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Changes in the Brain: Understanding the Different Types of Dementia Sarah Harlock MBA Memory Care Consultant Alzheimer’S Disease Assistance Center of WNY

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Changes in the Brain: Understanding the Different Types of Dementia Sarah Harlock MBA Memory Care Consultant Alzheimer’S Disease Assistance Center of WNY Dementia Changes in the Brain: Understanding the Different Types of Dementia Sarah Harlock MBA Memory Care Consultant Alzheimer’s Disease Assistance Center of WNY Dementia Defined Dementia by the Numbers • Great confusion on the part of the public and perhaps your registrants and • More than 5 million Americans currently have Alzheimer’s disease or a their families related dementia • Umbrella term to describe a decline in cognitive abilities • Every 67 seconds someone develops Alzheimer’s or a related dementia • Is not a diagnosis itself • One in three seniors dies with dementia • Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) came out in • Women are disproportionally affected r/t living longer than men 2013 and incorporates dementia into Major and Mild neurocognitive disorders • Numbers are changing due to reclassifications and better diagnostics • Encourage people to ask their doctor/ healthcare professional to define the • Lancet study in July 2013 showed a decline in prevalence of dementia type of dementia perhaps because of increased education and better health 1 Alzheimer’s Disease (Sporadic) Mild Cognitive Impairment • Alzheimer’s disease accounts for 70%+ of all cases of dementia • Considered Mild Neurocognitive Disorder of DSM‐5 • Begins in hippocampus, spreads to other parts of the brain, progresses in stages • Noticeable to the individual perhaps not to others • Diabetes and AD, Down’s Syndrome and AD • Is measurable on cognitive tests • Personality changes as precursor to AD 2011 Int. Journal of Geriatric Does not interfere with daily life, just requires extra effort • Psychiatry • MCI increases the risk of Alzheimer’s disease/ dementia but does not always • Self‐directed, goal‐oriented, who scored high on a measure of progress to that level of impairment conscientiousness had an 89% lower risk of developing AD. This was part of • MOCA vs. MMSE the Nun Study” of 2006. Other fascinating results. Alzheimer’s Disease Alzheimer’s Disease (Younger Onset) • Affects people under the age of 65 (40’s and 50’s) • Up to 10% of all cases of Alzheimer’s are younger onset • Two sub‐types: Common AD and Genetic AD • Significant difference in a person’s stage of life and therefore presents different challenges than sporadic AD 2 Vascular Dementia Mixed Dementia • Formerly called Multi‐infarct dementia, considered the 2nd most common form • Studies are showing and increased number of mixed dementias • Clots block blood flow to the brain depriving neurons of food and oxygen • Dementia ‐ Multifactorial • Could be the result of a single large event (stroke) or several smaller events • Although people are usually diagnosed with one type of dementia, upon Small vessel disease may be the biggest contributor to VaD • autopsy, they have found greater than 50% were mixed, making it possibly • Vascular Cognitive Impairment – expresses the range of impact the third most common form of dementia (NIA funded study) • Symptoms vary depending on the area involved and extent of the damage • AD and Vascular dementia, Dementia with Lewy Body and AD • Hypertension, heart problems, high cholesterol, diabetes Parkinson’s Disease & Dementia with Parkinson Lewy Body Continuum Lewy Body CORTICAL • Parkinson’s Disease and Dementia with Lewy Body continuum Dementia With Lewy Body • Dementia with Lewy Body considered 4th most common type of dementia • Diagnosis of DLB requires the presence of dementia and 2 of 3 core features, and/or some suggestive features Parkinson Disease Dementia • Mixed pathology is the rule vs. the exception Parkinson Disease SUBCORTICAL Courtesy of Geoff Kerchner, MD, PhD, Neurologist and Neuroscientist at Stanford's Center for Memory Disorders and Stanford University School of Medicine 3 Parkinson’s Disease and Dementia with Lewy Body Frontotemporal Disorders • Formerly called Pick’s disease • Frontotemporal disorders are a form of dementia caused by a family of brain diseases called Frontotemporal Lobar Degeneration • Classified into 3 categories of disorders defined by the earliest symptoms • May be as common as AD in the population under 65 years of age FTD Behavioral Variant FTD Language Variant • Behavioral Variant –bvFTD and Pick’s disease (not all bvFTD is Pick’s disease) • Most common form • Language Variant – Primary Progressive Aphasia, Progressive Nonfluent Aphasia, Semantic Dementia • Affects personality, behavior, judgment • PPA –changes in ability to speak, write and understand what others are Apathy, inappropriate and impulsive behavior, emotional flatness or • saying excessive emotions…Memory generally intact • Semantic PPA, Agrammatic PPA, Logopenic PPA • Often misdiagnosed as depression or another mental illness • Generally no problem with memory, reasoning, or judgment or behavior initially 4 FTD Movement Disorders Creutzfeldt‐Jakob Disease • Movement Disorder – Corticobasal Syndrome (CBS), Progressive • Prion protein, found throughout the body, begins folding into an abnormal Supranuclear Palsy (PSP), FTD –ALS three‐dimensional shape. This shape change gradually triggers prion protein • CBS and PSP are considered rare in the brain to fold into the same abnormal shape • FTD‐ALS includes behavior and/or language changes as well as the muscle • 3 Types –Sporadic, Familial, Infectious weakness, shrinking, and jerking of ALS • Initial diagnosis difficult as it looks like other mental health issues • Progresses quickly Huntington’s Disease Wernicke‐Korsakoff Syndrome • Caused by a single defective gene on chromosome 4, "dominant" meaning that anyone who inherits it from a parent with Huntington's will eventually • Thiamine (vitamin B‐1) deficiency develop the disease • Korsakoff is often preceded by Wernicke’s encephalopathy, not always • Symptoms develop between ages 30 & 50, but they can appear as early as age 2 or as late as 80 • Korsakoff syndrome is most commonly caused by alcohol misuse, but can also be associated with AIDS, chronic infections, poor nutrition and certain • Hallmark symptom is uncontrolled movement of the arms, legs, head, face other conditions and upper body, also causes a decline in thinking and reasoning skills, including memory, concentration, judgment and ability to plan and organize • Korsakoff syndrome causes problems learning new information, inability to • Huntington's disease brain changes lead to alterations in mood, especially remember recent events and long‐term memory gaps. Memory problems depression, anxiety, and uncharacteristic anger and irritability may be strikingly severe while other thinking and social skills are relatively unaffected 5 Other Diseases Causing Dementia In the Adult Day Health Care Center • Normal Pressure Hydrocephalus • Knowing the characteristics of these forms of dementia can help you make • PCA –Visual Variant of Alzheimer’s disease…or not these people successful in their day programs • Binswanger’s Disease • Can help guide your person‐centered approach • Multiple Sclerosis • Can help you help your registrant’s, their families and care partners • HIV • Thank you for all that you do! 6 Changes in the Brain: Understanding Different Types of Dementia Resources Organizations Alzheimer's Disease Education and Referral Center Alzheimer's Association (ADEAR) 225 North Michigan Avenue National Institute on Aging Floor 17 P.O. Box 8250 Chicago, IL 60601-7633 Silver Spring, MD 20907-8250 [email protected] [email protected] http://www.alz.org http://www.nia.nih.gov/alzheimers Tel: 312-335-8700 1-800-272-3900 (24-hour helpline) TDD: Tel: 1-800-438-4380 312-335-5886 Fax: 301-495-3334 Fax: 866.699.1246 Alzheimer's Foundation of America Alzheimer’s Drug Discovery Foundation 322 Eighth Avenue 57 West 57th Street 7th Floor Suite 904 New York, NY 10001 New York, NY 10019 [email protected] [email protected] http://www.alzfdn.org http://www.alzdiscovery.org Tel: 866-AFA-8484 (232-8484) Tel: 212-901-8000 Fax: 646-638-1546 Fax: 212-901-8010 Association for Frontotemporal Degeneration BrightFocus Foundation (AFTD) 22512 Gateway Center Drive Radnor Station Building #2 Suite 320 Clarksburg, MD 20871 290 King of Prussia Road [email protected] Radnor, PA 19087 http://www.brightfocus.org/alzheimers/ [email protected] Tel: 1- 800-437-2423 http://www.theaftd.org Fax: 301-258-9454 Tel: 267-514-7221 866-507-7222 John Douglas French Alzheimer's Foundation Lewy Body Dementia Association 11620 Wilshire Blvd. 912 Killian Hill Road, S.W. Suite 270 Lilburn, GA 30047 Los Angeles, CA 90025 [email protected] http://www.jdfaf.org http://www.lbda.org Tel: 310-445-4650 Tel: Telephone: 404-935-6444 LBD Caregiver Link: 800-539- Fax: 310-479-0516 9767 Fax: 480-422-5434 National Institute of Mental Health (NIMH) National Organization for Rare Disorders (NORD) National Institutes of Health, DHHS 55 Kenosia Avenue 6001 Executive Blvd. Rm. 8184, MSC 9663 Danbury, CT 06810 Bethesda, MD 20892-9663 [email protected] [email protected] http://www.rarediseases.org http://www.nimh.nih.gov Tel: 203-744-0100 Voice Mail 800-999-NORD (6673) Tel: 301-443-4513/866-415-8051 301-443-8431 (TTY) Fax: 203-798-2291 Fax: 301-443-4279 Changes in the Brain: Understanding Different Types of Dementia Resources Related NINDS Publications and Information The Dementias: Hope Through Research Information booklet about Alzheimer's disease, vascular dementia, and other types of dementia compiled by the National Institute of Neurological Disorders and Stroke (NINDS). NINDS Alzheimer's Disease Information Page Alzheimer's Disease (AD) information sheet compiled by the National Institute of Neurological Disorders
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