DrBruceBomans alzheimers disease

Bruce Boman Median  Median  Median  Median  Median  age age age age age in China is 35.5 years in Australia is 38 years in Singapore is 39 years in Hong Kong is 42 years Japan is 45 years Australia 12.8%  Japan 18%  Because of  Reduced infant mortality  Control of infectious diseases  Higher living standards  And so your country will age at a historically unprecedented rate  More swiftly than even Thailand  Percentage of elderly people living with their children has declined  More elderly people are either living with their spouse or living alone  Increased number of “skipgeneration” households where grandparents are living with their grandchildren   In 1992 83 % of elderly Vietnamese lived with their children  In 2008 this had fallen to 70% Males 70 years  Females 75 years   By 2034 your Ageing Index is projected to hit 100, meaning number of people over 60 years will outnumber children 15 years & under For every one hundred children & adolescents 15 & under  There will be 160 people 60 & over   All autosomal dominant gene mutations lead to excess production of amyloid beta 42 (Ab42) Normal brain Severe Alzheimer’s Dystrophic neurites Neuron with fibrillary tangles made of tau protein Central core of amyloid beta 42 PIB scan  CSF biomarkers   Decreased levels amyloid beta Increased levels tau Emotional support to patient & family  Sensitive disclosure of diagnosis & prognosis  Seeing spouse or parent dement is very distressing experience-like a slow bereavement  Treat depression & behavioural disturbances (details later)  Aim to reverse deficiency of acetylcholine in the cerebral cortex found in Alzheimer’s disease  Medications work by inhibiting acetylcholinesterase, the enzyme which metabolises acetylcholine     Acetylcholine pathways start in nucleus basilis of Meynert & spread out to most of cerebral cortex Nucleus basilis affected very early by Alzheimer pathology Results in lack of function of acetylcholine transmission Donepezil (Aricept) Galantamine (Reminyl) Rivastigmine (Exelon) All inhibit acetylcholinesterase & increase availability of acetylcholine in the cerebral cortex  No difference in efficacy  All need careful titration to avoid gastrointestinal side effects  Modest efficacy  About 2-3 point difference on MMSE over placebo  May be small improvement in cognition first three months  Main action is to delay progress of the dementia by about six to nine months  Continue to work in advanced stages of the illness   Do you have any questions? ... the most common:  Alzheimer’s disease 60%  Vascular dementia 20%  Dementia with Lewy bodies 10%   But because we have limited time I will focus on Alzheimer’s disease Alzheimer worked with... years Australia 12.8%  Japan 18%  Because of  Reduced infant mortality  Control of infectious diseases  Higher living standards  And so your country will age at a historically unprecedented