Post on 23-Dec-2015
NON-ALZHEIMER’S DEMENTIABobby Huff
PharmD Candidate 2012
ALZHEIMERS
Accounts for roughly 70% of dementia 80% in patients over 90 ~45% in patients in their 70’s
Disease is progressive and irreversible
Diagnosis confirmed upon autopsy The cortex shrivels up, damaging areas involved in thinking, planning and
remembering Shrinkage in the hippocampus, an area of the cortex that plays a key role
in formation of new memories Ventricles grow larger Disease is associated with formation of plaques and tangles in the brain
tissue
http://drpinna.com/can-diet-prevent-alzheimers-dementia-21735
NON-ALZHEIMERS
Many diseases, disorders and medical conditions share some common symptoms with Alzheimer’s Managed in many different ways
Several types Vascular dementia DLB ( dementia with lewy bodies) Parkinson’s dementia Frontotemporal dementia Huntington’s disease Dementia can also be caused by infectious
diseases, tumors, head injuries or even thyroid problems
NON-ALZHEIMER’S
Not only about memory Aphasia (language) Apraxia (in ability to performed asked tasks) Personality changes Impaired executive function (problem solving) Loss of object knowledge (agnosia) Psychosis Movement disorders
VASCULAR
Accounts for roughly 18 percent of dementia
Stroke interferes with blood flow to the brain Can manifest d/t
Multiple small strokes ( infarcts) Caused by blood clots or ruptured small arteries
Large stroke (post-stroke dementia)
http://www.thirdage.com/hc/c/what-is-vascular-dementia
VASCULAR VS. ALZHEIMERS
Vascular dementia can appear to be alzheimer’s because it appears with several of the same characteristics Memory problems Confusion Disorientation Trouble following directions
How its different Recalling day to day events is impaired
But for example recalling the face of people is not impaired Alzheimer’s generally affects both
VASCULAR
Signs of Vascular Dementia (stroke) Quick onset and abrupt presentation Memory loss could lead to hallucinations, w/draw
or even aggravated/agitated moods Garbled speech, loss of coordination or weakness
on one side of the body Diagnosis
MRI or CT scan will confirm or rule out the evidence of a stroke
Treating the factors which can lead to stroke can help slow the progress of dementia These being: HTN, Hyperlipidemia, Diabetes, Smoking
VASCULAR
Treatment No medications are approved for vascular
dementia The use of medications such as those used for
Alzheimer’s may provide some benefit Donepezil, Aricept etc..
In 2006 Donepezil was linked to 11 deaths in a clinical trial when used in patients who had vascular dementia. There were 11 deaths in the study group compared to 0 in the control. But other studies have showed benefit with Donepezil
DEMENTIA WITH LEWY BODIES (DLB)
Occurs when protein deposits in the brain These are called Lewy Bodies – impede cognitive
fx. Discovered by Fredrick Lewy ~1900
http://missinglink.ucsf.edu/lm/ids_104_neurodegenerative/Case2/Case2Micro.htm
DLB
Widely considered as the 2nd most common form of dementia Accounting for close to 20% of cases
DLB vs Alzheimer’s Both include
Confusion Concentration Memory impairment Hallucinations
Both are progressive but in Alzheimer’s people have good and bad days yet in DLB people can change in as little as an hour and can appear very extreme
DLB
REM sleep behavior disorder Could be an early sign of DLB
Movements, gesturing and speaking while asleep
DLB Patients also have
Mobility issues similar to Parkinson’s Slow, stiff, shaky movements Difficulty balancing Shuffling gait
DLB
Diagnosing A medical workup can help identify some
symptoms and narrow down the disease states Like Alzheimer’s dementia absolute diagnosis
can only be confirmed with an autopsy Treatment
No approved medications Medications used in Alzheimer’s and Parkinson’s
disease may provide some benefit in patients who have DLB
PARKINSON’S DISEASE
One out of five persons with Parkinson's can develop dementia Its due to Lewy Body formation in
Brain Brain stem
Vs. Alzheimer’s Parkinson’s is usually first diagnosed and then
the dementia related problems occur Usually doesn’t involve problems with language
PARKINSON’S DEMENTIA
Diagnosed Medical history Physical exam Neurological exam
*these are used to rule out other causes
Treatment There are no approved medications Overall therapy is designed to not only manage
the Parkinson’s disease itself but it is also designed to manage the dementia related problems
FRONTOTEMPORAL DEMENTIA
Associated with more rare diseases associated with the temporal lobes of the brain Front of the temporal lobes
Examples Picks Disease
Deposits of the tau protein (pick bodies) They can aggregate in certain lobesand lead to affects in personality, memoryand even behavior http://www.google.com/imgres?q=frontote
mporal+dementia
FRONTOTEMPORAL DEMENTIA
Vs. Alzheimer’s FTD is associated with:
Impaired judgement Personality changes Various changes in mood Language barriers and problems Decrease in hobbies/activities
FTD is also progressive like Alzheimer’s Yet personality and behavioral symptoms occur
earlier and disorientation occurs later It is most usually observed in the reverse order in
Alzheimer’s Also semantic memory (associated with the meanings
of words and objects) as well as episodic (time) memory are affected
semantic>episodic
FTD
Patients with Frontotemporal dementia may also exhibit inappropriate behavior They have little regard as to how people feel or
what they think of their actions
Diagnosed Medical exam Brain scan (may show atrophyof frontal or temporal lobes)
http://www.google.com/imgres?q=frontotemporal+dementia
FTD
Treatment No treatment Manage the patients symptoms as best as we
can in order to improve the quality of life.
