Joyce Cheng RN Community Health Nurse November 16, 2016  Dementia- an umbrella term used to describe a set of symptoms, including impairment in memory, reasoning, judgment, language and other thinking skills  Normal age-related memory loss doesn’t prevent you from living a full and productive life. These changes in memory are generally manageable and do not disrupt your ability to work, live independently or maintain a social life  Alzheimer’s disease  Vascular dementia (multi-infarct dementia)  Frontotemporal dementia  Lewy body dementia • Alzheimer's is the most common form of dementia, accounts for 60 to 80 percent of dementia cases. • Alzheimer's is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer's are 65 and older • Alzheimer's worsens over time. Alzheimer's is the sixth leading cause of death in the United States. • Alzheimer's has no current cure, but treatments for symptoms are available and research continues.  Asking the same questions repeatedly  Forgetting common words when speaking  Mixing words up  Taking longer to complete familiar tasks  Misplacing items in inappropriate places  Getting lost while walking or driving around a familiar neighborhood  Undergoing sudden changes in mood or behavior for no apparent reason  Becoming less able to follow directions  Vascular cognitive impairment-  Sleep deficiency-  Medications  Nutritional Deficiency  Stress, Anxiety, and Depression  Caused by reduced blood flow to the brain or blockage. Reduced blood flow lead to depriving of oxygen and essential nutrients.  Hypertension  High Cholesterol  Stroke- forgetfulness may be an early warning sign of stroke

 Sleep Apnea- wake up with a headache, daytime fatigue, snoring.  Insomnia  Deep sleep (REM rapid eye movement) plays an important role in memory  Sleep Stages Non-REM Sleep-  Stage 1- 5-10 minutes  Stage 2- light sleep, lower heart rate & body temp  Stage 3 &4- body repair, regrow tissue, build bone/ muscle, strengthen immune system Stage 5 REM Sleep- Increase Heart Rate & breathing, intense dreams, brain active, learning, thinking organizing into storing memories, balance mood,  Several types of drugs can affect memory(FDA)  Sleeping pills  Antihistamines  Anti-anxiety medications  Antidepressants  Certain Pain killers  Cholesterol-lowering medication- statins  Diabetes medication-metformin  Lack of Vitamin B12- can lead to confusion and dementia  Food contains Vitamin B12- dairy products, meat, and fish or Vitamin B12 fortified cereals  Significant stress or anxiety can lead to problems with attention and memory  Especially true if combined with poor sleep  Untreated chronic stress can lead to depression which could affect brain function. (Journal of Pharmacy & Bioallied Sciences)  Infection- Syphilis  Head injury- concussion  Brain Tumors and its treatments  Alcoholism, substance Abuse- A study found that men who drank heavily showed signs of mental decline one to six years earlier than light drinkers  Talk to your Primary doctor, to get a timely diagnosis and appropriate care  Adopt ways to cope memory loss  Treatment for memory loss depends on the cause. In many cases, it may be reversible with treatment. In others, memory may improve over time.  Treatments may also be specific to conditions related to memory loss. For example, drugs are available to treat memory problems related to Alzheimer’s disease

Symptoms:  Confusion  Trouble paying attention and concentrating  Reduced ability to organize thoughts or actions  Decline in ability to analyze a situation, develop an effective plan and communicate that plan to others  Difficulty deciding what to do next  Problems with memory  Restlessness and agitation  Unsteady gait  Sudden or frequent urge to urinate or inability to control passing urine  Depression

 Alzheimer's is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.  Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer's disease accounts for 60 to 80 percent of dementia cases.  Alzheimer's is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer's are 65 and older. But Alzheimer's is not just a disease of old age. Up to 5 percent of people with the disease have early onset Alzheimer's (also known as younger-onset), which often appears when someone is in their 40s or 50s.  Alzheimer's worsens over time. Alzheimer's is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer's, individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer's is the sixth leading cause of death in the United States. Those with Alzheimer's live an average of eight years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions.  Alzheimer's has no current cure, but treatments for symptoms are available and research continues. Although current Alzheimer's treatments cannot stop Alzheimer's from progressing, they can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer's and their caregivers. Today, there is a worldwide effort under way to find better ways to treat the disease, delay its onset, and prevent it from developing. Overview of disease progression The symptoms of Alzheimer's disease worsen over time, although the rate at which the disease progresses varies. On average, a person with Alzheimer's lives four to eight years after diagnosis, but can live as long as 20 years, depending on other factors.  Changes in the brain related to Alzheimer's begin years before any signs of the disease. This time period, which can last for years, is referred to as preclinical Alzheimer's disease. Three different categories: May overlap  Mild Alzheimer's disease (early-stage) In the early stages of Alzheimer's, a person may function independently. He or she may still drive, work and be part of social activities. Despite this, the person may feel as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects.  Friends, family or neighbors begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Common difficulties include:  Problems coming up with the right word or name  Trouble remembering names when introduced to new people  Having greater difficulty performing tasks in social or work settings  Forgetting material that one has just read  Losing or misplacing a valuable object  Increasing trouble with planning or organizing

