A PUBLIC HEALTH APPROACH

TO
ALZHEIMER’S AND OTHER
DEMENTIAS

ALZHEIMER’S & OTHER DEMENTIAS –

THE BASICS
LEARNING OBJECTIVES

 Define cognitive health

 Define and differentiate between dementia and Alzheimer’s
 List at least 5 common symptoms of Alzheimer’s
 Describe the changes that occur during the course of Alzheimer’s
 Identify at least 3 risk factors associated with Alzheimer’s
 Describe the role of caregivers

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 COMPETENCIES

Association for Gerontology in Higher Education (AGHE):

1.2.1 Distinguish normal biological aging changes from pathology including genetic
factors.
1.3.3 Demonstrate knowledge of signs, symptoms, and impact of common cognitive
and mental health problems in late life (e.g., dementia, depression, grief, anxiety).
1.2.4 Recognize common late-life syndromes and diseases and their related bio-
psycho-social risk and protective factors.

Association of Schools and Programs of Public Health (ASPPH):

Domain 1: Describe risk factors and modes of transmission for infectious and
chronic diseases and how these diseases affect both personal and population health.
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COMPETENCIES CONT.

National Association of Chronic Disease Directors (NACDD):

Domain 7: Discuss the underlying causes and management of chronic diseases,
including behavioral, medical, genetic, environmental and social factors.
Domain 7: Articulate key chronic disease issues.
Domain 7: Describe socioeconomic and behavioral determinants of health
disparities.

National Commission for Health Education Credentialing, Inc. (NCHEC):

7.1.1 Identify current and emerging issues that may influence health and health
education
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DISCUSSION QUESTION

What is cognitive health?

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COGNITIVE HEALTH
 Cognition: the ability to think, learn, and remember

 Cognitive health continuum:

“optimal functioning” to severe disability
 Linked to brain health

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1
Centers for Disease Control and Prevention, Division of Healthy Aging. What is a Healthy Brain? New Research Explores
Perceptions of Cognitive Health Among Diverse Older Adults.
COGNITIVE AGING
 The brain changes as it ages

 Increase in wisdom
and expertise
 Speed of processing,
making decisions,
remembering may
decline
 Normal part of aging

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2
Institute of Medicine. (2015) Cognitive Aging: Progress in Understanding and Opportunities for Action.
3
National Institute on Aging. (2013) Understanding Memory Loss: What To Do When you Have Trouble Remembering.
MILD COGNITIVE IMPAIRMENT (MCI)
 Difficulty with cognitive processes

 Not severe enough to interfere with daily life

 Increased risk of Alzheimer’s or dementia

 May be caused by external factors (vitamin B12 deficiency,

depression)

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Alzheimer’s Association. (2012) Mild Cognitive Impairment.
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National Institute on Aging, About Alzheimer’s Disease: Mild Cognitive Impairment. Accessed June 10, 2015 from website:
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https://www.nia.nih.gov/alzheimers/topics/mild-cognitive-impairment.
COGNITIVE IMPAIRMENT

 Difficulty with cognitive processes that affect everyday life

 Spans wide range of functioning

 Can occur as a result of

Alzheimer’s, dementia, stroke,
traumatic brain injury

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Alzheimer’s Association and Centers for Disease Control and Prevention. (2013) The CDC Healthy Brain Initiative: Public
Health Road Map for State and National Partnerships, 2013-2018.
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DEMENTIA
ALZHEIMER’S AND OTHER DEMENTIAS – THE BASICS

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 DEMENTIA

 Decline in mental ability severe enough to interfere with daily life

 Not a specific disease

 Not normal aging

 Caused by damage to brain cells from disease or trauma

 Many dementias are progressive

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Alzheimer’s Association. What is Dementia? Accessed June 8, 2015 from website: http://www.alz.org/what-is-dementia.asp#causes 11
TYPES OF DEMENTIA

 Alzheimer’s disease
 Vascular dementia
 Dementia with Lewy Bodies (DLB)
 Mixed dementia
 Parkinson’s disease
 Frontotemporal dementia
 Creutzfeldt-Jakob disease
 Normal pressure hydrocephalus
 Huntington’s disease
 Wernicke-Korsakoff Syndrome

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8Alzheimer’s Association. Types of Dementia. Accessed June 8, 2015 from website: http://www.alz.org/dementia/types-of-dementia.asp.
National Institute on Aging. (2015) Alzheimer’s Disease Fact Sheet.
VASCULAR DEMENTIA

 2nd most common cause of dementia

 20% - 30% of cases

 Caused by conditions that block or reduce blood flow to the brain

 Symptoms may occur suddenly following strokes or slowly as a

result of cumulative damage

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Alzheimer’s Association. (2015) Vascular Dementia.
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ALZHEIMER’S DISEASE
ALZHEIMER’S AND OTHER DEMENTIAS – THE BASICS

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 ALZHEIMER’S DISEASE: OVERVIEW

