longitudinal changes in memory and behaviour in dementia
TRANSCRIPT
Longitudinal changes in memoryand behaviour in dementia
Michael Hornberger
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