Dementia and Its Impact on Society

Lecture 7 - Dementia Diagnosis

• Dementia is a general term encompassing various conditions causing brain damage and changes
• It's not a disease itself; it describes impaired ability to perform daily tasks (TDLs) like dressing, showering, cooking, cleaning, etc.
• TDLs are impacted in dementia, affecting older adults
• Dementia has a clear neurological basis, involving accelerated neurodegeneration in specific brain areas
• 850,000 people in the UK (2019 study) = 1 in 14 people over 65+ are living with dementia
• Over 1.5 million dementia cases are forecast for the UK in 2040

Lecture Outline

• The lecture covers an introduction to aging and dementia, biological, cognitive, and neurophysiological/psychosocial aging
• Discusses MCI (mild cognitive impairment) diagnosis, research, and treatment
• Includes dementia diagnosis, research, and treatment
• Examines topics on living with dementia and dementia-friendly practices
• Emphasizes revision, feedback, and reflection

Overview of Today's Lecture

• Part One: What is dementia? - covers Alzheimer's Disease and Vascular Dementia causes and diagnoses
• Part Two: Frontotemporal Dementia and Lewy Body Dementia causes and diagnoses. Also a summary.

Part One: Dementia Diagnosis - Clinical Symptoms

• The lecture discusses the clinical symptoms of dementia

What is Dementia?

• Dementia is not a disease, but a general term.
• It describes the reduced ability to make decisions, remember, and perform everyday tasks.
• It's not part of normal aging, typically affecting older individuals..
• Specific parts of the brain show accelerated neurodegeneration.

Alzheimer's Disease

• Alzheimer's Disease (AD) is the most common form of dementia.
• It's characterized by : neurofibrillary tangles of tau protein in cells, amyloid plaque accumulation
• This leads to cell death and brain shrinkage.

Vascular Dementia

• Reduced blood flow to the brain (small vascular disease) is the cause
• Symptoms can be sudden or gradual. Can be preceded by cardiovascular diseases (CVD)
• The flow of blood into the brain is affected.

Frontotemporal Dementia

• Causes involve changes in the frontal and temporal lobes of the brain.
• Symptoms include personality changes, issues with language, and impaired behavior.

Lewy Body Dementia

• Lewy body protein is deposited on nerve cells. This is characterised by: hallucinations, sleep disturbances, and impaired thinking.

Other Dementias

• Other types involve connections to Parkinson's Disease, Huntington's, and HIV and others
• These are included under the umbrella term of Dementia

Different Types of Dementia

• Alzheimer's disease, Vascular dementia, Frontotemporal dementia, Lewy body dementia, Other Dementias.
• Prevalence, symptoms, and characteristics of each type are covered

Alzheimer's Disease (AD) - Cause

• Neuropathologically characterized by the presence of neurofibrillary tangles (Tau protein) and amyloid plaques in cell bodies.
• This leads to cell death and brain shrinkage

How Does Alzheimer's Change the Brain?

• This topic likely discusses visual aids related to brain changes in Alzheimer's

Alzheimer's Symptoms

• This section covers symptoms including memory loss, poor judgment, loss of initiative, taking longer for daily tasks, repeating questions, trouble handling money, wandering.

Factors Associated with Alzheimer's

• Factors such as aging, smoking, stroke, head injury, diabetes mellitus, hormonal abnormalities (menopause), and conditions like alcohol abuse and depression are discussed.

Stages of AD Diagnosis

• Tests, assessments, and differentiating AD diagnosis are covered.

Vascular Dementia (VD) - Cause

• Reduced blood flow to the brain (small vascular disease) causing cognitive decline.
• This leads to dysregulation of cerebral perfusion, blood-brain barrier (BBB) function, and neurovascular unit (NVU) coupling.
• It can cause sudden or slow changes in cognitive ability.

