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Dementia

This document discusses various types of dementia, including Alzheimer's disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia, mixed dementia, and Creutzfeldt-Jakob disease. It describes the symptoms and pathological causes of each type. It also discusses diagnostic criteria for dementia, risk factors, pathophysiology of Alzheimer's disease, early signs of dementia, managing dementia through therapeutic interventions and treatment approaches, cholinesterase inhibitors used to treat symptoms, and disease modification approaches.

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180 views40 pages

Dementia

This document discusses various types of dementia, including Alzheimer's disease, vascular dementia, dementia with Lewy bodies, frontotemporal dementia, mixed dementia, and Creutzfeldt-Jakob disease. It describes the symptoms and pathological causes of each type. It also discusses diagnostic criteria for dementia, risk factors, pathophysiology of Alzheimer's disease, early signs of dementia, managing dementia through therapeutic interventions and treatment approaches, cholinesterase inhibitors used to treat symptoms, and disease modification approaches.

Uploaded by

khusnul
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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DEMENTIA

Margono Imam Sjahrir, dr, SpS(K).


Bag/SMF. Ilmu Penyakit Saraf
FK. Unair/RSU. Dr. Soetomo
Dementia

• A generic term indicating a loss of intellectual


functions including memory, significant
deterioration in the ability to carry out day-to-day
activities, and often, changes in social behaviour.
Alzheimer’s Disease

• The most common cause of dementia is Alzheimer’s


disease (AD). Symptoms include memory problems,
a progressive deterioration in the ability to perform
basic activities of daily living (ADL), and behaviour
changes, mainly apathy and social withdrawal, but
also behavioural disturbances. Alzheimer’s disease
causes abnormal function and eventual death of
selected nerve cells in the brain. The average
survival period for patients following diagnosis is
eight to 10 years.
Vascular Dementia

• The role of vascular disease in the aetiology of


dementia is complex and controversial. In some
cases there appears to be a direct chronological
relationship between significant cerebrovascular
events and the onset of dementia. Consequently
patients may present with signs of stroke or other
vascular problems, for example, ischaemic heart
disease or hypertension. Onset may be abrupt or
there may be periods of sudden decline followed
by relative stability. Physical problems such as
urinary incontinence, decreased mobility and
balance problems are more commonly seen in
people with vascular dementia (VaD) than in
people with Alzheimer’s disease.
Dementia With Lewy Bodies
• Characteristic features of dementia with Lewy
bodies (DLB) are fluctuation of awareness from
day-to-day and sign of parkinsonisme such as
tremor, rigidity an slowness of movement or
proverty of expression. Visual hallucinatons or
delusions occur frequently. Falls are also common,
DLB has a similar pathological basis to Parkinson’s
disease dementia and both are associated with
progress cognitive decline and parkinsonism.
Aprroximately three quarters of older people with
Parkinson’s disease develop dementia after 10
years.
Fronto-temporal Dementia
• Fronto-temporal dementia (FTD) is uncommon by
comparison to Alzheimer’s disease or vascular
dementia but represents a significant proportion of
people who present with dementia under the age
of 65. Changes in behaviour such a disinhibition,
lack of judgement, loss of social awareness and
loss of insight are much more common than
memory problems. Disturbance of mood, speech
and continence are frequent. A positive family
history of a similar disorder is not uncommon.
Mixed Dementia
• Mixtures of two or more of the active dementias
can be found in the same person, with one or
other usually dominating. Studies suggest that the
interaction between vascular disease and the core
features of Alzheimer’s disease is extremely
complex and that rigid boundaries between
subtypes of dementia may be unduly artificial.
Response to treatment or side effects from
treatment in people whit mixed dementia may be
different from those in people with a specific
diagnosis.
Creutzfeldt-Jakob Disease
• Creutzfeldt-Jakob Disease (CJD) is a very
uncommon illness in which a abnormal protein
accumlates in the brain and leads to rapid
destruction of nerve cell. Termor, impaired
mobility and balance problems are common as are
behavioural ans mood disturbance. Death within
one to two years of the onset of clinical symptoma
is common. The management of patients with
sporadic CJD and variant CJD is not covered by this
guidelines.
The Hachinski Ischaemic Scale
Hachinski Ischaemic Scale

