How Do You Know If You’re Having a Memory Problem?

Speakers: John M. Ringman, M.D., Assistant ProfessorDiane Katz, MA, MPH, Director Education and Community Outreach Core

UCLA Alzheimer Disease CenterUCLA Department of Neurology

Sponsored by California’s Caregiver Resource Centers (CRCs) and the Department of Health Services, Alzheimer’s Disease Research Centers of California (ARCCs). Funded by the California Department of Mental Health and a Bristol-Myers Squibb Foundation grant to Family Caregiver Alliance.

www.californiacrc.org© 2006 Family Caregiver Alliance

180 Montgomery Street, Suite 1100San Francisco, CA 94104

What is Memory?Memory is the ability to store and retrieve

your memory “files”Multiple kinds of memory exist:

1) Habits and skills (e.g. riding a bike)2) Knowledge (what color is a banana?)3) Memory of events

a) Recent memoryb) Remote memory

• Information is taken in or registered• Information is STORED in short-term

memory, long-term memory, or is discarded

• In the final step of the memory process, Information needs to be RETRIEVED

Memory Process

1

Memory Changeswith Aging

Many older people complain about memory changes. These complaints usually pertain to difficulties in retrieving recent information.

• Registration can be affected by such things as vision and hearing deficits, pain, emotions (e.g. depression)

• Retrieval time increases as we age. This is a normal change. Consider the following strategies: – Don’t panic; try to relax– Give yourself extra time– Try to find another word to substitute for the

one you can’t remember (Tip of the tongue phenomenon)

– Have a sense of humor

2

Some memory changes are serious,

others are not

How can we tell the difference?

Normal vs. Serious Memory Changes

• Normal memory changes don’t get much worse over time

• Memory changes are considered serious when everyday life activities, such as cooking, shopping, or handling money are affected

• Serious memory changes get worse over several months to several years

3

Serious Memory ChangesSigns of serious memory changes may include:• Repeating phrases or stories in the same

conversation• Becoming lost in places you know well• Having trouble learning new things• Difficulty making choices or handling money• Not being able to keep track of what happens

each day

Other Memory Changes

Mild memory loss is sometimes referred to by physicians as Mild Cognitive Impairment or “MCI”

• MCI describes a gradual decline in thinking abilities

• An individual with MCI experiences memory decline greater than normally expected with aging

• People with MCI can still manage their daily activities

4

What Causes Serious Memory Changes?

The brain has billions of nerve cells called neurons which

• Communicate with

each other

• Carry out metabolism

• Repair themselves

If neurons cannot do these tasks, memory is severely disrupted.

5

What Is Dementia?Global, progressive deterioration of:

• Memory• Language• Thought• Behavior• Personality/Mood

Causes of Dementia

• Degenerative Dementias– Alzheimer’s disease (47-66%)– Dementia with Lewy bodies (5-20%)– Frontotemporal dementia (12-17%)

• Other– Vascular dementia (20-47%)– HIV, Creutzfeldt-Jakob, B12, NPH, neurosyphilis,

EtOH, head trauma

• 10% of Dementia cases may be medically treatable

6

Dementia* Prevalence Increases with Age

* Includes Alzheimer’s dementia and other types. Adapted from Graves, Kukull, Handbook of Dementing Illnesses, 1994.

Dementia is Not a Normal Part of Aging

7

Alzheimer Disease

Alzheimer disease is a brain disorder that • Occurs gradually • Destroys a person’s ability to learn,

make judgments, communicate and carry out daily activities

Alzheimer disease is not a normal part of aging

Diagnosis

“There is no cure so why should I bother being assessed?”• Doctors can rule out other treatable conditions

that may contribute to memory loss• Treatments may be started earlier, when they

may be more effective• Patients and families have more time to plan for

the future

8

How A Diagnosis Is MadeThe diagnosis of Alzheimer disease by an experienced clinical team may be based on:• Information from family and friends• Physical and neurological exams• Lab tests (to rule out other illnesses that cause

memory loss)• Memory and language testing• Brain scans (MRI, CT and PET)

Benefits of an Early Diagnosis

• More timely patient and family education• Important choices can be made while patient still

competent• Drug treatment started early may be more

effective• Greater possibility of benefiting from treatments

being developed– Possible participation in clinical trials– Many disease-modifying treatments being studied are

focused on early stages of the disease

9

How Do I Get A Diagnosis?

• Alzheimer Research Centers of California (ARCCs) provide diagnostic evaluations

For example, at UCLA, Call: (310) 794-6039

Managing Alzheimer’s Disease• Nonpharmacologic interventions

– Practical advice and direction– Education/support of family/caregivers– Activity programs to help ameliorate behavioral

symptoms• Medication to ameliorate behavioral

symptoms• Medications to enhance/maintain cognitive

function

10

Current Treatment

Right now, we do not have a treatment that can cure Alzheimer disease.

Medications may help prevent some symptoms from becoming worse for a limited time.

Donepezil HCI (ARICEPTTM) ADAS-cog*

11

Donepezil HCI (ARICEPTTM) ADAS-cog Placebo Washout Effect*

Treatments Currently Available Include:

• Donepezil (Aricept®)

• Rivastigmine (Exelon®)

• Galantamine (Razadyne®)

• Memantine (Namenda®)

12

Clinical Trials

• Clinical trials are studies that test new medications in people

• Doctors use clinical trials to discover new treatments and cures for diseases

• New treatments are possible only through the participation of patients and family members

How Do I Find Out About Clinical Trials?

