From Past to Present The Historical note and Dementia Burden

Surat Tanprawate*, MD, MSc(Lond.), FRCP(T) Chiang Mai University

*Certificate in History of Medicine, Birkbeck University, London *Wellcome Medical History Library 2013 Lecture for Dementia Better Care, Chiang Mai, Thailand

Man fools himself. He prays for a long life, yet he fears an old age.
Chinese Proverb

Longevity
Sarah Knauss, America 24th September 1880 30th December 1999 Age: 119 years 97 days

Shigechiyo Izumi, Japan 29th June 1865 21st February 1986 Age: 120 years 237 days

Maria Esther Heredia de Capovilla, Ecuador 14th September 1889 27th August 2006 Age: 116 years 347 days

Human Life Expectancy At Birth

Adapted from: Hayflick L. How and Why We Age. 1994

Life Expectancy at Age 65

1965.5 years 2005.20 years Worldwide

over 1/2 of all humans who have ever lived to age 65 are alive today!

Senile
The world is rapidly becoming geriatric Latin root, sen in senile means
pertaining to old age, not demented!

Gerontology is the study of aging Geriatrics is the medical care of the aged

Prevalence of dementia in 6 WHO world regions

(based on data extracted from Global prevalence of dementia: a Delphi consensus study)

Ferri et al. Lancet 2005; 366: 21117)

Cause of Dementia

(a) Causes of dementia in patients < 70 years old.

(b) Causes of dementia in patients > 70 years or older

A Canadian cohort study of cognitive impairment and related dementias (ACCORD) Neuroepidemiology 2003; 22: 26574).

Dementia booming of the aging baby boomers

Historical note
The past make the future

The Historical Note

The discovery of Alzheimers disease
The plaque, the tangle and Amyloid cascade Genetic breakthrough The diagnosis, and treatment

A 100 year journey from discovery to treatment

Auguste D hand writing

Alois Alzheimer
German psychiatrist

Auguste D (1906)

A 100 year journey from discovery to treatment

In November 1906, at a German psychiatrists meeting, Alois Alzheimer presented the pathological findings on a brain of a 56 y.o. woman who died after a progressive dementia

Auguste D (1906)

Drawing of neurofibrillary tangle by Alois Alzheimer

Bielschowsky-stained neurofibrillary tangles from Auguste D

Bielschowsky-stained tissue sections

Alois Alzheimer: The Psychiatrist with the Microscope

Bielschowsky-stained amyloid plaques from Auguste D

Auguste D

Bielschowsky-stained tissue sections from Johann F.

Cerebral cortex Bielschowsky-stained amyloid plaques

Johann F (1911): The second case from Alois Alzheimer Report

Ultrastructural studies of AD pathology

a neurofibrillary tangle contains masses of fibers with a periodic structure

early 1960s

paired helical filaments

Amyloid cascade hypothesis

The history-continue

1983:Coyle et al: Acetylcholine deficit in the cortex 1995: the first gene abnormalities in familial Alzheimer disease are identified (Presenilin 1 & 2)

Individual with trisomy 21 (Downs syndrome) exhibit high prevalence rates of AD neuropathology.

Mild, Moderate & Severe stages

Dementia/Alzheimers Stage

Mild
Memory loss Language problems Mood swings Personality changes Diminished judgment

Moderate
Behavioral, personality changes Unable to learn/recall new information Long-term memory affected Wandering, agitation, aggression, confusion Require assistance w/ADL

Severe

Symptoms

Gait, incontinence, motor disturbances Bedridden Unable to perform ADL Placement in long-term care needed

Volicer L. Clin Geriatr Med. 2001;17:377-391.

Progressive decline in cognitive functions

William Utermohlen self portraits

WU a patient with AD at the DRC - was aware of decline in his painting skills

Neuroimaging methods
(a) Computed tomography (CT) (b) magnetic resonance (MR) (c) positron emission tomography (PET) (d) single photon emission CT (SPECT) (e) functional MRI (fMRI).