 Moderate Alzheimer's disease (middle-stage) is typically the longest stage and can last for many years. As the disease progresses, the person with Alzheimer's will require a greater level of care. You may notice the person with Alzheimer's confusing words, getting frustrated or angry, or acting in unexpected ways, such as refusing to bathe. Damage to nerve cells in the brain can make it difficult to express thoughts and perform routine tasks. At this point, symptoms will be noticeable to others and may include:  Forgetfulness of events or about one's own personal history  Feeling moody or withdrawn, especially in socially or mentally challenging situations  Being unable to recall their own address or telephone number or the high school or college from which they graduated  Confusion about where they are or what day it is  The need for help choosing proper clothing for the season or the occasion  Trouble controlling bladder and bowels in some individuals  Changes in sleep patterns, such as sleeping during the day and becoming restless at night  An increased risk of wandering and becoming lost  Personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior like hand-wringing or tissue shredding  Severe Alzheimer's disease (late-stage) In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases, but communicating pain becomes difficult. As memory and cognitive skills continue to worsen, personality changes may take place and individuals need extensive help with daily activities.  Require full-time, around-the-clock assistance with daily personal care  Lose awareness of recent experiences as well as of their surroundings  Require high levels of assistance with daily activities and personal care  Experience changes in physical abilities, including the ability to walk, sit and, eventually, swallow  Have increasing difficulty communicating  Become vulnerable to infections, especially pneumonia

This type of dementia resembles Alzheimer's disease in that it also involves a progressive degeneration of brain cells that is irreversible. With this form of dementia, a person may have symptoms such as sudden onset of memory loss, behavior changes, or difficulties with speech and movement.  Changes in behavior may include becoming either withdrawn or disinhibited (e.g., losing the ability to restrain one's behavior and actions). The person may lose interest in personal hygiene, become easily distracted or repeat the same action over and over again. Overeating or compulsively putting objects in the mouth may occur. Sometimes incontinence is an early symptom of the disease. Other possible changes in behavior include  Inappropriate social behavior, e.g. they may say inappropriate things or come across as rude or tactless  Distractibility  Loss of insight into the behaviors of oneself and others (making it seem as if they don’t care)  Changes in food preferences  Blunted emotions  Decreased energy and motivation  Changes in personality, e.g. more outgoing people may become quieter and quiet people may become more extroverted  Problems with speech (language) can range from speaking less to total loss of speech, i.e. becoming mute. They may have difficulty finding the right words and may use circumlocution, i.e., talking around the words or describing what they mean. Echoing what has been said by others and stuttering are common symptoms. The person may have difficulty sustaining a train of thought or maintaining a conversation for any length of time. Writing and reading are also affected. In the early stage of frontotemporal dementia, behaviour changes or problems with speech (language) can appear separately. As the disease progresses, these two areas will overlap. Unlike Alzheimer's disease, a person with frontotemporal dementia often remains oriented to time and memory is not a problem in the early stages. In the later stages of the disease, general symptoms of dementia arise, i.e. confusion and forgetfulness. Motor skills are lost and swallowing difficulties occur.

Lewy body dementias (LBD) are the second most common form of degenerative dementia.  The only other form of degenerative dementia that is more common than LBD is Alzheimer’s disease (AD). LBD is an umbrella term for dementia associated with the presence of Lewy bodies (abnormal deposits of a protein called alpha-synuclein) in the brain.

 Three common presentations:  Some individuals will start out with a movement disorder leading to the diagnosis of Parkinson's disease and later develop dementia. This is diagnosed as Parkinson’s disease dementia.  Another group of individuals will start out with a cognitive/memory disorder that may be mistaken for AD, but over time two or more distinctive features become apparent leading to the diagnosis of ‘dementia with Lewy bodies’ (DLB).  Lastly, a small group will first present with neuropsychiatric symptoms, which can include hallucinations, behavioral problems, and difficulty with complex mental activities, also leading to an initial diagnosis of DLB. Regardless of the initial symptom, over time all three presentations of LBD will develop very similar cognitive, physical, sleep and behavioral features.  Common symptoms:  Impaired thinking, such as loss of executive function (planning, processing information), memory, or the ability to understand visual information.  Fluctuations in cognition, attention or alertness;  Problems with movement including tremors, stiffness, slowness and difficulty walking  Visual hallucinations (seeing things that are not present)  Sleep disorders, such as acting out one’s dreams while asleep  Behavioral and mood symptoms, including depression, apathy, anxiety, agitation, delusions or paranoia  Changes in autonomic body functions, such as blood pressure control, temperature regulation, and bladder and bowel function.

Microscopic image of a Lewy body (alpha-synuclein protein). Courtesy of Carol F. Lippa, MD, Drexel U. College of Medicine