DEMENTIA
Case History <ul><li>A 79 years old retired female school teacher who has been very independent, started forgetting her us...
Organic Mental Disorders <ul><li>Delirium  (Acute) </li></ul><ul><li>Dementia  (Chronic) </li></ul><ul><li>Amnestic Disord...
Introduction <ul><li>It is not enough for a great nation merely  to have added new years to life </li></ul><ul><li>Our obj...
Epidemiology <ul><li>The total world population increased by 26%  </li></ul><ul><li>between 1980 and 2000 </li></ul><ul><l...
Sri Lankan figures  <ul><li>In 1995 Population >65yrs  - 6.2% </li></ul><ul><li>Predicted figure for  2010  - 8.6% </li></...
Sri Lankan figures  -  continued <ul><li>CLASSIC SURVEYS - </li></ul><ul><li>NEWCASTLE  UPON TYNE,  </li></ul><ul><li>KAY ...
 
 
LINDESAY ET AL (1990) FROM THE GP’S LIST <ul><li>Dementia  05% </li></ul><ul><li>Depressive illness  13% </li></ul><ul><li...
Dementia  (Royal College of  Physicians   1981) <ul><li>Global impairment of higher mental functions including memory ,the...
Dementia <ul><li>Simpler definition </li></ul><ul><li>Generalized impairment of memory, intellect & personality without im...
Dementia  <ul><li>Incidence  5%  over 65 years </li></ul><ul><li>20%  over 80 years </li></ul><ul><li>Alzheimer’s disease(...
ICD 10   <ul><li>Dementia in Alzheimer’s disease with early onset  < 65 yrs </li></ul><ul><li>Relatively rapid progress </...
 
Dementia in AD with late onset
Vascular dementia   <ul><li>Vascular dementia of acute onset </li></ul><ul><li>Multi infarct dementia  </li></ul><ul><li>S...
Alzheimer’s Disease <ul><li>Genetic  Environmental </li></ul><ul><li>Increased production and decreased clearance of A bet...
Alzheimer’s  Disease <ul><li>Aetiology </li></ul><ul><li>Genetic predisposition- </li></ul><ul><li>Chromosome 21 APP speci...
Alzheimer’s  Disease Aetiology –  continued Presenelin 2 in chr . 1 Early onset AD  Aluminium toxicity (Infectious agent,r...
Acetylcholine Transferase Activity
Risk   <ul><li>< 65 - 1/1000 </li></ul><ul><li>>65 - 1/50 </li></ul><ul><li>>80 - 1/5 </li></ul>
Macroscopic appearance <ul><li>Often low brain weight </li></ul><ul><li>Gyral atrophy and sulcal widening </li></ul><ul><l...
Microscopic appearance <ul><li>Plaques- central amyloid core </li></ul><ul><li>Tangles-paired helical filaments (abnormal ...
 
 
 
Vascular dementias <ul><li>Stepwise progression </li></ul><ul><li>TIAs or strokes </li></ul><ul><li>Labile affect </li></u...
Other dementias (mainly presenile) <ul><li>Pick’s disease </li></ul><ul><li>Huntington’s disease </li></ul><ul><li>Creutzf...
<ul><li>Hypothyroidism </li></ul><ul><li>Vitamin deficiencies </li></ul><ul><li>Normal pressure hydrocephalus </li></ul><u...
Dementia with Lewy Bodies <ul><li>Visual hallucinations - common </li></ul><ul><li>Memory , language ,reasoning ,attention...
Mild Cognitive Impairment (MCI) <ul><li>Transitional state between normal ageing and mild dementia </li></ul><ul><li>Most ...
Screening tests in dementia   <ul><li>CAMDEX (Cambridge examination for mental disorder in the elderly) </li></ul><ul><li>...
Investigations in all cases <ul><li>F.B.C.  </li></ul><ul><li>E.S.R. </li></ul><ul><li>Urea & Electrolytes </li></ul><ul><...
Investigations in all cases  - continued <ul><li>B12 and Folate levels </li></ul><ul><li>M.S.S.U. </li></ul><ul><li>Chest ...
Management of Dementia <ul><li>Assessment </li></ul><ul><li>Treat primary cause if found </li></ul><ul><li>Correct nutriti...
Management of Dementia  - continued <ul><li>Be aware of dangers of anti cholinergics </li></ul><ul><li>Multi disciplinary ...
Drug treatment   NICE (National Institute of Clinical Excellence) <ul><li>Acetyl Cholinesterase inhibitors </li></ul><ul><...
Drug treatment -  continued <ul><li>Disease modifying agents </li></ul><ul><li>- Vitamin E </li></ul><ul><li>- Selegiline ...
Future strategies <ul><li>Neuropeptides (eg. Somatostatin analogues) </li></ul><ul><li>Growth factors (eg. Gangliosides ) ...
Multi infarct dementia <ul><li>Attend to hypertension </li></ul><ul><li>Anti platelet drugs </li></ul><ul><li>Drugs improv...
Upcoming SlideShare
Loading in...5
×

