Notes - KU School of Medicine

Memory Loss: It’s Not
Always Alzheimers
Andrew Massey, M.D.
Department of Internal Medicine
University of Kansas School of Medicine--Wichita
Hendrikjje van
Andel Schipperr
Age 115
“Don’t smoke and
don’t drink too much
alcohol except on
sundays & holidays.
And you must remain
active . . . Eat a herring
every day & drink
orange juice.”
Human Intelligence . . . or Cognition
• The ability of the brain
1. to choose to either ignore or focus attention
2. to learn and remember
3. to form ideas, & communicate thoughts
• The process of perception, memory, judgement,
reasoning, and decision making
“In our civilization
& under our form
“The essence of intelligence is
of government,
intelligence
is so
skill in
extracting meaning from
highlyeveryday
honored life.”
that it is rewarded
--unknown
by exemption from
the cares of office.”
--Ambrose Bierce
(1842-1914)
“Sometimes I think the surest sign that
intelligent
life
exists
elsewhere
in
the
“Knowing a great deal
universe
is
that
none
of
it
has
tried
to
is not the same as being
contact
us.”
smart. Intelligence is
--Bill
Waterson
not information alone
but also judgement . . .
the manner in which
information is collected
& used.”
--Carl Sagan
Facts
• Predominantly a disease of the elderly, but
affects young, too
– Prevalance for Alzheimer’s
• >65 y.o., 5%
• >85 y.o., 50%
• 2nd most feared disease among the elderly
– 5 million affected in U.S.
– Estimate 20 million by 2050
Myths
• It is irreversible
• It is untreatable
• There are no effective
means to prevent it
Dementia
• Loss of memory or other cognitive functions
• Can be caused by numerous untreatable, but
also treatable diseases
• Sometimes mistaken for other symptoms
– Normal aging
– Benign forgetfulness
– Aprosexia
10 Warning Signs
1. Memory loss
2. Difficulty performing
familiar tasks
3. Misusing words
4. Confusion about time
5. Confusion about
place
6. Problems with
judgement &
reasoning
7. Difficulty with
abstract concepts
8. Personality change
9. Mood changes
10. Loss of initiative
Causes
• Most common untreatable cause is:
– Neurodegenerative disease such as Alzheimers
• Common treatable causes:
–
–
–
–
–
stroke
pseudo-dementia (depression)
medications
metabolic disorders
infections
Diagnosis: Step 1
• Discuss your symptoms with your doctor
• Physical Examination
–
–
–
–
General physical exam
Depression screening
Neurological exam
Mental status exam
Orientation
Attention & concentration
Memory
Learning
Language
Visual-spatial skills
Executive functions
Folstein MiniMental State
Examination
(MMSE)
Montreal
Cognitive
Assessment
(MoCA)
Alzheimers Disease
Assessment Scale
(ADAS)
"AOCCDRNIG TO RSCHEEARCH AT
CMABRIGDE UINERVTISY, IT
DEOSN'T MTTAER IN WAHT OREDR
THE LTTEERS IN A WROD ARE, THE
OLNY IPRMOETNT TIHNG IS TAHT
THE FRIST AND LSAT LTTEER BE AT
THE RGHIT PCLAE."
Theory and History of the
Technology of Civilization
by Barry B. Powell
c2009
Diagnosis: Step 2
• Routine laboratory tests
–
–
–
–
–
Electrolytes, blood sugar, liver, & kidney
Blood count
Thyroid test
Vitamin B12 level
Urinalysis
Diagnosis: Step 3
• Brain scan (routine)
– CT (or MRI)
Step 4: Special Evaluations
(not routinely performed)
•
•
•
•
•
•
Neurology Consult
Psychiatry Consult
Neuropsychometric testing
Spinal Tap
EEG (electroencephalogram)
Cerebral arteriogram
Step 5: Pay the Bill
Learning Pearl
Though most UNTREATABLE
causes of dementia can only be
definitely diagnosed by AUTOPSY
OR BRAIN BIOPSY, reasonable
certainty can be made by a detailed
history, physical exam, &
laboratory tests or x-rays that
EXCLUDE TREATABLE causes
Treatment
• Specific treatment for reversible causes:
– B12, antibiotics, modify medications, prevent
stroke, treat depression, thyroid supplement,
remove/treat brain tumor, shunt for
hydrocephalous, etc.
Treatment
1. Cures
or reverse the damage
2. Delays
or stop progression
of the disease
3. Symptomatic
4. Provide Hope
Replace neurotransmitters
Decrease inflammation
Decrease toxic substances
Vaccine
• Effect of physical activity on cognitive
function in older adults at risk for
Alzheimer Disease
• Conclusion
– A 6 month program of physical activity
provided a modest improvement in cognition
over an 18 month follow-up period
Journal of the American Medical Association.
Sept 3, 2008, vol 300(9), pg 1027
• Healthy diet, exercise, and socialization
may protect against dementia.
– Healthy diet to avoid obesity may decrease risk
for dementia
– Physically active adults have lower risk for
Alzheimer’s disease than inactive adults
– Social disengagement may be a risk factor for
cognitive impairment among older persons
(Neurology Reviews, Aug 2008, pg 37)
Prevention
•
•
•
Take care of your “hardware”
Invest
in “software”
Prevent
head injuries (or stroke)
Take
care
of
the
brain’s
“vessel”
Wear
protective
headgear
Learn a new skill or hobby
Wear
seat
belts
Eat
healthy
Make new friends . . . socialize
Do
not
endorse
risky
behavior
Exercise
Keep
informed . . . read
Drug
abuse
Get
enough
Keep activelysleep
engaged . . . participate
Alcoholism
See your
doctor & listen
Stop smoking
“Anyone who stops
learning is old, whether
20 or 80. Anyone who
keeps learning is
young. The greatest
thing in life is to keep
your mind young.”
--Henry Ford
The Alzheimer’s Project
May 10, 2009
4 Part Documentary, HBO
Neurology, 2000;54:2205-2211