Martha Stearn, MD
Institute for Cognitive Health
St John’s Medical Center
Jackson, Wyoming
 2% of the total body weight
 Uses 20% of the body’s blood supply
 Achieves it’s maximum weight at age 20
 Most of brain’s oxygen use goes to grey matter
Infancy communication
Childhood language and spatial
Young Adult brain growth peaks
Middle Age memory, learning,
more difficult
Old Age continued slowing, more
memories and wisdom
 The Cerebrum
 Brain Stem
 Cerebellum
 100 billion cells
 One trillion connections
 SEROTONIN low levels in depression
DOPAMINE low levels in DLB
 ACETYLCHOLINE low levels in AD, TBI, DLB,
Vascular dementia
 NOREPINEPHRINE
 GLUTAMATE high levels in AD
 Loss of intellectual abilities of sufficient severity to
interfere with occupational or social functioning
 to the point that one cannot function independently
successfully
The Memory Continuum
 PRECLINICAL the stage is being set
 CLINICAL Mild Cognitive Impairment
 DEMENTIA Conversion to dementia
 All involve abnormal deposition of specific proteins in
the brain (amyloid and tau) that is a progressive
process gradually damaging more neurons over time
 Clinical significance
These proteins can be biomarkers for identifying
those at risk
 Certain lifestyle changes have been shown to reduce that rate
of protein deposition
 Research geared toward drugs that will eliminate, prevent or
dissolve these proteins
The Dementias
 Alzheimer’s Disease
 Vascular Dementia
 Dementia with Lewy Bodies
 FrontoTemporal Dementia
 Dementia of Parkinson’s Disease
 NPH
85
disease by age
AMNESIA)
 Short term memory loss (
and at least one of the following domain
dysfunctions:
APHASIA
AGNOSIA
ABSTRACTION
APRAXIA
 Also known as multi-infarct dementia
 Often presents as a mix with AD
 Risk factors similar to those for heart disease:
 Hyperlipidemia
 HTN
 Smoking
 Diabetes
 Family history for vascular disease
Onset may appear more rapidly than AD
May not be progressive if risk factors controlled
 VISUAL-SPATIAL PROBLEMS OFTEN MORE
PROMINENT FROM THE START
 HALLUCINATIONS COMMON
 MENTAL STATUS TENDS TO FLUCTUATE
UNPREDICTABLY
 DIFFICULTY WITH CIRCADIAN RHYTHM
 PARKINSONISM ON PHYSICAL EXAM
 More common than AD in the 50-65 age group
 Memory loss less likely to be presenting
symptom
 Behavioral issues, change in personality,
disinhibition are presenting hallmarks
 Language difficulties
 Cholinesterase inhibitors
 Donepezil
 Rivastigmine
 Galantamine
Glutamate inhibitor
Memantine
Atypical antipsychotics
 Quetiapine
 Mirtazapine
 Risperidone
 Haloperidol—can be deadly for pts with dlb
• Bad drugs:
• antihistamines, haloperidol, hypnotics,
benzodiazepines; narcotics
• Anticholinergics:
• bladder control meds; diarrhea control meds; some
asthma drugs, eg tiotropium, ipratropium
 Behavioral issues
 Insomnia
 Depression
 Not eating
 Anxiety
 Hallucinations
 Paranoia
 Falling
 Driving
 Wandering
 Malnutrition
 Aspiration
Making a diagnosis
Medications
Lifestyle
Team approach
Dealing with caregiver
burden
 Neuropsychological testing
 Physical therapy for balance and fall prevention
 Speech therapy
 Occupational therapy for home safety evaluation and
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driving evaluation
Support groups
Exercise classes
Brain Imaging
Blood work: TSH, B12, Lipids, complete metabolic
profile, CBC