Transcript PMA 2020 Alzheimer’s Disease Curricula

ACT on Alzheimer’s
Disease Curriculum
Module I: Disease Description
Disease Description
• These slides are based on the Module I:
Disease Description text
• Please refer to the text for all citations,
references and acknowledgments
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Module I: Learning Objectives
Upon completion of this module the student should:
•Gain understanding of normal aging and cognitive
functioning.
•List potential causes of dementia and memory loss.
•Identify the impact that Alzheimer’s disease and other
dementias have on the human brain and functioning.
•Demonstrate knowledge of Alzheimer’s disease
including: stages and categories, symptoms, diagnosis,
risk factors, and disease duration.
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Normal Aging
Normal Aging
• Intelligence remains intact
• Principal changes in “normal” aging:
1. General slowing of cognitive performance
2. Decrease in mental flexibility
• Solving new problems with old solutions
3. Mild word-finding difficulties
• Names of places, objects, people
4. Mild decrease in working memory
• Manipulating information mentally (working a math
problem in your head)
• “Senior moments”
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Normal Aging
• Independence in daily activities preserved
• Complains about memory but provides considerable
detail re: instances of forgetfulness
• Patient often more concerned than close family
• Recent memory intact for important events
• Normal performance on mental status exam
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Description of Dementia
What is Dementia?
A chronic and persistent disorder caused by a
brain disease or injury that produces a decline
in memory and intellect from some previously
higher level of functioning severe enough to
interfere with everyday life.
Dementia is NOT normal aging
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Dementia
Brain tumor
Pick’s disease
Vascular dementia
Lewy Body Disease
Alzheimer’s Disease
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Causes of Dementia
• According to Adams (2002), the causes of
dementia in people 71 years and older are:
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Alzheimer’s Disease
• Alzheimer’s disease is the most common form
of dementia, accounting for 60-80% of all
cases
• Symptoms of Alzheimer’s disease include:
– Early stage symptoms may include difficulty
remembering names and recent events
– Mid-stage symptoms may include deficits that
impact language and visuospatial function
– Later stages include impaired judgment, confusion
and difficulty walking, talking and swallowing
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Vascular Dementia
• Vascular dementia (VD) was previously known
as multi-infarct or post-stroke dementia
• VD is rarely the primary cause of dementia (510% of all cases)
• VD frequently overlaps with Alzheimer’s
disease
• Clinical manifestations can be divided into
cortical and subcortical syndromes
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Vascular Dementia
• For cortical syndromes, the presenting
symptoms vary to the original stroke location
• For subcortical syndromes, presenting
symptoms include focal motor signs, gait
disturbance, and personality changes, and
cognitive changes including mild memory
deficit
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Other Forms of Dementia
• While Alzheimer’s disease and Vascular
Dementia account for the vast majority of
dementia cases, there are other forms of
dementia:
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Lewy Body dementia
Mixed dementia
Parkinson’s disease
Frontotemporal lobar dementia
Creutzfeldt-Jakob disease
Normal pressure Hydrocephalus
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Memory Loss
• In addition to dementia, memory loss can
result from a variety of conditions:
– Vascular (stroke, hypoxic injury after cardiac
arrest)
– Infectious diseases (Herpes simplex, HIV)
– Toxic (alcoholism, medication overdose)
– Autoimmune
– Metabolic (B12 deficiency, electrolyte imbalance)
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Memory Loss
• Other non-dementia conditions that may
cause memory loss:
– Neoplastic (brain tumor)
– Traumatic (traumatic brain injury)
– Endocrine (Hypothyroidism)
– Episodic (seizure, migraine)
– Neurodegenerative (Huntington’s Disease)
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Neuroanatomy of Memory Loss
• Memory is divided into the following memory
systems:
– Episodic memory: remember last minutes to
years, this type of memory is most commonly
impacted by Alzheimer’s disease
– Working memory: type of memory lasting
seconds, impacted by vascular dementia
– Semantic memory: consists of factual information
– Procedural memory: driving a car or riding a bike
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Alzheimer’s Disease
Alzheimer’s Disease Is:
• A progressive, degenerative, neurological disease of
the brain
• A steady decline in memory and cognitive functioning
severe enough to interfere with everyday life
• Related to specific chemical and structural changes in
the brain
• NOT reversible
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What does Alzheimer’s Look Like?
• Neurofibrillary tangles
• Amyloid plaques
• Decrease in chemicals that
facilitate memory
• Cell death
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Impact of Alzheimer’s on Brain
Size
Image appears courtesy of Dr.
