Dementia

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 Age Specific Dementia
Prevalence (ADI, 2009)

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 THE FUTURE FIGURES
PROJECTED DEMENTIA, ELDERLY AND TOTAL POPULATION (1990-2030)
Herderson AS, Jorm AF: Definition and Epidemiology of Dementia, p14, 2000

300 300

250
Dementia 250 Dementia
Elderly Elderly

Increase over 1990 (%)

Increase over 1990 (%)

Total Total
200 200

150 150

100 100

50 50

0 0
1990 2000 2010 2020 2030 1990 2000 2010 2020 2030

More Developed Countries Less Developed Countries

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Diagnosis of Dementia in the Philippines

OFTEN MISSED
1. Low expectations from older persons
 Decision making
 ADL’s: driving, shopping, taking public transport,
washing clothes

2. Stigma of psychiatric illness

 Rationalize
 Trivialize
 Cover up

3. Misconceptions
 It is “normal”
 No treatment
 Ready acceptance
 Interest in AD re Public Health Agencies

 Not recognized as serious problem: reasons

1. Insufficient Awareness
2. Misconceptions
3. Not Priority
4. Cultural/Family Beliefs

 Priority
1. Infectious Diseases
2. Heart Diseases
3. Cancer
4. Cerebrovascular Disease
5. Alzheimer’s Disease
 Dementia

Acquired sustained decline in

cognition which interferes with
an individual’s daily activities.
 Dementia
 Memory Impairment*
 Aphasia - disorder of language
 Agnosia - disorder of recognition
 Apraxia - impaired execution of tasks
 Executive Dysfunction - impaired abstraction,
sequencing, monitoring

Asso AP, 1993 DSM 4th ed.

McKhann G et al,Neurology 1984;34:939-944
 Cognition

Dementia
Function Behavior

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 Memory in Normal Aging vs Dementia

Normal Aging Dementia

 Slow  Slow
 Accurate recall  Inaccurate recall
 Remedied by cues e.g.  Reminders fail
appointment calendars
and lists eventually, recall is poor
despite cueing
 Stable
 Progressive decline
 Does not interfere with
function  Interferes with function
 Memory in Normal Aging vs Dementia

Normal Aging Dementia

 Misplaces items  Misplaces personal
infrequently items frequently
 Independent retrieval  Needs help from others
possible to find items
 Can follow directions  Can hardly follow
(oral or verbal) directions even with
guide
 Capable of self-care
 Gradually unable
 Evaluation

 Short Screening Tests

 MMSE

 Clock-Drawing Test

 ADAS-Cognitive

 Short Blessed

 Global Assessment
 Clinical Dementia Rating (CDR)
 Defining Terms in Filipino

 Forgetful
 “Malilimutin” (Tagalog)
 Generally used in all ages
 Acceptable in common usage

 Dementia
 “Ulianin” (Tagalog)
 More serious forgetfulness
 Implies disturbance in cognitive function and behavior
 Derogatory and disrespectful
 Often avoided
 Huwisyo
Isang salita na ang ibig sabihin ay:
 Gising (mulat ang mata)
 Tumutugon sa kanyang naririnig, nakikita, nasasalat, o naaamoy

 Nakakaintindi/Tamang bigkas ng salita

 Nakikipag-usap, tama ang sinasabi

 Nasa tama ang gawa

 Walang pagbabago sa datihan o karaniwang ginagawa

 Tamang pag-alala
 Walang problema sa pagtanda ng mga dapat tandaan o alalahanin
 Nakakaalala ng direksyon (hindi nawawala sa pamilyar na lugar)
 Natututo o napapag-aralan ang mga bagay-bagay (capable of new learning)

 May tamang pandamdam

 Hindi pabago-bago ang ugali o personalidad
 Tamang pag-uugali
 MEMORY
Memorya (Pagtanda, Pag-alala)

