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Title: Dementia

  • Geriatrics Advocacy Group
  • UBC Internal Medicine

  • We are happy to provide general medical
    information and answer your questions
  • This talk is not a substitute for seeing your
  • We will not be able to give you personal medical

  • What is Dementia?
  • What are risk factors?
  • Can you do anything about them?
  • How is dementia diagnosed?
  • Treatments for Dementia
  • Lifestyle
  • Medications
  • Living with Dementia
  • Safety
  • Caregivers
  • Future Research

What is Dementia?
  • A group of symptoms
  • Memory loss
  • Problems with reasoning, judgment, language
  • AND
  • Problems with day to day functioning (work,
    driving, social relationships)
  • AND
  • A progressive illness

Symptoms of Dementia
  • Problems with short term memory
  • Appointments
  • Conversations
  • Events
  • Repeating stories
  • Difficulty remembering names, faces
  • Forgetting acquaintances and friends

Symptoms of Dementia
  • Trouble making sense of language
  • Trouble finding the right word
  • Difficulty naming objects
  • Understanding complicated instructions
  • Trouble doing familiar things
  • Driving, banking
  • Cooking, cleaning, laundry
  • Dressing, bathing

Symptoms of Dementia
  • Confusion in unfamiliar places
  • Getting lost
  • Personality changes
  • Easy to anger, emotional
  • Suspicious
  • Seeing or hearing things that arent there

Dementia or Normal Aging?
  • Normal changes of aging
  • Slower to process information
  • Hearing and vision may decrease
  • Motor speed decreases
  • Unlike dementia, these changes should not prevent
    normal day-to-day activities

Other things that cause memory trouble
  • A recent medical illness
  • Starts suddenly
  • Changes between sleepy and agitated
  • Depression
  • Sad mood
  • Decreased initiative
  • Some medical conditions
  • Vitamin deficiencies
  • Low thyroid function
  • Sleep Apnea

Mild Cognitive Impairment
  • Somewhere between memory changes of normal aging
    and dementia
  • Can affect memory, or other domains or both
  • Increases the risk of getting dementia BUT not
    everyone who has MCI will go on to develop

Causes of Dementia
  • Alzheimers Dementia
  • Most common form of dementia
  • 10 of 65-75 year olds
  • 20 of 75-85 year olds
  • 30 of gt 85 year olds
  • Gradually progresses over time
  • Cause not known for sure
  • Genetics in some families (more rare)
  • Messenger chemicals and inflammation in the brain
  • Brain gradually losses size (atrophy)

Causes of Dementia
  • Vascular dementia
  • Second most common type of dementia
  • Caused by small strokes
  • Areas of brain that have stopped getting oxygen
    and die
  • The strokes might not have other symptoms
  • Strokes happen suddenly and cause sudden
    worsening of memory

Causes of Dementia
  • Mixed Dementia
  • Combination of Alzheimers and Vascular
  • Very common
  • Gradual decline with occasional sudden worsening
  • Frontal Temporal Dementia
  • Often has personality changes early on
  • Parkinsons Disease related Dementia
  • Others

What Are the Risk Factors for Dementia?
Risk Factors
  • Genetic
  • Vascular
  • Lifestyle

Family History
  • Most cases of dementia are NOT genetic, inherited
    or running in the family
  • Some cases of dementia run in the family where
    multiple members in several generations have
  • Often dementia comes on at younger age
  • Can come on at older age and look like usual
    Alzheimers disease

Cardiovascular (Heart and Blood Vessels)
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Smoking
  • All of these increase the
  • risk of stroke
  • These are risk factors for both AD and vascular
  • What can do to help with this?
  • Exercise, healthy diet, quit smoking
  • Managing the above medical conditions well

  • Potential Lifestyle factors
  • Traumatic head injuries
  • Toxic exposures
  • Physical activity / Diet
  • Education

Diagnosing Dementia
How is it DIAGNOSED?
  • The only true way is to test a sample of the
  • This cannot be done in a live person!
  • Doctors are researching ways to diagnose dementia
    using brain scans and other tests
  • The diagnosis is made by your doctor
  • Talking to the patient and family
  • Physical examination
  • Brain scans and laboratory tests in some cases

