILIAR TASKS

3. PROBLEMS WITH LANGUAGE

4. DISORIENTATION TO TIME AND PLACE

5. POOR OR DECREASED JUDGEMENT

6. PROBLEMS WITH ABSTRACT THINKING

7. MISPLACING THINGS

8. CHANGES IN MOOD OR BEHAVIOR

9. CHANGES IN PERSONALITY

10. LOSS OF INITIATIVE

What’s the Difference?

• AD symptoms • Normal age related Memory changes

Forgets entire experiences Forgets part of an experience

Rarely remembers later Often remembers later

Gradually unable to follow written/spoken directions

Usually able to follow written/spoken directions

Gradually unable to use notes as reminders

Usually able to use notes as reminders

Gradually unable to care for self Usually able to care for self

STAGES OF ALZHEIMER’S STAGES OF ALZHEIMER’S DISEASEDISEASE

STAGE 1STAGE 1 No ImpairmentNo Impairment

STAGE 2STAGE 2 Very Mild DeclineVery Mild Decline

STAGE 3STAGE 3 Mild DeclineMild Decline

STAGE 4STAGE 4 Moderate Decline = Early Stage ADModerate Decline = Early Stage AD

STAGE 5STAGE 5 Moderately Severe Decline = Mid Stage ADModerately Severe Decline = Mid Stage AD

STAGE 6STAGE 6 Severe Decline Moderate = Severe or Mid Stage Severe Decline Moderate = Severe or Mid Stage ADAD

STAGE 7STAGE 7 Very Severe Decline = Late stage AD Very Severe Decline = Late stage AD

Treatment and Prevention of AD

• Cholinesterase inhibitors

• Anti-inflammatory drugs

• Estrogen Replacement Therapy

• Antioxidants

• Complementary and alternative medicine

• The “ use it or lose it “ approach

• A vaccine

Medical legal considerations in Medical legal considerations in a patient with ADa patient with AD

Power of AttorneyPower of Attorney

Health Care ProxyHealth Care Proxy

GuardianshipGuardianship

Family dynamics in dealing Family dynamics in dealing with an AD patientwith an AD patient• Decision makingDecision making

• SafetySafety

• Maintaining good healthMaintaining good health

• MedicationsMedications

• NutritionNutrition

• Financial well beingFinancial well being

• Alternative living situationsAlternative living situations

• Choosing physicians and other professionalsChoosing physicians and other professionals

• Exploring community resourcesExploring community resources