• Contact your local Alzheimer’s Association

• Contact your local Alzheimer Disease Research Center

• For UCLA, contact the Kagan Treatment Development Program at:

(310) 794-6191

13

Caregiver and Patient Resources• Family Caregiver Alliance

www.caregiver.org(800) 445-8106

• Alzheimer’s Associationwww.alz.org(800) 660-1993

• Alzheimer’s Disease Education and Referral (ADEAR) Center www.nia.nih.gov/alzheimers(800) 438-4380

• Alzheimer’s Disease Research Centers of California (ARCCs)www.dhs.ca.gov/CDIC/alzheimers/

14

Alzheimer’s Disease Research Centers of California (ARCCs)

Fresno University of California, San Francisco(559) 227-4810Email: alz@ucsfresno.eduWebsite: http://fserve.fresno.ucsf.edu/alzheimer/

Irvine University of California, Irvine(949) 824-5847Website: http://www.alz.uci.edu/

Los Angeles University of Southern California(323) 442-7600Website: http://www.usc.edu/schools/medicine/departments/psychiatry_behavioralsciences/research/gsc/

Los Angeles/DowneyUniversity of Southern CaliforniaRancho Los Amigos National Rehabilitation Center(562) 401-8130

Los Angeles/San Fernando Valley University of California, Los AngelesGeneral Information: (310) 206-5238UCLA Appointments: (310) 794-1195Centinela Freeman-Marina Center: (323) 563-5915Olive View/UCLA Center: (818) 895-9541Website: http://www.npistat.org/adrc/

Martinez University of California, Davis(925) 372-2485Website: http://alzheimer.ucdavis.edu/

Palo AltoStanford University/VA Palo Alto Health Care System(650) 858-3915Website: http://arcc.stanford.edu/

Sacramento University of California, Davis(916) 734-5496Website: http://alzheimer.ucdavis.edu/

San DiegoUniversity of California, San Diego/SOCARE(858) 622-5800

San Francisco University of California, San Francisco(415) 476-6880Website: http://memory.ucsf.edu/index.html Alzheimer’s Disease ProgramMail Station 7210Post Offi ce Box 997413Sacramento, CA 95899-7413Phone: (916) 552-8995

© 2006 Family Caregiver Alliance

Caregiver Resource Centers and the Regions They ServeBay Area Caregiver Resource Center/Family Caregiver AllianceStatewide Resources Consultant180 Montgomery Street, Suite 1100 San Francisco, California 94104Phone: (415) 434-3388 or (800) 445-8106Website: www.caregiver.orgE-mail: info@caregiver.orgAlameda • Contra Costa • Marin • San FranciscoSan Mateo • Santa Clara Counties

Coast Caregiver Resource Center1528 Chapala Street, Suite 302Santa Barbara, California 93101Phone: (805) 962-3600 or (800) 443-1236 (regional)Website: www.coastcrc.orgE-mail: ccrc@silcom.com San Luis Obispo • Santa Barbara • Ventura Counties

Del Mar Caregiver Resource Center736 Chestnut Street, Suite FSanta Cruz, California 95060Phone: (831) 459-6639 Website: www.delmarcaregiver.orgE-mail: hpc@hpcn.org Monterey • San Benito • Santa Cruz Counties

Del Oro Caregiver Resource Center5723A Marconi Avenue Carmichael, California 95608Phone: (916) 971-0893 or (800) 635-0220 (regional)Website: www.deloro.org E-mail: crc@deloro.org Alpine • Amador • Calaveras • Colusa • El Dorado Nevada • Placer • Sacramento • San JoaquinSierra • Sutter • Yolo • Yuba Counties

Inland Caregiver Resource Center1420 East Cooley Drive, Suite 100Colton, California 92324Phone: (909) 514-1404 or (800) 675-6694 (California)Website: www.inlandcaregivers.comE-mail: info@inlandcaregivers.orgInyo • Mono • Riverside • San Bernardino Counties

Los Angeles Caregiver Resource Center3715 McClintock Avenue Los Angeles, California 90089-0191Phone: (213) 821-7777 or (800) 540-4442 (California)Website: www.losangelescrc.orgE-mail: lacrc@usc.edu Los Angeles County

Mountain Caregiver Resource Center2491 Carmichael Drive, Suite 400 Chico, California 95928Phone: (530) 898-5925 or (800) 822-0109 (regional)Website: www.caregiverresources.org/MCRC_home E-mail: smrossi@csuchico.eduButte • Glenn • Lassen • Modoc • Plumas • ShastaSiskiyou • Tehama • Trinity Counties

Orange Caregiver Resource Center251 East Imperial Highway, Suite 460 Fullerton, California 92835Phone: (714) 578-8670 or (800) 543-8312 (regional)Website: www.caregiveroc.orgE-mail: ocrc@stjoe.orgOrange County

Redwood Caregiver Resource Center141 Stony Circle, Suite 200Santa Rosa, California 95401Phone: (707) 542-0282 or (800) 834-1636 (regional)Website: www.redwoodcrc.orgE-mail: rcrc@redwoodcrc.org Del Norte • Humboldt • Lake • Mendocino • Napa Solano • Sonoma Counties

Southern Caregiver Resource Center3675 Ruffi n Road, Suite 230 San Diego, California 92123Phone: (858) 268-4432 or (800) 827-1008 (California)Website: www.scrc.signonsandiego.comE-mail: scrc@caregivercenter.orgSan Diego • Imperial Counties

Valley Caregiver Resource Center3845 North Clark Street, Suite 201 Fresno, California 93726Phone: (559) 224-9154 or (800) 541-8614 (regional) Website: www.valleycrc.orgE-mail: info@valleycrc.orgFresno • Kern • Kings • Madera • Mariposa • Merced Stanislaus • Tulare • Tuolumne Counties

www.californiacrc.org