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Advance Dementia Conference May 17 from http://www.alz.org/

connie dello buono

Connie’s notes:  I will be editing these notes soon.

Age is a risk factor in Dementia from 114 studies.

N Manhattan , carribean women , 8% – 74% under 65% age range , 24-63% over 85 age ; twice the range compared to Hispanics and African American

1950, Guam, late onset , nuero fibrlattory tangles no plaque , 9% guam dementia, 3% from other causes
for incidence:
> carribean

Disaggregate data: Lowest and highest prevalence in Latino – Hispanic

Epidemeology

Kaiser data

Healthcare utilization, 1 visit per year
Starting age 65 yrs of age

  1. African American highest
  2. American Indian and Alaska natives
  3. Latinos , Mexican , Pacific Islanders
  4. Asian Americans: Chinese, Filipino, Japanese

What proportion shall develop Dementia, more than 1 in 4 at age 65 shall develop Dementia in their lifetime.

70% dementia higher in African American

Lifetime risk is higher in all race

Causes Dementia: Social and behavioral factors are primary factors

Years of formal education and vascular risk factors are factors contributing to Dementia.

20,000 LGBT seniors in SF , In 2013 LGBT access fewer than 10% services by admin of aging. 1. Ageism, homophobia, transphobia, heterosexism ; forces ; Health equity Issue: one third ; single, childless and living alone, did not have informal caregiving support ; 44% of transgender seniors fear accessing services, they experience distress,

Do not assume caregiving needs based on sexual status. Ask people how they identify themselves.

Dr Frank Longo , Stanford

We need randomized trial, prospective trial.

Pharmacologic intervensions: What about non-pharmacologic?

           Be a champion for those with Alzheimer’s disease.

Creating a world without Alzheimer’s disease.

Katrina.lastname@ucsf.edu

DR Anna Chodos , geriatrician. UCSF

CVD risk modification

AD cognitive toolkit

Annual functional and cognitive monitoring and reassessing at regular intervals. Upon sudden

1 MOCA and 2 ADA

Know your patient: beneficial interaction with impact, disease mgt – progression and stages , managing the comorbidity , consider using appropriate meds,

First line of Tx: behavior meds, simplifying tasks, involving mental health pros, de-emphasize meds.

Thyroid med, not taken Delirium

Dr Maldonado, psychosomatic med at Stanford, adult psychiatry, addiction med, forensic med

Common Dx 1. 6 leading causes of preventable disease

Change protocol to sedate heart surgery patients reduces incidence of Delirium. Help reduces 40% delirium

If you have any cognitive impairment, developing delirium will dramatically accelerate progression of disease

Death rate 1 to 8%

Survival rate, no delirium, delirium for 1 d .

$164B delirium costs per year

Dx delirium more effectively:

  1. Hyper active delirium
  2. Hypo = common ; 60% ; most people cannot recognize it ; depressed or delightful
  3. Mixed = not real

If med service call psy to assess: 50-50 depression or delirium , 46% depressed has hypo active delirium , greater incidence of persistence delirium, lowest amount of acetycholine in their brain.

The most abundant dietary sources of choline—a precursor to acetylcholine—are animal fats such as egg yolks, cream, fatty cheeses, fatty fish, fatty meats, and liver. Non-animal sources include avocadoes and almonds.

Physical therapist can diagnose delirium better.

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