AGEING, MEMORY LOSS AND ALZHEIMERS DISEASE - PowerPoint PPT Presentation

Loading...

PPT – AGEING, MEMORY LOSS AND ALZHEIMERS DISEASE PowerPoint presentation | free to download - id: b3612-YjZiM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

AGEING, MEMORY LOSS AND ALZHEIMERS DISEASE

Description:

AGEING, MEMORY LOSS AND ALZHEIMER'S DISEASE? Dr JANE HECKER ... health (chronic pain, exercise, diet, alcohol,) attitudes(anxiety, poor self-confidence) ... – PowerPoint PPT presentation

Number of Views:548
Avg rating:3.0/5.0
Slides: 32
Provided by: janeh8
Learn more at: http://w3.unisa.edu.au
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: AGEING, MEMORY LOSS AND ALZHEIMERS DISEASE


1
AGEING, MEMORY LOSS AND ALZHEIMERS DISEASE?
  • Dr JANE HECKER
  • Dept Internal Medicine, Royal Adelaide Hospital
  • College Grove Hospital

2
(No Transcript)
3
MEMORY
  • Age
  • health (chronic pain, exercise, diet, alcohol,)
  • attitudes(anxiety, poor self-confidence)
  • lifestyle (participation in cognitive activities)
  • lifestyle (stress, workload, fatigue,
    relationship problems)

4
DIFFERENTIAL DIAGNOSISDEMENTIA
  • Depression
  • Delirium
  • Drugs
  • Decline in memory

5
DEMENTIA
  • Alzheimers disease 60
  • Vascular dementia 20
  • Dementia with Lewy bodies 10-15
  • Fronto-temporal dementia 10
  • Dementia associated with other neurological
    conditions e.g. Parkinsons disease
  • Mixed dementia

6
Prevalence of Alzheimers disease
50
30
16
8
4
2
1
Kurz A. Eur J Neurol 1998 5(Suppl 4) S1-8 Wimo
A et al. Int J Geriatr Psychiatry 1997 12 841-56
7
Advantages of an early diagnosis of AD
  • Enables early treatment - cognitive enhancers
  • Future planning for patient and caregiver
  • Early provision of community support and
    healthcare resources can decrease stress
  • May provide cost savings and delay
    institutionalisation

Ref Doraiswamy et al, 1998.
8
HISTORICAL POINTERS
  • Forgetting recent events despite prompting
  • Failure to attend appointments
  • Frequent repetition of statements, stories or
    questions
  • Frequent lost or misplaced items
  • Losing track in conversation, word-finding
    difficulty
  • Difficulty understanding conversation or
    following the story in a book or on TV
  • Confusion with time eg. day, date, time of day
  • Becoming lost, unable to find the way

9
HISTORICAL POINTERS
  • Difficulty handling money or paying bills
  • Difficulty working gadgets, planning or preparing
    meals, performing handyman tasks
  • Neglect of personal care, home maintenance or
    nutrition
  • Withdrawal from previous community and social
    activities (poor work performance if employed)
  • Difficulty coping with new events or change to
    routine
  • Personality and behaviour change

10
Clinical features of AD
  • Loss of cognition
  • short-term memory
  • language
  • visuospatial functions
  • Loss of daily function
  • instrumental activities of daily living (ADL)
  • self-maintenance skills
  • Behaviour and personality change

11
(No Transcript)
12
AD a progressive CNS disorderwith a
characteristic pathology
Brainatrophy
Senileplaques
Neurofibrillary tangles
Katzman, 1986 Cummings and Khachaturian, 1996
13
Natural history of Alzheimers disease
Severe
Early diagnosis
Mild-to-moderate
30
Symptoms
25
Diagnosis
20
Mini-Mental State Examination (MMSE)
Loss of functional independence
15
Behavioural problems
10
Nursing home placement
5
Death
0
1 2 3 4 5 6 7 8 9
Time (years)
Feldman and Gracon. The Natural History of
Alzheimers Disease. London Martin Dunitz, 1996
14
Cholinergic Deficit underlies clinical symptoms
  • Cholinergic deficit
  • progressive loss of cholinergic neurones
  • progressive decrease in available ACh
  • impairment in ADL, behaviour and cognition

