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1) Dementia is characterized by deterioration of intellectual abilities such as memory, language, and problem solving that interfere with daily life. Common causes include Alzheimer's disease and vascular dementia. 2) Evaluation of dementia involves ruling out other conditions like delirium and assessing for treatable causes through examinations, labs, and imaging. 3) Management includes psychosocial support, treating behavioral issues pharmacologically, and medications to enhance neurotransmitters like acetylcholinesterase inhibitors for mild-to-moderate Alzheimer's disease.

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43 views40 pages

Dementia Ad

1) Dementia is characterized by deterioration of intellectual abilities such as memory, language, and problem solving that interfere with daily life. Common causes include Alzheimer's disease and vascular dementia. 2) Evaluation of dementia involves ruling out other conditions like delirium and assessing for treatable causes through examinations, labs, and imaging. 3) Management includes psychosocial support, treating behavioral issues pharmacologically, and medications to enhance neurotransmitters like acetylcholinesterase inhibitors for mild-to-moderate Alzheimer's disease.

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knowledgeguruos179
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CLINICAL APPROACH

&
MANAGEMENT OF
DEMENTIA
Dr.M.Madhusudanan
DEMENTIA :DEFINITION

Dementia is a syndrome
characterized by deterioration of
previously acquired intellectual
abilities, in a fully conscious
patient that interferes with social
& occupational functioning
DEMENTIA :
CRITERIA FOR DIAGNOSIS ( DSM IIIR)
1.Acquired cognitive impairment that
includes memory impairment and at least
one of the
following:aphasia ,apraxia ,agnosia and
defects in executive functioning
2.deficits severe enough to cause impairment
in occupational and social functioning
3.Diagnosis should not be made in presence
of delirium
FACULTIES AFFECTED IN
DEMENTIA
• COGNITIVE FACULTIES:
• Memory : Recent > remote.
• Language : Expressive > receptive
• Visuospatial dysfunction
• Other cognitive deficits:
– Executive dysfunction
FACULTIES AFFECTED IN
DEMENTIA
• OTHER FACULTIES:

• Behavioral problems
• Gait
• Praxis
• Continence
FACULTIES AFFECTED IN
DEMENTIA
• EXECUTIVE DYSFUNCTION
– Inability to plan & organize.
– Inability to initiate, stop and modify behavior in
response to changing stimuli.
– Inability to handle sequential problems
– Impaired abstract thinking
– Impaired problem solving.
– Impaired novelty detection
FACULTIES AFFECTED IN
DEMENTIA
• Behavioral problems:
– Disinhibition and impulsivity of
thought, affection & action.
– Fails to appreciate consequences
of one’s action.
– Lack of insight.
CAUSES OF DEMENTIA
• Diseases in which dementia is the only
evidence of disease.
• Diseases in which dementia is
associated with other neurologic signs
• Diseases in which dementia is
associated with other medical diseases
DISEASES IN WHICH DEMENTIA
IS THE ONLY EVIDENCE OF
DISEASE.

•Alzheimer disease.
•Frontotemporal dementia.
•Some cases of AIDS
DISEASES IN WHICH DEMENTIA
IS ASSOCIATED WITH OTHER
NEUROLOGIC SIGNS
• Vascular dementia.
• Brain tumour
• Head trauma: Subdural hematoma.
• Normal pressure hydrocephalus.
• Progressive multifocal leukoencephalopathy.
• Vasculitis affecting brain.
DISEASES IN WHICH DEMENTIA
IS ASSOCIATED WITH OTHER
NEUROLOGIC SIGNS( cont..)
• Huntington’s chorea
• PSP, CBGD, DLBD, OPCA
• Progressive myoclonic epilepsies.
• Lipid storage diseases.
• Multiple sclerosis & Dysmyelinating
diseases.
• Slow viral infection: CJD
DISEASES IN WHICH DEMENTIA
IS ASSOCIATED WITH OTHER
MEDICAL DISEASES
• Endocrine: hypothyroidism
• Nutritional deficiency: Wernicke’s, SCD.
• Neurosyphilis.
• Hepatolenticular degeneration.
• Prolonged hypoglycemia& hypoxia.
• Heavy metal exposure ( As, Hg, Mn, Bi & gold)
• Dialysis dementia.
• AIDS
THE TWO MOST COMMON
DEMENTIAS

ALZHEIMER’S DEMENTIA

AND

MULTI INFARCT DEMENTIA


CLINICAL FEATURES OF
ALZHEIMER’S DEMENTIA
• EARLY STAGE

1. Deficits in memory
2. Dysfluent and empty speech
3. Deficits in visuospatial orientation
4. Defective calculation
CLINICAL FEATURES OF
ALZHEIMER’S DEMENTIA(Cont….)
• INTERMEDIATE STAGE