Richard E. Powers, Director of the
Alabama Bureau of Geriatric
Psychiatry, alzbrain.org
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Symptoms of Alzheimer’s Disease
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Memory loss that disrupts daily life
Challenges in planning or solving problems
Difficulty completing familiar tasks
Confusion with time or place
Trouble understanding visual images or spatial
relationships
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Symptoms of Alzheimer’s Disease
• New problems with words in speaking or
writing
• Misplacing things or losing the ability to
retrace steps
• Decreased or poor judgment
• Withdrawal from work or social activities
• Changes in mood and personality
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Categories of Alzheimer’s Disease
• The severity of Alzheimer’s disease can be
broken down into three categories:
– Mild cognitive decline
– Moderate cognitive decline
– Severe cognitive decline
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Categories of Alzheimer’s Disease
• Mild cognitive decline includes three stages:
– Stage 1: no impairment, normal function
– Stage 2: very mild cognitive decline, occasional
memory lapses; may be normal aging or the
earliest signs of Alzheimer’s disease
– Stage 3: mild cognitive decline, early-stage
Alzheimer’s may be diagnosed at this stage;
family and friends may begin to notice changes
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Categories of Alzheimer’s Disease
• Moderate cognitive decline includes two
stages:
– Stage 4: moderate cognitive decline (mild or
early-stage Alzheimer’s disease); careful medical
interview should discover clear-cut symptoms
– Stage 5: moderately severe cognitive decline
(moderate or mid-stage Alzheimer’s disease);
individuals begin to need help with day-to-day
activities
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Categories of Alzheimer’s Disease
• Severe cognitive decline includes two stages:
– Stage 6: Severe cognitive decline (moderatelysevere or mid-stage Alzheimer’s disease),
memory loss worsens, changes in personality and
individuals may need help with daily activities
– Stage 7: Very severe cognitive decline (severe or
late-stage Alzheimer’s disease), individuals lose
the ability to respond to their environment and
need help with much of daily personal care
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Diagnosis of Alzheimer’s Disease
• Diagnosis of Alzheimer’s disease is commonly
made by an individual’s primary care
physician or neurologist. Steps in the
diagnosis process include:
– Getting a family and medical history
– Family members provide input
– Conducts cognitive test and physical and
neurologic exams
– May include MRI or CT scans to detect changes in
the brain
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A Modern Diagnosis of
Alzheimer’s
• In 2011, the National Institute on Aging (NIA)
recommended new diagnostic criteria and
guidelines for Alzheimer’s disease
• The new criteria and guidelines update, refine
and broaden the guidelines published in 1984
• Three new stages of Alzheimer’s disease were
proposed in 2011 to replace the prior stages
that were developed in 1984
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Three Stages of Alzheimer’s
• Preclinical Alzheimer’s disease
• Mild Cognitive Impairment (MCI) due to
Alzheimer’s disease
• Dementia due to Alzheimer’s disease
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Preclinical Alzheimer’s Disease
• Measurable changes in the brain that indicate
signs of disease, but no development of
symptoms
• Alzheimer’s disease changes in the brain 20
years before symptoms occur
• Additional biomarker research is needed
before this stage of Alzheimer’s disease can
be diagnosed
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MCI due to Alzheimer’s disease
• Individuals with MCI have mild but
measurable changes in thinking abilities
• 10-20% of people over 65 years of age have
MCI
• We do not know why some people with MCI
develop dementia and others do not
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Dementia due to Alzheimer’s Disease
• This stage encompasses all stages of
Alzheimer’s disease as they are listed in the
previous stage descriptions from mild / early
stage to severe / late-stage
• This stage is characterized by memory,
thinking and behavioral symptoms that impair
a person’s ability to function in daily life
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Causes of Alzheimer’s Disease
• The cause or causes of Alzheimer’s disease are
not yet known
• Experts believe that Alzheimer’s develops as a
result of multiple factors, rather than a single
cause
• These factors include a variety of changes in the
brain
– Accumulation of the protein-amyloid outside neurons
– Accumulation of the protein tau inside neurons
• Genetic mutation is a known cause of
Alzheimer’s disease
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Risk factors for Alzheimer’s
• Most people with Alzheimer’s are over the
age of 65. In addition to advancing age, other
risk factors include:
– Family history
– Apolipoprotein E-ε4 (APOE-ε4)
– Mild Cognitive Impairment (MCI)
– Cardiovascular disease risk factors
– Social engagement and diet
– Head trauma and traumatic brain injury (TBI)
– Lack of education
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Alzheimer’s Disease Duration
• Studies indicate that people age 65 and older with
Alzheimer’s disease survive a median of three to
eight years after a diagnosis, yet some live as long as
20 years
• On average a person with Alzheimer’s will spend
more years (40% of the total number of years with
Alzheimer’s) in the most severe stage of the disease
than in any other stage
• Alzheimer’s disease is the sixth leading cause of
death in the United States
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