November/December 2016 - Dementia

Page 11

Dementia

Colleague Interview: A Conversation with Anne Murray, M.D.

A

nne Murray, M.D. is the Medical Director, Berman Center for Outcomes and Clinical Research at Hennepin County Medical Center. She received her medical degree from the University of Minnesota Medical School; M.Sc. from Harvard School of Public Health (Epidemiology); completed a residency in Internal Medicine at Mayo Graduate School of Medicine; a Fellowship in Geriatrics, Division on Aging at Harvard Medical School, served as a Kellogg Fellow, Harvard University School of Public Health, and a Hartford Foundation Research Fellow. Dr. Murray is a Professor of Medicine, Clinical Scholar Track, University of Minnesota Medical School and a Faculty Member in Gerontology, the Graduate School University of Minnesota. She is a former President and Chair of the West Metro Medical Society (Twin Cities Medical Society).

Is dementia a disease or simply the aging process? Dementia is a disease and is not part of normal aging. About 10% of current adults can expect to develop dementia before their death. The prevalence of dementia increases exponentially with each decade after age 65, to about 10% between ages 6574, 20% ages 75-85, and over 50% for those ages 85 and older.

Please comment on the various forms of dementia — the etiologies, frequency, clinical course implications and as a comorbidity with another condition such as Parkinsonism or chronic kidney disease. Entire textbooks are written regarding dementia, so we’ll stick to the basics. Dementia is the umbrella term for chronic global cognitive impairment that encompasses multiple etiologies. Although it was previously believed that there was usually one primary etiology for a given case of dementia, it is now understood that most cases have three or more pathologies on brain autopsy that contribute to the dementia. This is one of the reasons no clear cure or preventive medication has been identified for dementia: most investigational medications have been targeted to only one brain pathology. Mixed Alzheimer’s disease/Vascular dementia is viewed by many as the most common form of dementia, based on brain autopsy studies in patients with previous cognitive assessments.

MetroDoctors

The Journal of the Twin Cities Medical Society

The most common individual cause of dementia is Alzheimer’s disease (AD). The other common primary causes of dementia include Vascular (previously known as multi-infarct), Lewy body disease (most often seen in Parkinson’s disease, but often seen in other dementias), frontotemporal dementias, or tauopathies (including Pick’s disease), and hippocampal sclerosis. Traumatic brain injury, HIV dementia, and Wernicke-Korsakoff ’s (B1 thiamine deficiency due to alcoholism) dementia are other less common causes, as are other neurodegenerative diseases, metabolic and infectious causes and tumors. Age is the strongest risk factor for dementia, and each year of education beyond high school is protective against dementia. Factors that contribute to all types of dementia include the same cardiovascular risk factors that increase the risk of cardiovascular disease: mid-life hypertension and abdominal obesity, chronic inflammation and oxidative stress, diabetes, and lack of exercise, or sedentary behavior. (Elevated lipids are controversial). Diabetes doubles the risk of dementia. Chronic kidney disease (CKD-pre-dialysis) is another more recently described strong risk factor for cognitive impairment. CKD patients have tremendously elevated levels of inflammation, almost all have hypertension and 50% are diabetic. There are about 3 million people in the U.S. with moderate to late stage CKD (most over age 60), defined as a reduced estimated glomerular filtration rate (eGFR) of less than 45 mL/min/1.73 m2. (Continued on page 11)

November/December 2016

9