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From Past to Present

The Historical note andDementia Burden

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

*Certificate in History of Medicine, Birkbeck University, London

*Wellcome Medical History Library2013 Lecture for Dementia Better Care, Chiang Mai, Thailand

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

Chinese Proverb

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Longevity

Shigechiyo Izumi, Japan

29th June 186521st February

1986 Age: 120 years 237 days

Sarah Knauss, America

24th September 1880

30th December1999 Age: 119 years 97 days

Maria Esther Heredia de Capovilla,

Ecuador

14th September 1889

27th August2006 Age: 116 years 347 days

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Human Life Expectancy At Birth

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

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Life Expectancy at Age 65

1965.5 years

2005.20 years

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

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Senile

The world is rapidly becoming geriatric

Latin root, sen in senile meanspertaining to old age, not demented!

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

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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)

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(b) Causes of dementia in patients > 70 years or older(a) Causes of dementia in patients < 70 years old.

A Canadian cohort study of cognitive impairment and related dementias (ACCORD)Neuroepidemiology2003; 22: 26574).

Cause of Dementia

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Dementia booming of the

aging baby boomers

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Historical noteThe 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

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A 100 year journey fromdiscovery to treatment

Auguste D (1906)

Alois Alzheimer

German psychiatrist

Auguste D hand writing

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A 100 year journey fromdiscovery to treatment

In November 1906, at a Germanpsychiatrists meeting,Alois Alzheimerpresented the pathological findings on abrain of a 56 y.o. woman who died aftera progressive dementia

Auguste D (1906)

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Bielschowsky-stained tissue

sections

Bielschowsky-stained amyloid plaques from Auguste D

Bielschowsky-stained neurofibrillarytangles from Auguste D

Drawing of neurofibrillary tangle byAlois Alzheimer

Alois Alzheimer: ThePsychiatrist with theMicroscope

Auguste D

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Johann F (1911): The secondcase from Alois AlzheimerReport

Bielschowsky-stained tissue sections from Johann F.

Cerebral cortex Bielschowsky-stainedamyloid plaques

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Ultrastructural studiesof AD pathology

a neurofibrillary tangle contains masses

of fibers with a periodic structure

paired helical filamentsearly 1960s

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Amyloid cascade hypothesis

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The history-continue

1983:Coyle et al: Acetylcholine deficit inthe cortex

1995: the first gene abnormalities infamilial Alzheimer disease are identified(Presenilin 1 & 2)

Individual with trisomy 21 (Downs syndrome) exhibit high

prevalence rates of AD neuropathology.

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Mild, Moderate & Severe stages

Mild Moderate Severe

Memory loss

Language

problems

Mood swings

Personality

changes

Diminished

judgment

Behavioral, personality

changes

Unable to learn/recall

new information

Long-term memory affected

Wandering, agitation,

aggression, confusion

Require assistance w/ADL

Gait, incontinence,

motor disturbances

Bedridden

Unable to perform ADL

Placement in

long-term care

needed

Dementia/Alzheimers

Stage

Symptoms

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

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William Utermohlen -self portraits

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

Progressive decline in cognitive functions

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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).

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