Bartus et al., 1982 Cummings and Back, 1998,
Perry et al., 1978
15
Treating Alzheimers Disease
16
Central Cholinergic Synapse
Acetyl CoA Choline
Post synaptic
17
Cholinesterase inhibitors a rational
therapeutic approach in AD
Weinstock, 1999
18
CHOLINESTERASE INHIBITORS-Second Generation
  • Donepezil (Aricept)
  • Rivastigmine (Exelon)
  • Galantamine (Reminyl)

19
A.D. CLINICAL TRIALS
  • 9204 patients in 21 clinical trials ? modest
    benefit in mild-mod AD
  • Donepezil - 8 trials, 2664 patients
  • Rivastigmine - 7 trials, 3370 patients
  • Galantamine - 6 trials, 3170 patients

20
ABC the key symptom domainsaffected in AD
Activities of daily living
Behaviour
Cognition
21
AAN Guidelines CONCLUSIONS
  • Significant treatment effects have been
    demonstrated with several different
    cholinesterase inhibitors (tacrine, donepezil,
    rivastigmine, galantamine) indicating that the
    class of agents is consistently better than
    placebo. The disease eventually continues to
    progress despite treatment and the average
    effect size is modest. Global changes in
    cognition, behaviour, and functioning have been
    detected by both physicians and caregivers,
    indicating that even small measurable differences
    may be clinically significant.

22
Mean change in daily time spent by caregiver
assisting with ADL at 6 months GAL-INT-1

Galantamine 24 mg/day
Change from baseline in daily time spent
assisting with ADL (min)
Placebo
p lt 0.05 vs baseline
23
NICE RECOMMENDATIONSCOST EFFECTIVENESS
  • cost savings on institutional care not well
    established
  • quality of life (QALY) not easily measured
  • Oscar Wilde knowing the price of everything and
    the value of nothing

24
Therapeutic Dilemmas Alzheimers Disease
  • Which drug?
  • Who to treat?
  • When to start treatment?
  • How long to treat?
  • By whom?
  • Whether to treat?

25
Memantine (Ebixa)
  • NMDA receptor antagonist
  • trialled predominantly in moderately severe to
    severe dementia
  • modest benefit in cognition, function, behaviour
  • expensive 180 per month, no PBS subsidy

26
PREVENTION?
  • AN OUNCE OF PREVENTION IS WORTH A POUND OF
    CURE
  • Benjamin Franklin

27
(No Transcript)
28
(No Transcript)
29
Protective Factors?
  • NSAIDs (anti-inflammatories)
  • statins (cholesterol lowering)
  • moderate alcohol consumption
  • higher education
  • ongoing intellectual stimulation
  • physical and leisure / social activities
  • diet - fruit and vegetables, low in saturated fat

30
The pathological cascade of AD
Clinical symptoms
Cholinergic dysfunction
Neurodegeneration
Neurofibrillary tangles
Genetic risk factors
?-amyloid
Apo-E
TAU hypophosphorylation
PS1,2
Environmental risk factors
Pathogenetic mutations
APP
31
Post and Whitehouse - Guidelines on Ethics of
Care of People with Alzheimers Disease
  • As the 20th century draws to a close, it is
    the decline of the mind contained in a still
    viable body that raises some of the most urgent
    concerns for medical ethics and society. The
    emphasis on technical reason and productivity
    that characterizes our modern industrial cultures
    may create a bias against people with dementia.
    It is important to realize that emotional and
    relational well-being can be enhanced despite
    dementia and to insist that human dignity can
    still be respected. In severe dementia, the
    finest expression of this respect may be through
    the touch of a hand rather than through
    technology.
About PowerShow.com