What happens at the doctor's office?
  • Talking to the patient and family
  • Memory changes
  • Trouble doing day-to-day activities
  • Safety concerns
  • Driving
  • Getting lost
  • Burning pots on the stove, leaving taps on to
  • Other medical conditions
  • Conditions that increase the risk of dementia or
  • Medications that could make memory worse
  • Pain medications, sleeping pills, alcohol
  • Depression
  • Family history of dementia

What happens at the doctors office?
  • Physical Examination
  • Checking for signs of stroke, Parkinsons or
    other conditions that cause dementia
  • Memory Testing
  • The Mini-Mental test
  • Written test of memory and thinking
  • The doctor may also do other memory tests

What happens at the doctors office?
  • Investigations
  • Usually blood work is done to make sure there
    isnt a medical cause for the memory change
  • Blood work to check vitamins and thyroid levels
  • Imaging
  • CT or MRI scans
  • Not every person needs a head scan
  • Scans are only done if there are signs of stroke,
    bleeding in the brain or other worrisome signs

Diagnosis of Dementia
  • No one test can diagnose dementia
  • Memory tests or brain scans alone are not enough
  • Diagnosis is made after combining the medical
    assessment and memory tests

How to Prevent Dementia?
Prevention - Without Drugs
  • Exercise the brain
  • Exercise the body
  • Keep socially active
  • Quit smoking
  • Alcohol in moderation
  • Wear a helmet and avoid hitting your head
  • Healthy diet
  • Omega fatty acids (fish oil)

Brain Training?
  • Exercise for the brain
  • Learning new things
  • helps keep the brain
  • healthy
  • Playing games
  • Cards
  • Ma Jong
  • New hobbies

Social Engagement - Getting Out and About
  • Visiting friends and
  • relatives
  • Joining clubs
  • Senior centres
  • Volunteering

  • Mediterranean diet
  • Plenty of fruits and vegetables
  • Regular consumption of fish
  • Antioxidants
  • Healthy fats (omega 3)

Prevention With Drugs
  • May be helpful
  • Omega 3 acids
  • May be harmful
  • Vitamin E and estrogen may increase heart
    attack and stroke
  • Anti-inflammatories heart and kidney side
  • Ginkgo biloba may increase bleeding
  • Preventing strokes
  • Keep good control of blood pressure, diabetes and
  • Baby aspirin in people with risk of stroke ask
    your doctor

Treatment of Dementia
Types of Treatment
  • Non-medication treatment
  • Medication treatment

Non-Medication Treatment
  • Lifestyle
  • Regular exercise and socializing
  • Keep a regular routine
  • Sleep
  • Meals
  • Dressing and bathing
  • Toileting
  • Keep enjoyment in life
  • Massage and aromatherapy
  • Pets
  • Music
  • Photo albums and happy memories

Non-Medication Treatment
  • Sleep problems
  • Limit daytime naps
  • Encourage physical activity in the day (not
  • No alcohol or caffeine in the evenings
  • Keep a night light in the bedroom or hall
  • Keep a calm and regular night-time routine
  • Hot milk and an evening snack
  • Sleeping medicine
  • Use if cannot sleep even with a good routine
  • Side effects like increasing confusion

Tips For Caregivers
  • Patience with repetitive behaviors
  • The person doesnt realize they are doing it
  • Speak slowly, using one idea at a time
  • Emotional outbursts, suspicion
  • Try to distract rather than argue
  • Suggest a cup of tea or a walk
  • If you are too frustrated, take a break
  • Go for a walk
  • Call a friend

Medical treatment
  • No medication can CURE dementia
  • Medication may slow down the dementia
  • In some people medication does not work at all
  • Some people cannot take medication because of
    side effects
  • Medication is started when memory changes
    interfere with day-to-day activities
  • What medication can do
  • Make people a little more organized and able to
    function day-to-day
  • May not actually improve memory

