Practical Matters in the Care of A Person with Dementia 7 th Annual Neurology Update for Primary Care Deborah S. Hoffnung, PhD, ABPP CN November 16, 2018 1
Typical Aging, MCI/CIND, dementia Common Dementia Subtypes Other Reasons for memory loss Neuropsychiatric Symptoms of Dementia Practical matters Screening for dementia Driving safety Medication compliance Capacity Assessment Modifiable risk factors? Outline Aging, Cognition, & Dementia Typical Cognitive Aging Reduced mental processing speed Less efficient encoding, greater difficulty recall after a delay Mild Cognitive Impairment/Cognitive Impairment Not Demented (CIND) Petersen et al., 1995 Subjective complaint of memory disturbance (now broader) Objective evidence of memory deficit (now broader) Generally preserved cognitive functions Intact ADLs Absence of dementia Normal aging to MCI to Dementia: conversion & reversion Dementia 2
Common Dementia Subtypes Alzheimer s Disease Vascular Dementia Dementia with Lewy Bodies Frontotemporal Dementia Risk for Dementia EBSCO: review + relative risk + dementia, 2008 2018 Dementia = AD, VD, or all dementias Factors that predict cognitive decline & dementia, progression from Normal Aging to MCI to Dementia Prodromal symptom Causative Additive Correlative 3
Factors that Predict Dementia* Increased Risk Decreased Risk Unclear/Questionable Diabetes, Metabolic Sleep duration 7 8h NSAID use Syndrome Headache Disorder Fish consumption Ginkgo Biloba extract Coronary heart disease, Statins Alcohol consumption heart failure Atrial fibrillation Calcium Channel Vitamin B supplement Blockers Obesity in midlife Marriage Vitamin E supplement Slow/decreased walking pace Treatment of hyperlipidemia, diabetes Head injury Consumption of fruit and vegetables Disturbed sleep/lack of Coffee consumption sleep Anxiety Use of ACE Inhibitor drugs Depression/Antidepressant Higher education Use Low Educational Attainment Physical activity Physical Inactivity Consumption saturated or trans fatty acids Low levels B vitamins Antihypertensive use Consumption of polyunsaturated or monounsaturated fatty acids Dementia Risk & Prevalence Langa, K.M., Is the risk of Alzheimer s disease and dementia declining? Alzheimer s Research & Therapy. 2015, 7:34 9 population based studies of dementia Declining age specific risk Langa et al., A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Intern Med. 2017; 177(1): 51 58 Prevalence declined significantly between 2000 and 2012 More years of education associated with lower risk of dementia Average years of education increased significantly Despite significant age and sex adjusted increase in cardiovascular risk profile among older US adults 4
Other Reasons for Memory Loss Potentially treatable dementias DEMENTIAS mnemonic, adapted from Little, MO. Reversible dementias. Clin Geriatr Med, 2018; 34: 537 562. Drugs* Eyes, Ears* (sensory deficit) Metabolic* (thyroid dx, vitamin deficiencies) Emotion* (depression) Normal pressure hydrocephalus Tumor Infection* (respiratory, UTI) Atrial fibrillation, alcoholism Sleep apnea* Other Reasons for Memory Loss, cont d Medication related adverse events Potentially Inappropriate Medications 2015 Beers Criteria Sleep Disorders Sleep apnea But Depression Pseudodementia Vitamin Deficiency* B12, folate, vitamin D But. 5
Neuropsychiatric Symptoms in Dementia Agitation, depression, apathy, delusions, hallucinations Prevalence Impact on functioning, quality of life Non pharmacological strategies to manage behavioral symptoms Practical Matters Screening for Dementia Specific instruments Practical guidelines Driving Safety Predictors of driving safety Medication Compliance Interventions Capacity Assessment Testamentary Capacity Healthcare Decision Making Capacity 6
For updated (all) slides: deborah.hoffnung@alegent.org 7