http://www.riversideonline.com/health_reference/Brain-Spine-Stroke/DS00874.cfm
HUNTINGTON'S DISEASE
Caused by a genetic abnormality Huntingtin (HTT gene) Leads to the destruction of nerve cells in the
bran and lowers the levels of neurtransmitters Causes declines
Mental Emotional Behavioral
These patients are born with the defective gene Yet do not experience symptoms until middle age
A parent has a 50 % chance to pass the defective gene on to a child
GENETICS Transcription is regulated by an interplay between histone
acetyltransferases and histone deacetylases. Researchers have found that mutant huntingtin protein (Htt) inhibits histone acetylation by blocking histone acetylases or recruiting them into aggregates. The reduction in histone acetylation leads to decreased transcription.
http://www.nature.com/nature/journal/v413/n6857/fig_tab/413691a0_F1.html
HUNTINGTON'S DISEASE
Vs Alzheimer’s Both have
Personality changes Mood swings Disorientation
Attention and judgment can be impaired early on when the disease presents Memory occurs later
Also commonalities with Parkinson’s Involuntary movements appear
Jerky, clumsy, irregular
http://neuroskeptic.blogspot.com/2010/10/cannabinoids-in-huntingtons-disease.html
HUNTINGTON’S DISEASE
Patients may also begin fidgeting Eventually the patient will lose the ability to walk,
talk and swallow
Diagnosed HD is diagnosed by a blood test to look for the
specific gene defect
Treatment Must manage the symptoms, there is no cure or
medical treatment. Increase meds vs. quality of life Because each Huntington's patient is unique, drug
treatment must be individualized Treatment Algorithms are out there
DEMENTIA VIA INFECTIOUS DISEASE
Bacterial or viral infections can enter the brain For example HIV/AIDS this can cause a person to
have memory and concentration problems. Person’s may also see a loss of motivation and
decreased interest in things that were recently enjoyed
Creutzfeld-Jakob disease (Mad Cow) Very rare (1 in 1,000,000) Infection by transmission of a prion (infectious protein) Infect and destroy the brain’s nerve cells
Memory and behavioral changes caused by the prion progress rapidly
DIAGNOSIS OF ID
Blood Tests Medical history Neurological exam EEG (electroencephalogram) Brain scan Cerebral spinal fluid analysis (spinal tap) Autopsy is a definitive diagnosis
Holes will be visible in the structure of the brain (mad cow)
http://commons.wikimedia.org/wiki/File:Variant_Creutzfeldt-Jakob_disease_(vCJD),_H&E.jpg
OTHER CAUSES OF DEMENTIA
Brain tumor Head injury Thyroid disorder Metabolic disorder Endocrine disorder
SOURCES Rosenblatt A, et al. A physician's guide to the management of Huntington's disease. Huntington's Disease Society of
America. http://www.hdsa.org/images/content/1/1/11682.pdf. Accessed December 5, 2011.
Gillian P. Bates Huntington's disease: Exploiting expression, Nature 413, 691-694(18 October 2001)doi:10.1038/35099656. Accessed December 10, 2011.
Newman E. Michael New NIST SRM Helps Improve Diagnosis of Huntington's Disease From NIST Tech Beat: December, 2011. Accessed December 10, 2011
Spencer, Paula. Non-Alzheimer's Causes of Dementia; http://health.msn/health-topcs/alzheimes-disease/non-alzheimers-causes-of-dementia
Various Authors.http://www.mayoclinic.com/health ; Accessed December 2011
CJD (Creutzfeldt-Jakob Disease, Classic. Centers for Disease Control and Prevention. 2008-02-26. Accessed December 10, 2011.
Redefining Non-Alzheimer's Dementias, http://www.mayoclinic.org/medicalprofs/non-alzheimers-dementias.html, Accessed December 14, 2011