RespiteMatch.com Health Blog

Definition of Dementia

􀂃 Permanent, progressive loss of multiple intellectual functions

􀂃 In 1906 Alois Alzheimer first described this disease by studying a brain specimen from an autopsy

􀂃 Alzheimer’s disease is one type of dementia, although the term is often used synonymously with dementia

Epidemiology of Dementia

􀂃 Approximately four million Americans are afflicted with Alzheimer’s disease

􀂃 Alzheimer’s disease is the fourth leading cause of death among individuals over the age of 65.

􀂃 Approximately 10% of the population over 65 have Alzheimer’s. Forty seven percent of those over the age of 85 are demented, which is the fastest growing segment of the US population. With the aging of America, it is estimated that by the year 2050 the US will have 67.5 million people over the age of 65 compared with 25.5 million today.

􀂃 Dementia afflicts both men and women in all racial, religious, and socioeconomic groups.

Clinical Symptoms

􀂃 Intellectual - Amnesia: Loss of memory function - Aphasia: Loss of ability to understand the spoken or written word (receptive) or inability to speak (expressive) - Apraxia: Loss of the ability to perform remembered motor tasks, for example, buttoning a shirt or turning a door knob - Agnosia: Loss of the ability to remember what things look like (visual agnosia), for example, the face of a close relative

􀂃 Psychiatric - Depression: 25% - Psychosis (hallucinations and delusions): 30-40% - Poor judgment, irritability, inappropriate behavior - Major personality changes 􀂃 Non-neurological systems - Only the brain is damaged by Alzheimer’s disease. Other organ systems are not damaged. Causes of Dementia Dementia is caused by the death of nerve cells. Once a nerve cell dies, it cannot be replaced and its function may be lost.

Nerve cell death is caused by:

􀂃 Alzheimer’s disease: 60-70%

􀂃 Multiple small strokes: 15-30%

􀂃 Multiple other causes: 10-15% Reversible Causes of Intellectual Decline 􀂃 Five to 20 percent of the elderly patients who appear demented have treatable diseases such as depression, hormone imbalance (i.e. hypothyroidism) or medication induced confusion. Causes of Alzheimer’s Disease There is no clear reason why nerve cells die. Inheritance plays some role:

􀂃 5% of cases are clearly inherited (autosomal dominant) 􀂃 20-60 percent may have a genetic predisposition

􀂃 There is no specific genetic test for Alzheimer’s disease 􀂃 Diet and lifestyle do not contribute to Alzheimer’s’ disease

Treatment for Dementia

􀂃 Current: - No known treatment stops nerve cell death in Alzheimer’s disease - Current medications may slow progression in early states - Psychiatric symptoms can be treated with medication

􀂃 Future - Future therapies will try to prevent the death of nerve cells and maximize the function of surviving nerve cells - Adequate preventive measures are probably 10 years into the future - Brain cell implants offer little promise

Stages of Dementia

􀂃 Dementia is a relentless, progressive disease

􀂃 No patient’s course is ever predicable 􀂃 Patients have long survival because other organ systems are not damaged 􀂃 Early Years (3-5) of Disease - Mild amnesia (memory loss), good function at home, few psychiatric symptoms 􀂃 Middle Years (3-10) of Disease - Many intellectual impairments, poor function at home, many psychiatric/behavioral problems

􀂃 Late Years (5-20) of Disease - Multiple, severe intellectual impairments - No function at home - Total care patient to include feeding tubes -

Loss of bowel and bladder functions Continuum of Care

􀂃 Essential components for a complete continuum of care include: - Inpatient/outpatient clinical evaluation and treatment - Domiciliary care - Nursing home dementia units - Adult day care for demented clients - Respite care - Home health services

Family support groups Financing Care

􀂃 50-60 percent of all nursing home patients are demented. The annual cost of nursing home care ranged between $36,000 and $40,000. Most expenses are ultimately borne by patients’ families. 􀂃 Approximately 70% of the care given Alzheimer’s patients is provided by the families. The cost of the family caring for the patient at home averages $18,000 per year.

􀂃 Paying for Alzheimer’s disease—including the cost of diagnosis, treatment, nursing home care, and lost wages—is estimated to be more than $80 billion each year in the U.S.

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