Medical treatment
  • Cholinesterase Inhibitors
  • Approved for Alzheimers, Vascular, Mixed and
    Parkinsons Dementias
  • Donepezil (Aricept), Rivastigmine (Exelon),
  • Side effects include nausea, diarrhea, slow heart
    beat and dizzy spells
  • Memantine (Ebixa) is also used in more severe
  • Has side effects such as dizziness, and can
    worsen aggression and confusion

Living with Dementia
Planning for the Future
  • Involve family and close friends and explain
  • The diagnosis
  • The persons memory will decline
  • The person will need more help over time
  • Plan for the future while the person can still
    talk about what they prefer
  • Living Arrangements
  • Health Care
  • Substitute Decision Maker who will make medical
    decisions if the person becomes unable
  • Advance Directives a written document about
    medical preferences

  • Understand their financial situation
  • Bank accounts
  • Income
  • Assets (home)
  • Debt
  • Will
  • Power of Attorney
  • Assigns a person to take over finances if they
    become unable to manage

  • When to stop?
  • Who can help?

  • Pacing around
  • Can get lost or fall
  • Ways to manage
  • Close supervision
  • Provide a safe place to wander (mall)
  • Provide alternative activities
  • Environment control
  • Lock doors
  • Remove hazards
  • Maintaining contact
  • Wandering registry Safely Home, GPS, cell phones

Tips For Caregivers Safety Measures at Home
  • Locks on medicine cabinets
  • Locks for stove
  • Keep furniture in the same place to prevent falls
  • No electrical appliances in bathroom
  • Keep water heater below 50 C
  • Help the person with personal care
  • Ask for a home therapist visit from your doctor
  • Home safety and equipment suggestions

For Caregivers Take Care of Yourself!
  • Caregiving is consuming!
  • Take time for yourself
  • Preventing burnout will allow you to care for
    your loved one better and longer
  • Exercise and socialize
  • Take care of your own medical problems
  • Consider respite care and outside supports
  • Respite through care facilities
  • Home Care
  • Adult Day Centers
  • Connect with other caregivers through the
    Alzheimers Society of BC

News Flash - What is new in the Dementia World?
Diagnosis of Dementia
  • New techniques show how the brain is working
  • PET, SPECT scans
  • More accurate and detailed scans
  • Early on may predict who is at risk of developing
    Alzheimers disease
  • May help to tell different types of dementia apart
  • Mostly used in research
  • Soon could be used routinely

Diagnosis of Dementia
  • Biomarkers
  • Clues from cerebrospinal fluid (CSF), fluid
    around the brain
  • Take a sample of the fluid
  • Must stick a needle into the back to collect the
  • Invasive test with some risks
  • May be able to predict who among those with mild
    memory problems will eventually get Alzheimers
  • Only used in research right now
  • Soon could be used routinely

Treatment of Dementia
  • There is currently no cure for any type of
  • Researchers are working hard on new treatments
    and ways to prevent dementia
  • Vaccines
  • New medications
  • New treatments may be ready as early as 5 10
    years from now

Take Away Points
  • Dementia is common
  • Dementia is a memory problem that interferes with
    day-to-day activities
  • There are many different causes of dementia
  • Alzheimers and Vascular most common
  • Not all memory problems are dementia

Take Away Points
  • Risk factors
  • Cardiovascular
  • Genetics
  • Prevention
  • Healthy diet and exercise
  • Social activities
  • Controlling medical conditions
  • Prevent strokes

Take Away Points
  • Diagnosis of dementia is done by a doctor and
  • Talking with a patient and their family,
  • A physical exam
  • Memory testing
  • In some cases blood or imaging tests

Take Away Points
  • Treatment of dementia involves
  • Support systems for the patient and caregivers
  • Medication
  • Safety and planning for the future are important
  • The Alzheimers Society is wonderful resource for

Take Away Points
  • Theres a lot of research going on in dementia
  • New information is coming about prevention,
    diagnosing and treating dementia

Thank You!
  • Faculty Advisor Dr. R. Wong
  • Geriatric Medicine Fellow Dr. J. Chase
  • Presentation Contributors
  • Drs. E. Dempsey, K. Gan, J. Iosfina, M. Spencer,
    M. Wan, W. Wong
  • To you for the invitation to speak