Alzheimers Disease Dr Tayseer Zein FRCP MD Senior

Alzheimer's Disease Dr. Tayseer Zein FRCP MD Senior Consultant Neurologist Head, Department of Neurology Al Qassami Hospital - Sharjah

Ø The fog comes first on little cat feet Ø The fog thickens Ø Then, the fog is complete Ø Death, when it comes, is a formality

Incidence Ø 36 million in the world Ø 3 times by 2050 Ø 6 th cause of death Ø Age > 65 10% Ø Age > 85 50% Ø Expensive 200 billion per year in USA

Definition Ø A clinical syndrome of insidious onset Ø Progressive decline in cognition Ø Interferes with activities of daily living Ø Inappropriate for age and background

How Alzheimer’s Disease does Brain Damage

How Alzheimer’s Disease does Brain Damage

What Triggers the Process Ø Age Ø Genetic factor (* Apo E 4 on chromosome 14) Ø Head trauma Ø Lack of education Ø Increase maternal age Ø FH of Down’s syndrome

What other factors in the future Ø Lack of physical activity Ø Hormonal deficiency

Criteria for diagnosis of probable Alzheimer’s Disease Ø Ø Ø Deficits in > 2 areas of cognition Worsening of memory & 1 cognitive function Age: 40 - 90 years No disturbance of consciousness Exclusion of secondary causes of dementia

Diagnostic accuracy is crucial Ø Reversible dementia (10 - 15%) Ø Educating family members & caregivers Ø Make appropriate plans

Diagnosis of Alzheimer’s Disease Ø An exclusion diagnosis Detailed history Detailed mental state examination Free test is at: www. medafile. com Neuroimaging Blood tests

History Ø Baseline character, personality & education Ø The change in which domains of cognition Ø The impact of changes on DLA Personal skills Family Work Financial matters

Blood Tests Ø TFT Ø LFT Ø UES Ø B 12 level

Diagnosis of Alzheimer’s Disease Ø An Active diagnosis - SPECT (Functional MRI) - Amyloid PET scan - CSF & blood biomarkers

Normal Brain Alzheimer’s Brain

CSF Biomarkers Ø Decrease Beta amyloid in CSF Ø Increase Tau protein in CSF Ø Decrease Synclein protein in CSF

Blood Biomarkers Ø Reduced Cortizol Ø Reduced CRP Ø Reduced Alpha interferon plasma protein Ø Increase Interleukein-13

Neuropsychiatric changes in Alzheimer’s disease Ø Depression 20% Ø Delusions 40% Ø Hallucinations 25% Ø Anxiety 20% Ø Aggression 50%

Management of Alzheimer’s Disease AD is a condition we can treat even though we don’t have a cure yet

The Dementia Care Package Ø Directed towards the patient & caregivers Ø Delay functional decline & disability Ø Control symptoms Ø Maximization of quality of life Ø Support caregivers

Pharmacological Therapy for Cognitive Symptoms Cholinesterase Inhibitors Ø Increase Acetylcholine in the brain Ø Delay deterioration of function in ADLS Ø Donepezil, Rivastigmine & Galantamine

Memantine Ø Ø NMDA receptor antagonist Regulate Glutamate in the brain Protect brain cells from exitotoxicity Delay worsening of symptoms

Future drugs for Alzheimer Disease Ø Monoclonal antibodies Ø Beta secretase inhibitors Ø Selective partial alpha nicotinic agonist Ø Immunoglobulins Ø Magnetic stimulation during brain training

Pharmacological Therapies for psychiatric manifestations Ø Ø Ø Anti dementia drugs SSRI Atypical antipsychotic drugs Smallest dose for short period

Non pharmacological Intervention for Patient Care Ø Create Calm environment Ø Caregivers’ reaction should be in a calm controlled manner Ø Avoid darkness

Ø Ensure Safety environment Ø Keep daily living routine Ø Regular general medical health monitoring Ø Discuss advanced care planning

Interventions for Supportive Care to Caregivers Ø Education of AD Ø Accession to resources Ø Long term plan Ø Emotional support

Prevention Ø Vitamin E (dose < 400 IU/ day ) Ø Higher education Ø Increase physical activity Ø NSAI agents Ø HRT Ø Mediterranean diet Ø Statins Ø Control of Hypertension & Diabetes mellitus

Thank You