Is he mentally ill?

In elderly, people often assume that state can’t be fixed and so don’t look into it

May be superimposed on another diagnosis

Drug intoxication (including prescriptions)

• Drug intoxication (including prescriptions)

• Infections

• Fever

• Malnutrition

• Head trauma

• Pneumonia

• Congestive heart failure

• Cancer

• Uremia

• Dehydration

• Stroke

• Treatment: medical emergency

• Usually reversible
• May involve medications (neuroleptics or benzos for drug withdrawal)
• May involve environmental manipulations such as orienting techniques

Senility

• Senility

• Gradual deterioration of intellectual abilities to the point that social and occupational functioning are impaired.

• Onset is typically gradual

• Memory for recent events is affected in early stages.

• With time, increasingly marked comprehension, motor control, problem solving and judgment

• Often accompanied by impairment in emotional control or moral or ethical sensibilities

• Dementia may be progressive or static

• Occasionally reversible if underlying cause can be treated

• Causes: stroke, degenerative diseases (Alzheimer’s, Huntington’s, Parkinson’s), infectious diseases (syphilis, meningitis, AIDS), intracranial tumors and abscesses, dietary deficiencies (B vitamins), head injury, anoxia, toxic substances

• 30 % of those over 80

• 3-9% of world’s adults

• 5 million Americans

• 70 forms identified

Most common form of dementia. Accounts for 50-66% of all cases.

• Most common form of dementia. Accounts for 50-66% of all cases.

• Sometimes occurs in middle age (called early onset), but most often after age 65 (late onset). Prevalence markedly increases in late 70s and early 80s.

• Problem may be underestimated.

• Women have a slightly higher risk.

• May survive for 20 years, but time between onset and death is usually 8-10 years.

Begins with mild memory problems, lapses of attention, difficulties in language and communication.

• Begins with mild memory problems, lapses of attention, difficulties in language and communication.

• As symptoms worsen, difficulty completing complicated tasks. Eventually, sufferers have difficulty with simple tasks, distant memories are forgotten, changes in personality are very noticeable.

• Typically early on deny they have a problem. Then become anxious or depressed about state of mind. Many become agitated.

• As sx worsen, show less and less awareness of limitations.

• During late stages, may withdraw. Also late stage—wandering, confused about time and space.

• Eventually fully dependent. Fail to remember close relatives. Uncomfortable at night (sundowners). Late phase may last 2-5 yrs.

• Stay physically healthy until later stages of disease. Often succumb to opportunistic infections—spend a lot of time lying—prone to pneumonia.

• Can only be officially diagnosed after death

Marked by neurofibrillary tangles

• Marked by neurofibrillary tangles

• Twisted protein fibers found within the cells of the hippocampus and other areas.
• Occur in all people as they age, but Alzheimer's patients have lots

• Senile plaques

• Sphere-shaped deposits of a small molecule called beta-amyloid protein that form in the spaces between cells in the hippocampus, cerebral cortex, and other areas.
• Normal part of aging, Alzheimer's patients have lots. In most people, these are comprised of 40 amino acids with a few that have 42. In Alzheimer's, there are many more AB42s.
• Plaques may interfere with communication between cells and so cause cell breakdown or cell death.

Genetics

• Genetics

• Many, but not all cases, run in families.

• Distinguish between familial vs. sporadic Alzheimer's

• Early onset—three rare genetic mutations that can cause this (about 5% of cases)—on chromosomes 21, 14, 1

• Late onset—chromosome 19

• MZ twins are not perfectly concordant.

• Genetic risks interact with environment—diet, exposure to metals such as aluminum, experiencing head trauma

• Exposure to ibuprofen may be protective

No effective treatment exists

• No effective treatment exists

• Medications such as Cognex and Aricept and Namenda help delay

• Work on vaccines continues

• Behavioral techniques to control wandering, incontinence, inappropriate sexual behaviors, and poor self-care

• Treating caregivers—social death of the patient; anticipatory grief

• Caregivers are at risk for depression
• Counseling and support are effective
• About 70% live at home
• ¾ of caregivers are women
• Caring for a loved one takes an average of 69-100 hours per week
• Major worries of caregiver—54% -cost of help, 49%-Alzheimer's related stress on family, 49%-lack of time to attend to own needs; Alzheimer's Assoc, 1997, Thomas et al 2002