Alzheimer's disease

Alzheimer’s Disease : 

Alzheimer’s Disease Laura King BNPCS3 Principles of Clinical Science and Therapeutics for Nutrition and Dietetics

Alzheimer’s Disease : 

2 Alzheimer’s Disease Dementia UK: the full report. Alzheimer’s Society 2007 Increased life expectancy = increased dementia in old age Current cost to UK = £17bn, 5% of GDP

Alzheimer’s Disease : 

3 Alzheimer’s Disease Definition Aetiology, risk factors & epidemiology Disease impact NICE guidance for treatment Dietary management Agencies involved in care

Definitions : 

4 Definitions Dementia: progressive decline in memory, reasoning and communication skills loss of skills required to carry out daily activities caused by structural and chemical changes in the brain Alzheimer’s disease: Formation of cortical amyloid plaques Neurofibrillary tangles in neurones Leads to gradual onset of dementia Source: Ginkgo: A Web-based Resource Centre on dementia Care

Plaques & Tangles : 

5 Plaques & Tangles Source: www.ahaf.org

Neuroimaging - PET Scan : 

6 Neuroimaging - PET Scan Landau, S. M et al. 2008

Hypothetical causes : 

7 Hypothetical causes Adapted from: Ritchie and Lovestone 2002

Hypothetical causes : 

8 Hypothetical causes Adapted from: Ritchie and Lovestone 2002

Diagnosis : 

9 Diagnosis Gold standard = neuropathological findings on autopsy Bird 2008

Diagnosis : 

10 Diagnosis Clinical diagnosis correct in 80-90% of cases Visuospatial skills eg. map reading may deteriorate before memory-loss noticeable (Johnson et al. 2009) Clinical signs = slowly progressing dementia Detailed history from relatives can confirm deterioration in intellectual functioning Neuroimaging shows gross cerebral cortical atrophy

Presentation & Symptoms : 

11 Presentation & Symptoms Burns, A. et al. BMJ 2009;338:b158

Disease impact – global : 

12 Disease impact – global World Alzheimer Report 2009 - Alzheimer’s Disease International

Disease impact - economic : 

13 Disease impact - economic Source: Dementia UK: the full report. Alzheimer’s Society 2007

NICE Guidance – Treatment : 

14 NICE Guidance – Treatment Dementia often presents with mixed pathology, but treat according to dominant condition Refer to Memory assessment services Promote independence and maintenance of function Offer participation in a structured group cognitive stimulation programme Use an assessment and care-planning approach to manage symptoms in the most appropriate manner for the patient Source: NICE-SCIE. 2006 Dementia Clinical guideline 42

NICE Guidance – Pharmacological : 

15 NICE Guidance – Pharmacological In moderate Alzheimer’s (MMSE score 10-20) prescribe acetylcholinesterase inhibitors: Donepezil Galantamine Rivastigmine Source: NICE-SCIE. 2006 Dementia Clinical guideline 42

Acetylcholinesterase Inhibitors : 

16 Acetylcholinesterase Inhibitors Source: Rang et al 2001

Dietary Management : 

17 Dietary Management Problems: Underweight and weight loss are common in demented patients Consequence of inadequate energy intake due to poor eating habits, not the disease per se Agitation and pacing behaviour may increase energy requirements Infections are common and increase likelihood of malnutrition Nutritional interventions: Finger foods may help people with short attention spans Food fortification to increase energy intake Environment and social setting is pleasant and conducive to eating Patient dignity preserved Patient-specific problems are addressed Thomas & Bishop 2007

Multi-agency care network : 

18 Multi-agency care network Adapted from: Copeman et al. 1999

Summary : 

19 Summary Progressive disease Age-related Drug treatment retards progression Multi-agency care required Cost of care will be a challenge in UK & globally

References : 

20 References Bird, T. D. (2008) Genetic aspects of Alzheimer disease. Genetics in Medicine, 10, 231-239. Burns, A. & S. Iliffe (2009) Alzheimer's disease. British Medical Journal, 338. Copeman, J., K. Hyland & G. Oldfield (1999) Postregistration training and education: the NAGE experience. Journal of Human Nutrition and Dietetics, 12, 395-402. Johnson, D. K., M. Storandt, J. C. Morris & J. E. Galvin (2009) Longitudinal Study of the Transition From Healthy Aging to Alzheimer Disease. Archives of Neurology, 66, 1254-1259. Landau, S. M et al (2008) Comparing rates of change in cognitive measurements and regional glucose metabolism in Alzheimer's disease and mild cognitive impairment: Data from the Alzheimer's disease neuroimaging initiative. Neurology, 70, A447-A447. Rang HP, Dale MM and Ritter JM. (2001) Cholinergic transmission. In: Pharmacology, 4th edition. Edinburgh, UK: Harcourt Publishers Ltd, 110–138. Ritchie, K. & S. Lovestone (2002) The dementias. Lancet, 360, 1759-1766. Thomas, B and Bishop, J. 2007. Ch 4.30 Dementias. In Manual of Dietetic Practice, 4th Edition. Oxford, UK: Blackwell Publishing Ltd, 341.