Lecture+17+Alzheimers+1 - Dementia Loss of cognitive...

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1 Dementia Loss of cognitive function usually requires memory loss plus 1 or 2 other cognitive domains Interferes with activities of daily living Normal level of consciousness Stroke and Dementia Vascular or “multi-infarct” dementia Multiple strokes loss of brain tissue loss of cognitive function Probably more complex - interaction with Alzheimer’s disease Stroke is clearly a risk factor for brain atrophy and dementia
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2 Framingham Stroke Risk Profile (FSRP): Aggregate score of stroke risk factors More stroke risk factors More brain atrophy Rates of dementia in older adults by prevalent cardiovascular disease Rate per 1000 person- years HR= 1.3 HR= 1.4 HR=2.7 HR=1.4 HR= 1.9 HR is the adjusted Hazards ration from Cox Model adjusted for age,race, education, income, Apo-E4 allele, 3MSE
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3 Hypertension Diabetes Age Smoking Vascular Risk Factors Blood Vessel Damage Kidney Damage Heart Damage Brain Damage 0 5 10 15 20 25 30 35 40 45 50 Prevalence 60 65 70 75 80 85 Age Age-Associated Prevalence of Alzheimer’s Disease
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4 Clinical Features of AD Subtle onset, gradual progression Begins with memory loss inability to form new memories - Which Brain Region ? Gradual involvement of other cognitive abilities langauge (aphasia), visuospatial ability, problem solving, judgement, reasoning Behavioral disturbances depression, apathy, agitation Costs of AD in the US 5.1 Million Americans have AD 500,000 < age 65, 42% > age 85 About 400,000 new cases/year in the US Will increase to 615,000 new cases in 2030 (Why?) Average Medicare Costs are increased 3X for people with AD Estimated total costs $150 billion/year 47% of Nursing Home residents have a diagnosis of AD Average cost for a private room in a nursing home: $75,000/year 10 Million Americans are caring for someone with AD 25% of caregivers provide 40 hours care/week 40% have serious emotional stress Depression, physical illness more common in caregivers
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Lecture+17+Alzheimers+1 - Dementia Loss of cognitive...

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