 Most common type of dementia

 60% - 80% of cases

 Progressive – symptoms gradually

worsen over number of years

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Alzheimer’s Association. What is Alzheimer’s? Accessed June 8, 2015 from
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website: http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp
ALZHEIMER’S DISEASE: HISTORY

 Identified in 1906 by
Dr. Alois Alzheimer
 Examined brain of woman
who died after mental illness
 Found abnormal clumps (plaques)
and tangled fibers (tangles)

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11
National Institute on Aging. (2015) Alzheimer’s Disease Fact Sheet.
ALZHEIMER’S DISEASE:
PHYSICAL CHANGES
 Brain shrinks dramatically
o Nerve cell death
o Tissue loss
 Plaques: abnormal clusters
of protein fragments
 Tangles: twisted strands
of another protein

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12
Alzheimer’s Association. Brain Tour. Accessed July 1, 2015 from website:
http://www.alz.org/braintour/3_main_parts.asp
ALZHEIMER’S DISEASE: CAUSES
 Precise changes in brain largely unknown
 Probably develops as a result of complex interactions among:
o Age
o Genetics
o Environment
o Lifestyle
o Coexisting medical conditions

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Alzheimer’s Association. Risk Factors. Accessed June 8, 2015 from website:
http://www.alz.org/alzheimers_disease_causes_risk_factors.asp
 YOUNGER-ONSET ALZHEIMER’S
DISEASE

 Affects people younger than 65

 Many are in their 40s and 50s

 200,000 have younger onset (in U.S.)

 4% of population with Alzheimer’s

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Alzheimer’s Association. Younger/Early Onset Alzheimer’s & Dementia. Accessed June 8, 2015 from website:
http://www.alz.org/alzheimers_disease_early_onset.asp 19
DISCUSSION QUESTION

What are the characteristics of

Alzheimer’s disease?
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10 WARNING SIGNS OF ALZHEIMER’S

1. Memory loss that disrupts daily life

2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships

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Alzheimer’s Association. (2009) Know the 10 Signs.
10 WARNING SIGNS OF ALZHEIMER’S
(CONTINUED)

6. New problems with words in speaking or writing

7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality

16 Alzheimer’s Association. (2009) Know the 10 Signs. 22

STAGES OF ALZHEIMER’S DISEASE

 Average lifespan 4-8 years after

diagnosis; as long as 20 years
 Progresses slowly in 3 stages:

o Mild (early-stage)

o Moderate (middle-stage)

o Severe (late-stage)

Alzheimer’s Association. Stages of Alzheimer’s. Accessed June 8, 2015 from

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website: http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp 23
MILD ALZHEIMER’S (EARLY-STAGE)
 Able to function independently
 Common difficulties:
o Forgetting familiar words
o Losing everyday objects
o Trouble remembering names
o Greater difficulty performing tasks
o Forgetting material just read
o Increasing trouble with planning, organizing

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Alzheimer’s Association. Stages of Alzheimer’s. Accessed June 8, 2015 from website:
http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp
MODERATE ALZHEIMER’S (MIDDLE-
STAGE)

 Requires increasing care

 Symptoms include:
o Forgetfulness of personal history
o Confusion about place or time
o Need for help with bathing, toileting, dressing
o Changes in sleep patterns
o Increased risk of wandering
o Personality and behavioral changes

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Alzheimer’s Association. Stages of Alzheimer’s. Accessed June 8, 2015 from website:
http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp
SEVERE ALZHEIMER’S (LATE-STAGE)

 Typically longest stage

 Requires full-time care
 Loss of awareness of
recent experiences
and surroundings
 Changes in physical
abilities (walking,
sitting, swallowing)
 Vulnerable to infections

20Alzheimer’s Association. Stages of Alzheimer’s. Accessed June 8, 2015 from website: 26

http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp
RISK FACTORS
ALZHEIMER’S AND OTHER DEMENTIAS – THE BASICS

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RISK FACTORS: AGE

 #1 risk factor is advancing age

 Approximately doubles every 5

years after age 65
 1 in 3 people age ≥85

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Alzheimer’s Association. Risk Factors. Accessed June 8, 2015 from website:
http://www.alz.org/alzheimers_disease_causes_risk_factors.asp 28
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Alzheimer’s Association, 2015 Alzheimer’s Disease Facts and Figures, March 2015
RISK FACTORS: FAMILY HISTORY,
EDUCATION

 Family history

 Hereditary/Genetics

 Education, cognitive engagement

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Alzheimer’s Association. Risk Factors. Accessed from website:
http://www.alz.org/alzheimers_disease_causes_risk_factors.asp 29
RISK FACTORS: RACE & ETHNICITY

 African-Americans: 2 times greater risk

 Hispanics: 1.5 times greater risk
 Cardiovascular risk factors more common
 Lower levels of education, socioeconomic
status

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Alzheimer’s Association (2016) Alzheimer’s Disease Facts and Figures 30
RISK FACTORS: WOMEN