 Para maintindihan natin ang salitang kalimot, dapat

malaman kung paano tayo nakakatanda o
nakakaalala (nakakamemorya)
 Makakaalala tayo dahil sa ating utak
 Kung may problema sa utak, maaaring magka-
problema sa pag-alala
 Stages of Memory

 Immediate recall (Agarang pag-alala o pagbigkas)

 Pagkarinig ng salita o numero, ulitin ito

 Recent memory
 Alala ng nakaraan (oras o araw)
 Pagtanda ng pangyayari – kanina lang (episodic memory)
 “Ano ang ginawa mo kahapon?”
 “Sino ang bisita mo noong isang linggo?”
 “Ang perang hawak mo ay pambili o sukli?”
 Stages of Memory

 Remote memory
 Para sa mga nangyari noon pa (mahigit isang taon)
 Mga bagay na natatandaan gaano man katagal
 Kailan ipinanganak, wedding anniversary, pangalan ng
magulang, kapatid
Nalimutan lang o Ulyanin?
 Mga Maagang Palatandaan ng Pag-ulyanin
(Warning or Early Signs)

 Palaging nakakalimot ng pangalan o bagay-

bagay at hindi na unabis na naalala (totally
no recall)
 Pagkalimot ng kakatapos lang na
pangyayari (episodic memory)
 Hirap sa paghanap ng wastong salita para
sa gustong sabihin (loss of words)
 Mga Maagang Palatandaan ng Pag-ulyanin
(Warning or Early Signs)

 Palaging naliligaw sa dati nang pamilyar na

lugar (disorientation)
 Palagiang pagkawala ng kanyang gamit
(misplacing things)
 Paulit-ulit na pagtatanong (repetitive)
 Pagbabago ng ugali (personality change)
 Order of Forgetting

Grandchildren

Youngest Children

Oldest Children

Spouse

Mother or Father
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 Mga Sanhi ng Ulyanin

 Alzheimer’s Disease  Vascular Dementia

 slow brain atrophy  stroke

 Vascular Dementia
 stroke
Famous People with DEMENTIA
Famous People with DEMENTIA
 Alzheimer’s
Normal Brain Disease

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 Assessment

 Mini-Mental State  Clock Drawing Test

Examination (MMSE) (CDT)
 Dementia is Treatable and Preventable :
No to Nihilism and Ageism!

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 Alzheimer’s Disease
Normal Brain:
30-60
5 Genetic Environment

Brain Atrophy
4 (Neuronal Cell Death)
Neurochemical Changes

Cognitive Impairment 3

Age Associated (CIND) MCI (CIND, Early Dementia) 2

10-15%/yr mild
1-2%
moderate
1
severe

DEMENTIA ? DEMENTIA
 Why Do We Need Treatment For
Dementia?
 Dementia is a major public health issue
 Not treating will have enormous economic
consequences as populations age
 Dementia should be treated like other important
health issues facing younger patients
 We have proven effective treatments
 Improved treatments urgently needed
 Clinical trials essential to prove efficacy and safety
 Cholinergic Hypothesis

 Cholinergic neurons are essential for memory in

animal models
 scopolamine inhibition of cholinergic function results in
cognitive loss
 lesion in cholinergic tracts also results in cognitive loss
 nicotine stimulates rapid information processing
 cholinergic-rich grafts restore memory functioning

 Cholinergic neurons are lost first and most in AD

 choline acetyltransferase (ChaT) markers lost in AD
 reduced choline uptake and ACh release in AD
 neuronal loss in cholinergic nuclei in AD
Blokland (1995); Dunnett (1991); Francis et al (1999)
 Treatment in Practice

Four Patterns of Response

 Improvement or no change
 Improvement followed by deterioration after one
year
 Stabilisation followed by deterioration after one
year
 Deterioration from start
Treatment
Pharmacological
 Treatment
Non-Pharmacological
 Treatment
Non-Pharmacological (Preventive?)
“Caring is an aging process
to rediscover self”