Am I Losing My Mind?Normal Aging vs. Early Signs of Dementia

Laurey Sherman, RN, BSN

Founder, Providence Senior Living

www.ProvidenceAL.com

Is It Alzheimer’s or Just Normal Aging?

• Terminology

• The Difference Between Normal Aging, Mild Cognitive Impairment, and

Dementia, Causes, Risk Factors, Diagnosis

• Progression Path of Alzheimer’s Disease

Terminology

• ADL=Activities of Daily Living (bathing, dressing, grooming, toileting)

• Normal Aging

• Mild Cognitive Impairment (MCI)• Incipient Dementia

• Isolated Memory Impairment

• Cognitive Impairment, No Dementia (CIND)

• Short Term Memory Loss (STML)

• Age-Associated Cognitive Decline (AACD)

• Alzheimer’s Disease (AD) / Dementia

Alzheimer’s Disease / Dementia

Progressive Incapacitating

Mild Cognitive Impairment

More Pronounced Mild Affect ADL

Normal Aging

Gradual Normal ADL

Normal Aging Pattern and Factors

Normal Aging Pattern

• Gradual Changes In:

• Intelligence

• Memory

• Attention

• Language

• Reasoning

• Speed of Processing

• No Changes in Day to Day Functioning

• Usually not noticeable to Friends or Family

Factors Affecting Normal Aging

• Stress

• Medications

• Sensory Changes

• Physical Decline *

• Depression or Anxiety *

* Recent Research suggests these may be precursors for Dementia

It’s Time For the MINI-MENTAL!

Mild Cognitive Impairment (MCI)

• The Intermediate Stage between Normal Aging and Dementia

• 20% over Age 65 have MCI

• More severe problems with memory, judgment, language and thinking

• Family and friends usually notice a change

• Usually doesn’t interfere with your day-to-day activities

• Sometimes worsens. Sometimes improves.

• May be Permanent or Temporary

Causes of MCI

• May or May Not be Related to Alzheimer’s Disease

• Parkinson’s Disease (Lewy Body proteins)

• Strokes or other changes in blood flow to the brain (e.g., Trauma)

• Shrinkage of the Hippocampus

• Ventricular enlargement

• Brain Plaques (beta-amyloid proteins)

• Chemotherapy or other Drugs

Risk Factors & Diagnosis of MCI

Risk Factors

• Age

• APOE-e4 gene

• Diabetes

• Smoking

• Depression

• High Blood Pressure

• High Cholesterol

• Lack of Exercise

• Lack of Mental and Social Stimulation

Diagnosis

• Medical History & Physical Exam

• Cognitive Tests (MMSE, etc)

• CT, MRI, Blood Tests

• Declining over time

• Confirmation with Family/Friend

• This diagnosis ISN’T DEMENTIA!

Alzheimer’s—the Most Common Form of

Dementia

• Short Term Memory Loss affects DAILY LIFE

• Difficulty Problem Solving

• Difficulty Completing FAMILIAR tasks

• Confusion with Time and Place

• Trouble Understanding Visual Images and Spacial Relationships

• New Problems with Words and Writing

• Misplacing/Inability to RETRACE steps

• Decreased or Poor Judgment

• Social/Work Withdrawal

• Changes in Mood/Personality

• 95%--A combination of genetic, lifestyle, and environmental factors

• 5%--Genetic

• Damage/Death of Brain Cells, specifically the hippocampus

• “Plaques and Tangles”—incapacitate the brain cells

What Causes Alzheimer’s Disease (AD)?

One of the First Signs of AD is Short Term

Memory Loss (STML)

Definition:

• “Short Term” is 30 seconds to several days, things you are currently thinking about

• “Short Term” is 5-9 items. Long Term is far more.

• Memories Travel The Brain:

Frontal LobeHippocampusCerebral Cortex

• STML—when problems occur in the Frontal Lobe

Diagnosis:

• Medical History & Physical Exam

• Cognitive Tests (MMSE, etc)

• CT, MRI, Blood Tests

Early AD Can Look Like MCI

Symptoms of Mid-Stage AD

• Repeating statements without realizing the repetition

• Forget things without remembering them later

• Misplacing things, often in illogical locations

• Disorientation—month, day, season, year

• Difficulty finding words, problems with reading and forming sentences

• Inability to keep track of bills, problems with simple math

• Repeatedly Burning things on the stove, Getting lost while driving

• Personality Changes—aggression, frustration, anger, blaming others

Disease Progression and Prognosis

• Functional Assessment Staging Test (FAST) Stages 1—7f

• Memory AttireToiletingSpeakingWalkingSittingSwallowing

• Palliative Care (“Hospice”) is Appropriate at Stage 7a (“Speaks 5-6 words per day”)

• Death is usually attributed to Heart or Respiratory Failure, Secondary to Dehydration

• Disease Progress is Usually 4-10 Years, but Can Go Longer

Resources for this Presentation

• Love in the Land of Dementia

• The 36-Hour Caregiver

• MayoClinic.org

• Alz.org

• webMD.com

• Auer S., Reisberg B, The GDS/FAST staging system. Int Psychogeriatr 9 Suppl 1:167-71, 1997