 2/3 of affected population

 16% of women age ≥ 71 (11% of men)
 At age 65 have more than 1 in 6 chance
(1 in 11 for men)
 Age ≥ 60, are twice as likely to develop
Alzheimer’s than breast cancer

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Alzheimer’s Association, AAIC Press Release, July 21, 2015
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Alzheimer’s Association, Public Health E-News, July 22, 2015 31
MODIFIABLE RISK FACTORS:
HEAD TRAUMA

 Moderate and severe traumatic brain

injury
o Moderate injury: 2.3 times greater risk

o Severe injury: 4.5 times greater risk

 Risk remains for years after injury

27 Alzheimer’s Association. (2015) Traumatic Brain Injury.

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MODIFIABLE RISK FACTORS: LIFESTYLE

 Increases risk
 Current smoking
 Midlife obesity
 Decreases risk
 Physical activity
 Heart-healthy diets: DASH, Mediterranean diet
 Mental and social activity

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Alzheimer’s Association. (2014) Alzheimer’s and Public Health Spotlight: Heart Health and Brain Health. 33
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Alzheimer’s Association. Prevention and Risk of Alzheimer’s & Dementia. Accessed July 16, 2015 from website:
http://www.alz.org/research/science/alzheimers_prevention_and_risk.asp
MODIFIABLE RISK FACTORS:
CARDIOVASCULAR

 Heart-head connection
 Cardiovascular risk factors:
o High blood pressure in midlife
o Heart disease
o Stroke
o Diabetes

Alzheimer’s Association. Prevention and Risk of Alzheimer’s & Dementia. Accessed July 16, 2015 from
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website: http://www.alz.org/research/science/alzheimers_prevention_and_risk.asp
TREATMENT & MANAGEMENT
ALZHEIMER’S AND OTHER DEMENTIAS – THE BASICS

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DIAGNOSING ALZHEIMER’S DISEASE

 No single test
 Medical evaluation
o Medical history
o Mental status testing
o Information from
family and friends
o Physical and neurological exams
o Rule out other causes

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Alzheimer’s Association. Diagnosis of Alzheimer’s Disease and Dementia. Accessed June 8, 2015 from website:
http://www.alz.org/alzheimers_disease_diagnosis.asp
TREATING & MANAGING ALZHEIMER’S

 No cure
 Drug and non-drug treatments
 Primary goals of treatment:
o Maintain quality of life
o Maximize function in daily activities
o Enhance cognition, mood, behavior
o Foster safe environment
o Promote social engagement
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Alzheimer’s Association. Health Care Professionals and Alzheimer’s. Accessed June 8, 2015 from website:
http://www.alz.org/health-care-professionals/medical-management-patient-care.asp
ALZHEIMER’S: CO-MORBIDITIES

 Additional chronic conditions (e.g., heart

disease, diabetes, depression)
 Difficult to manage
 Higher rates of hospitalizations
and costs
o 3 times as many hospital stays
o 3 times average Medicare costs
 Preventable hospitalizations

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Alzheimer’s Association. (2013) Combating Alzheimer’s Disease: A Public Health Agenda.
UNIQUE ASPECTS
ALZHEIMER’S AND OTHER DEMENTIAS – THE BASICS

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ALZHEIMER’S: UNIQUE ASPECTS

 Financial hardship

o May lose income and savings

o Increased reliance on public programs
 Stigma

 Vulnerability to abuse

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Alzheimer’s Association. Abuse. Accessed July 16, 2015 from website: https://www.alz.org/care/alzheimers-dementia-elder-abuse.asp
CAREGIVERS
ALZHEIMER’S AND OTHER DEMENTIAS – THE BASICS

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ALZHEIMER’S: CAREGIVERS

 Responsibilities:
o Dressing, bathing, toileting, feeding
o Shopping, meal preparation, transportation
o Medication
o Financial management
o Emotional support
 Increasing levels of care
 Results in complete dependence

35 Alzheimer’s Association. (2015) Alzheimer’s Disease Caregivers.

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CAREGIVERS: CHALLENGES

 Physical, financial, psychological challenges

o $10.2 billion additional annual health care costs (2015)
o 60% rate emotional stress as high or very high
o 40% suffer from depression

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Alzheimer’s Association. 2016 Alzheimer’s Disease Facts and Figures.
CONCLUSION: KEY POINTS

 Disease likely develops as result of multiple factors

 Symptoms worsen over time; average lifespan 4-8 years (up to 20)
 Risk factors include: age, family history, head trauma, education,
lifestyle, cardiovascular conditions
 African-Americans, Hispanics, women more likely to develop

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ROLE OF PUBLIC HEALTH

 3 key public health intervention tools:

o Surveillance/monitoring
o Primary prevention (risk reduction)
o Early detection and diagnosis

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DEMENTIA CAPABLE SYSTEMS AND
DEMENTIA FRIENDLY COMMUNITIES

 Dementia capable systems

o Public health research and translation

o Support services
o Workforce training
 Dementia friendly communities

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FOR MORE INFORMATION

For more information, please visit the Alzheimer’s Association

website at: http://www.alz.org

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