Abrupt onset 2
Stepwise progression 1
Fluctuating course 2
Noctural confusion 1
Relative preservation of personality 1
Depression 1
Somatic complaints 1
Emotional incontinence 1
History of hypertension 1
History of strokes 2
Evidence of associated atherosclerosis 1
Focal neurological symptoms 2
Focal neurological sign 2
Diagnostic Criteria for
Dementia
• Development of multiple cognitive deficits
manifested by both
• Memory impairment
• One (or more) of the following
• aphasia
• apraxia
• agnosia
• disturbance in executive functioning
• Significant impairment in social or occupational
functioning representing a significant decline from
a previous level of functioning
Pathological Causes of
Dementia in Elderly

Alzheimer's Disease
50%

Other Causes

Dementia with
Lewy Bodies
Vascular Disease
10% 10%

10% Mixed Alzheimer's/


20% Vascular Disease
Dementia risk factors

• Age
• Head injury
• Family history of DAT
• Family history of Down’s syndrome
• Vascular disease
• Female sex
• Level of education
• APOE allele 4
Alzheimer’s Disease
Pathophysiology
• Neuropathology
• Plaques
• Neurofibrillary tangles
• Molecular Pathology
• Amyloid protein (APOE allele 4)
• Paired helical filaments (map tau)
• Neurotransmitter Pathology
• Acetylcholine
• Abnormalities in Oxidative Metabolism
Early Signs Of Dementia

• Early Signs Of Dementia


• Frequent forgetfulness
• Mood or personality changes
• Problems with familiar tasks
• Language problems
• Spatial disorientation
• Loss of judgement
• Time and place disorientation
Is MCI a Prodrome of Dementia?

•General Elderly Population:


•1 to 2% per year convert to
dementia
•MCI Population:6 - 25% per year
convert to dementia
MANAGING DEMENTIA
Early Detection Of Dementia
• Early Detection Of Dementia
• Detailed history
• Collateral sources
• Mental status examination
• Neuropsychological testing
• Medical workup
• Laboratory
• Neuroimaging
Resistances To Care

• Denial of illness
• Patient
• Caregiver
• Professional
• Lack of resources
• Transportation
• Financial
Therapeutic Interventions

• Cognitive interventions
• Cognitive retraining
• Functional performance
• Enhance ADL’s
• Sleep and exercise
• Environmental intervenous
• Use of color and light
• Caregiver interventions
• Education
• Respite and support groups
Dementia Treatment Approaches

• Preventive
• Antiamyloid, antitau
• Gene therapy
• Disease modifying
• Estrogens
• NSAID’s
• Statins
• Symptomatic
• Antipsychotic drugs
• Antidepressant drugs
• Cholinergic agents
Cholinesterase Inhibitors:
Mechanisms and Characteristics
Tacrine Donepezil Rivastigmine Galantamine Memantine
Cognex Aricept Exelon Razadyne Namenda

Mechanism AChEl AChEl AChEl AChEl NMDA


of action BuChEl BuChEl Nicotinic antagonist

Half life hrs 2- 4hrs 73hrs 5hrs 6- 8hrs 60- 80hrs

Starting 10 mg 5 mg qd 1.5 mg bid 4 mg bid 5 mg qd


dose qid

Maximum 40 mg 10 mg qd 6 mg bid 12 mg bid 10 mg bid


dose qd
Disease Modification
Reference
1. Harvey, RJ, Fox, NC and Rossor, MN. : Dementia
Handbook, 1st ed, 1999. Martin Dunitz, UK.
2. Levestone, S and Gauthier, S. : Management of
Dementia, 1st ed, 2001. Martin Dunitz, UK.
3. Knopman, DS et al : Practice Parameter :
Diagnosis of Dementia (An evidence-based
review). Report of the quality stnadards
subcommittee of the American Academy of
Neurology. Neurology, 56, 2100, 1143-1153
didaptkan pada
http://www.aan.com/profesionals/practice/pdf
s/9/0071.pdf.
4. Scottish Intercollegiate Guidelines Network. Management of
Patient with dementia, A National Clinical Guideline, chapter 86,
Febr 2006. Didapatkan pada :
http://www.sign.ac.UK/pdf/sign86pdf.

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