Symptoms of Vascular Dementia

• Cognitive deficits and neurological symptoms like memory impairment, aphasia (difficulty speaking), apraxia (difficulty with motor movement), tremor and balance issues.
• Temporal lobe damage leads to aphasia and memory loss. Parietal lobe damage causes movement problems (apraxia).

Central Pathway of Vascular Dementia

• Risk factors such as DM (Diabetes Mellitus), HTN (High Blood Pressure), and HLD (High Cholesterol) for vascular decline cause impairment.

Frontotemporal Dementia (FTD): Causes

• Genetic mutations are associated with this type of dementia.
• Major mutations involve the tau gene (MAPT), the GRN gene, and the C9ORF72 gene.
• These mutations can disrupt protein production and transport processes in the brain
• The gene mutations tend to have behaviors linked to frontotemporal dementia.

Types of Frontotemporal Dementia

• Includes behavioral variants (bvFTD), primary progressive aphasia (PPA) Movement Disorders (FTD-MND) & others
• These subcategories can exhibit overlapping symptoms

Frontotemporal Dementia (FTD): General Symptoms

• Socially inappropriate behavior (impulsivity, lack of sympathy), difficulty with mental flexibility, reduced personal hygiene, language problems (slow speech, word repetition), movement problems (slow, stiff), lack of bladder/bowel control

Frontotemporal Dementia (FTD): Sub-Type Symptoms

• Detailed diagnostic criteria for different subtypes of FTD are presented (bvFTD, PPA, etc.)
• Assessment criteria include behavior changes, language issues, and other findings including possible structural and/or functional impacts

FTD-MND/FTLD: Diagnosis

• Diagnosing FTD is challenging given its many subtypes
• FTD-MND/FTLD shares traits with FTD and includes ALS.
• Clinical assessment includes examining synapse loss, neuronal loss, and atrophy in frontal and temporal lobes.
• Tau and TDP-43 protein presence is noted in diagnosis

FTLD Classifications

• Comprehensive classification of FTLD-related cases by subtypes (Tauopathies, TDP-43 proteinopathies, Others)

Lewy Body Dementia (DLB) - Causes

• Lewy bodies, a protein deposit, are linked to DLB and a commonality with Parkinson's Disease.
• Patients with Lewy bodies tend to have neurofibrillary tangles and Aβ plaques similar to other forms of dementia
• Risk factors for DLB include age over 60, male gender, family history of DLB or Parkinson's.

DLB-Genetics

• Recent research links particular genes are associated with Lewy Body Dementia (GBA, TMEM175, BIN1, SNCA, APOE).

DLB Symptoms

• Main symptoms include visual hallucinations, cognitive fluctuations affecting memory and attention, movement changes such as tremors and rigidity, behavioral changes, and sleep problems such as insomnia.

Challenges in Dementia Diagnosis

• Several conditions share similar symptoms to dementia types (e.g. delirium, depression, thyroid issues, liver/kidney problems, urinary tract infections, and stroke).
• Visual and/or hearing difficulties can also make diagnosis challenging.

National Dementia Strategy (2009)

• Key focus on earlier diagnosis of dementia is emphasized as an integral part of the strategy.
• Problems include the lack of a definitive diagnosis, making early detection difficult

Summary of Today's Lecture - Table

• Overview table with key information for each dementia type (Alzheimer's, Vascular, Lewy Body, Frontotemporal)
• Includes description, cause/heredity, and main pathological features/symptoms.

Reading List

• Included relevant articles, guidelines, and websites for further study on particular dementia diagnoses and research.

Additional Notes (Possible)

• Additional information regarding diagnostic criteria and imaging (e.g., SPECT, PET, MRI) or other methods, may be present since images and charts/graphs are included in the OCR output.

This quiz explores the economic effects of dementia, focusing on key aspects such as government funding for research, symptoms of different types, and the underlying neuropathological changes in the brain. Test your knowledge on dementia and its comparison with other diseases like cancer.