longitudinal changes in memory and behaviour in dementia

Longitudinal changes in memoryand behaviour in dementia

Michael Hornberger

m.hornberger@uea.ac.uk

Time/Age

Dementia

Healthy Ageing

Diagnosis

Co

gnit

ion

N

eu

rop

sych

iatr

ic

Ever

yday

Fu

nct

ion

Dementia progression

Crisis

Disease management

Time/Age

Dementias

Healthy Ageing

Diagnosis

Co

gnit

ion

N

euro

psy

chia

tric

Fu

nct

ion

Pharmacological treatment

Kondokar and colleagues

N = 2460

Clinicopathology

Villemagne et al., 2015

Behaviour

Dementia – clinicopathology

Villemagne et al., 2015

Neuropsychiatric symptoms

Kloeters et al., Neuroimage (2013)

Weickert et al., Cortex (2013)

Hornberger et al., HBM (2014)

Bertoux & Hornberger, JNNP (2015)

O’Callaghan et al., Brain (2016)

Hornberger et al., 2011, BrainO’Callaghan et al., 2013, ADADO’Callaghan et al., 2014, JNNP

Insight/Decision making Disinhibition/Impulsivity

Emotion & faux-pas

Bertoux et al., Alzheimer’s & Dementia (2013)Bertoux & Hornberger, JNNP (2015)

Bertoux et al. JNNP (2016)

Emotion – disease stages

Bertoux et al., ADAD (2014)

Controls

AD

bvFTD

Mild AD

Moderate AD

MMSE < 24 > 3 years disease duration

Longitudinal changesExecutive function

• 111 participants (33 AD, 31 bvFTD, and 47 controls) • Followed-up annually over a 4-year period

Ramanan et al., JINS 2017

Longitudinal changesNeuropsychiatric function

• 39 participants (18 svPPA, 21 bvFTD) • Followed-up annually over a 4-year period• Cambridge Behavioural Inventory

O’Connor et al, Neurology CP 2016

Memory

Dementia – clinicopathology

Villemagne et al., 2015

Episodic memory - sensitivityAlzheimer’s disease Healthy elderly

Hartshorne et al., 2015

Episodic memory - specificity

Pennington et al., JAD (2011)Hornberger et al., Brain (2012)Tan et al., Brain (2014)Aggleton et al., Brain (2016)

bvFTD AmnTau (Pick)

bvFTDTau (Pick)

bvFTD AmnTDP-43

bvFTDTDP-43

Hornberger et al., Neurology (2010)Hornberger & Piguet, Brain (2011)

Longitudinal changesEpisodic memory• 111 participants (33 AD, 31 bvFTD, and 47 controls) • Followed-up annually over a 4-year period

Ramanan et al., JINS 2017

Spatial disorientation

Tu et al., Cortex (2015)

Yew et al., JAD (2013)

Tan et al., DCGD (2013)Tan et al. Brain (2014)

Population-level navigation behaviour

Map of an example level Trajectory plot for one individual

Hornberger & Spiers, 2016

Sea Hero Quest – prelim results~2.7 million players worldwide18-95 years of age193 countries

Time/Age

Dementia

Healthy Ageing

Diagnosis

Co

gnit

ion

N

eu

rop

sych

iatr

ic

Ever

yday

Fu

nct

ion

Dementia progression

Crisis

Spatial disorientation – getting lost

“Mrs BB had been diagnosed as having dementia…There were concerns about Mrs BB’s safety when she went out, with reports of her becoming lost, disorientated, anxious, and approaching strangers for help or lifts… When the carer visited in the morning, Mrs BB was missing. It appears that Mrs BB had left her home at some point the previous evening. The body of Mrs BB was found lying in a ditch by the side of the road by a member of the public.”

Dementia Research and Care Clinic - TRACC

Time/Age

Dementia

Healthy Ageing

Diagnosis Disease progressionSymptom managementCarer support

Crisis

Co

gnit

ion

N

euro

psy

chia

tric

Fu

nct

ion

Take home messages

• Disease management in dementia requires taking into account changes of symptoms over the disease duration

• Very little is known how symptoms change prospectively in different dementia subtypes • How can these changes be anticipated to prevent potential crises?• proactive vs. reactive

• Symptom changes may vary according to the underlying dementia pathology• Memory and executive function seems to be progressively getting worse across

AD and FTD• Neuropsychiatric symptoms, however, can increase or decrease for different

dementias as the dementia progresses

• Spatial disorientation, one of the most common symptoms in dementia, has so far been little explored in disease management, despite its potentially fatal consequences

Thank you – Vielen Dank

UEA Dementia Research Collaboration

m.hornberger@uea.ac.uk