DEMENTIA DEMENTIA Dr. Ross Alexander Dunne Consultant Old Age - - PowerPoint PPT Presentation

DEMENTIA DEMENTIA

• Dr. Ross Alexander Dunne

Consultant Old Age Psychiatrist Dementia Lead, NIHR-CRN:GM Clinical Director GM Dementia Research Centre Honorary Senior Lecturer, University of Manchester Academic Lead Manchester D-TRC 1

• More people will develop in LMICs
• Most research is WEIRD (Western, Educated,

Industrialised, Rich, Democracies)

• More people are living with dementia than ever,

but a smaller proportion of the elderly are developing it in WEIRD countries

• 50 million people worldwide = Spain / South

Korea population

WORLD ALZHEIMER WORLD ALZHEIMER REPORT 2018 REPORT 2018

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THE SYNDROME THE SYNDROME A decline in 2 or more areas of cognition below the level needed for "normal" (for you) function during everyday living THE DISEASES THE DISEASES Alzheimer disease THE SUBTYPES THE SUBTYPES If independence and "normal" function is maintained, but there is objective pen-and- paper impairment then you have "Mild Cognitive Impairment" Lewy body disease Frontotemporal dementia Vascular dementia Classic hippocampal Posterior variants Language presentation Movement presentation Cognitive presentation Language

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Behavioural Subcortical Post stroke

DISEASE PROCESSES DISEASE PROCESSES

PRIMARY NEURODEGENERATIVE PRIMARY NEURODEGENERATIVE Alzheimer (Amyloid + Tau) Lewy Body (alpha - syn) FTD (Tauopathy) SECONDARY NEURODEGENERATIVE SECONDARY NEURODEGENERATIVE Cerebrovascular disease Infectious (nvCJD) Toxic (Alcohol) - not Korsakoff's

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Why do people come to clinic? Symptoms + Insight Symptoms + problems (for other people) Neuropsychiatric complications of disease Self-neglect Motivation Mood Sleep

DIAGNOSING DEMENTIA DIAGNOSING DEMENTIA

Mandatory stock image of elderly person’s hands (holding version, note tasteful crochet) Mandatory stock image of elderly woman staring wistfully out a window

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https://knightadrc.wustl.edu/cdr/cdr.htm 9 . 1

https://knightadrc.wustl.edu/cdr/cdr.htm

The CDR is the standard research tool for grading dementia severity. People with a CDR of 0 have no

• bjective cognitive
• impairment. Those with 0.5

have mild cognitive impairment.

What is missing ????

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https://knightadrc.wustl.edu/cdr/cdr.htm

Very severe (4) Complete memory loss and poor speech Not oriented to person Unable to speak or

• nly just

Bedbound Help eating & toileting Completely physically dependent

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ALZHEIMER DISEASE ALZHEIMER DISEASE

2 PROTEINOPATHIES 2 PROTEINOPATHIES

• 1. AMYLOIDOSIS

AMYLOIDOSIS

• 2. TAUOPATHY

TAUOPATHY

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ALZHEIMER DISEASE ALZHEIMER DISEASE

AMYLOID IMAGING AMYLOID IMAGING

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ALZHEIMER DISEASE ALZHEIMER DISEASE TAU IMAGING TAU IMAGING

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ALZHEIMER DISEASE ALZHEIMER DISEASE PET - MRI PET - MRI

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MILD COGNITIVE IMPAIRMENT MILD COGNITIVE IMPAIRMENT

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EARLY DIAGNOSIS IS IMPORTANT EARLY DIAGNOSIS IS IMPORTANT

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MEDIAL TEMPORAL LOBE MEDIAL TEMPORAL LOBE Hippocampus PHG Entorhinal cortex MTA score - marker of neuronal i j

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BRAAK AND THE UNITARY HYPOTHESES BRAAK AND THE UNITARY HYPOTHESES

Protein folding and aggregation Geographical predeliction Prodromal sequence Protein overlap Gradual Generalisation Mitcohondrial and energy dysfunction Long unmyelinated neurons

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SURVIVAL SURVIVAL

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AD V DLB SURVIVAL AD V DLB SURVIVAL

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PARKINSON'S DISEASE PARKINSON'S DISEASE

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Coyle-Gilchrist et al 2015 Neurology

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Coyle-Gilchrist et al 2015 Neurology

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2015 - 2017 PREMATURE DEATHS FROM STROKE 2015 - 2017 PREMATURE DEATHS FROM STROKE

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2015 - 2017 PREMATURE DEATHS FROM HEART DISEASE 2015 - 2017 PREMATURE DEATHS FROM HEART DISEASE

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Prevalence PAR 1000s of cases

DEMENTIA PREVENTION PAR DEMENTIA PREVENTION PAR

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