1.Ideational and ideomotor apraxias


2.Changes in personality and behaviour
3.Paranoid delusions and hallucinations
4.Wandering
5.Abnormal eating patterns
6.Neglect of dressing, shaving and bathing
CLINICAL FEATURES OF AD

• LATE STAGE:
1) Difficulty in walking
2) Akinesia & rigidity
3) Release reflexes.
4) Incontinence.
5) Akinetic, mute,
bedridden
Duration of illness: 5-8 yrs
CLINICAL FEATURES OF
MULTI INFARCT DEMENTIA
CLINICAL FEATURES OF
MULTI INFARCT DEMENTIA
TREATABLE DEMENTIAS
TREATABLE DEMENTIAS
TREATABLE DEMENTIAS
TREATABLE DEMENTIAS
TREATABLE DEMENTIAS
TREATABLE DEMENTIAS
EVALUATION OF DEMENTIA
• Is it dementia?
– Rule out:
• Pseudodementia.
• Delirium.
• Wernicke’s aphasia
• Is it a treatable dementia?
Dementia Vs Pseudodementia
• Gradual onset • Sudden onset
• Older age group • Any age group
• Insight often lost • Heightened insight
• Specific pattern of • No pattern of memory
memory loss loss
• Approximate answers
• “ I don’t know “ answers
• Definite cognitive loss
• Inconsistent loss
• Sundowning present
•
• Sundowning absent.
Incontinence
• Almost never present
Delirium- clinical characteristics

• Course: Acute & fluctuating


• Clinical Features:
* Clouding of consciousness
* Inattention.
* Disordered thinking
* Perceptual disturbances
* Disturbed sleep - wake cycle.
* Altered psychomotor cativity
* Disorientation & memory impairment.
DEMENTIA Vs DELIRIUM
DEMENTIA DELIRIUM
ONSET Gradual Acute /
subacute
Inattention Absent Present
Perceptual Uncommon Very
disturbances common
Altered Sensorium Not present present
Type of memory Recent > remote Uniform
loss
DEMENTIA Vs RECEPTIVE
APHASIA
• RECEPTIVE APHASIA:

– Paraphasic errors, lack of comprehension


– Other cognitive functions are normal.
– No behavioral alteration
EVALUATION OF DEMENTIA
• HISTORY:
– Change from prior level of functioning.
– Cognitive changes.
– Personality changes
– History of myoclonic jerks.
– History of other organ failure
– Temporal course of illness.
EVALUATION OF DEMENTIA

Mental status examination.


General neurol. Examination.
Lab.tests to rule out treatable
dementia
LAB.TESTS
• Routine blood test & peripheral smear.
• Blood sugar/ urea.
• SGOT, SGPT & bilirubin.
• Serum calcium.
• Thyroid function tests
• Chest X-ray, CT / MRI
• STS
• Other special tests: CSF, EEG
DEMENTIA - MANAGEMENT

• Psychosocial therapy
• Behavioral therapy
• Pharmacotherapy.
PHARMACOTHERAPY

• To treat behavioral disturbances


associated with dementia.

• To treat dementia itself.


PHARMACOTHERAPY OF
BEHAVIORAL CHANGES
• Depression:
– Antidepressants with minimal anticholinergic
effects
• Trazadone, SSRI
• Anxiety / Agitation:
– Anxiolytics, Neuroleptics
• Prefer short acting benzodiazepines : lorezepam
• Insomnia / Nocturnal wandering
• Short acting benzodiazepines, Thioridazine
PHARMACOTHERAPY OF
DEMENTIA
• Drugs which enhance the effect of
neurotransmitters ( Ach E inhibitors).
• Tacrine.
• Donepezil.
• Rivastigmine
• Galanthamine
• Drugs thought to protect neurons.
PHARMACOTHERAPY OF
DEMENTIA
• ANTICHOLINESTERASE INHIBITORS
– TACRINE:
• Dose: 80-160 mg /day in Qid dosage.
– DONEPEZIL:
• Dose: 5 mg OD for 6 weeks: then 10 mg OD.
– RIVASTIGMINE:
• Dose: 6-12 mg /day in BD dosage.
– Galanthamine
• Dose: 19 –20 mg /day
CHOLINESTERASE
INHIBITORS
• EFFICACY:
– Found to delay functional decline by 4 months.
• SIDE EFFECTS:
– Cholinomimetic
• Gastrointestinal.
• Bradycardia.
• Worsening of asthma.
• Dreams, night mares, Insomnia
PHARMACOTHERAPY OF
DEMENTIA
• OTHER DRUGS:
– Ergot mesylates
• Hydergine, Nicergoline.
– Investigational neurotransmitter enhancing
drugs:
• Nicotine. Ginko biloba, Neurotrophic factors.
– Investigational Neuroprotective drugs:
• Oestrogen, Vit E, NSAIDs
THANK YOU

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