dementia

1,288

Published on

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,288
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
145
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

dementia

  1. 1. DEMENTIA
  2. 2. Case History <ul><li>A 79 years old retired female school teacher who has been very independent, started forgetting her usual appointments about one year ago. The forgetfulness has been gradually increased and now she finds it difficult to recall the date, month etc. and “misidentifies” her daughter as her sister who died a few years ago. She gets irritable over trivial matters and seems to be less affectionate than earlier. She started wandering about aimlessly and collecting rubbish and keeping them under her pillow over the last one month. She looks unkempt and tries to wear bed linen instead of her usual clothes. She would pass urine in a corner of her bed room. </li></ul>
  3. 3. Organic Mental Disorders <ul><li>Delirium (Acute) </li></ul><ul><li>Dementia (Chronic) </li></ul><ul><li>Amnestic Disorder </li></ul>
  4. 4. Introduction <ul><li>It is not enough for a great nation merely to have added new years to life </li></ul><ul><li>Our objective must also be to add new life to those years </li></ul><ul><li>- John F.Kennedy </li></ul>
  5. 5. Epidemiology <ul><li>The total world population increased by 26% </li></ul><ul><li>between 1980 and 2000 </li></ul><ul><li>Population over 65yrs increased by more than 53% </li></ul><ul><li>Developed countries - 29.4% </li></ul><ul><li>Developing countries - 77% </li></ul>
  6. 6. Sri Lankan figures <ul><li>In 1995 Population >65yrs - 6.2% </li></ul><ul><li>Predicted figure for 2010 - 8.6% </li></ul><ul><li>Predicted figure for 2020 -12.1% </li></ul>
  7. 7. Sri Lankan figures - continued <ul><li>CLASSIC SURVEYS - </li></ul><ul><li>NEWCASTLE UPON TYNE, </li></ul><ul><li>KAY ET AL 1964 </li></ul><ul><li>prevalence of dementia </li></ul><ul><li>>65 yrs 5.5% </li></ul><ul><li>>80 yrs 22% </li></ul>
  8. 10. LINDESAY ET AL (1990) FROM THE GP’S LIST <ul><li>Dementia 05% </li></ul><ul><li>Depressive illness 13% </li></ul><ul><li>(major depression 4%) </li></ul><ul><li>Anxiety states 12% </li></ul><ul><li>(Phobic 7%) </li></ul><ul><li>Paraphrenia 0.5% </li></ul><ul><li>Personality disorders,mania - Rare </li></ul>
  9. 11. Dementia (Royal College of Physicians 1981) <ul><li>Global impairment of higher mental functions including memory ,the capacity to solve the problems of day to day living,the performance of learned skills ,the correct use of social skills and control of emotional reactions without clouding of consciousness. </li></ul><ul><li>It is often irreversible and progressive. </li></ul>
  10. 12. Dementia <ul><li>Simpler definition </li></ul><ul><li>Generalized impairment of memory, intellect & personality without impairment of consciousness </li></ul>
  11. 13. Dementia <ul><li>Incidence 5% over 65 years </li></ul><ul><li>20% over 80 years </li></ul><ul><li>Alzheimer’s disease(AD) 50% </li></ul><ul><li>Multi infarct 20% </li></ul><ul><li>Mixed 15% </li></ul><ul><li>Other or no adequate diagnosis 15% </li></ul>
  12. 14. ICD 10 <ul><li>Dementia in Alzheimer’s disease with early onset < 65 yrs </li></ul><ul><li>Relatively rapid progress </li></ul><ul><li>Memory impairment with aphasia,agraphia, </li></ul><ul><li>alexia , acalculia , apraxia </li></ul>
  13. 16. Dementia in AD with late onset
  14. 17. Vascular dementia <ul><li>Vascular dementia of acute onset </li></ul><ul><li>Multi infarct dementia </li></ul><ul><li>Subcortical vascular dementia </li></ul><ul><li>Mixed cortical and subcortical dementia </li></ul><ul><li>Other vascular dementia </li></ul><ul><li>Vascular dementia ,unspecified </li></ul>
  15. 18. Alzheimer’s Disease <ul><li>Genetic Environmental </li></ul><ul><li>Increased production and decreased clearance of A beta 42 </li></ul><ul><li>Neuritic plaques Neurofibrillary tangles </li></ul><ul><li>Neuronal dysfunction and death with transmitter deficits </li></ul><ul><li>Dementia </li></ul>
  16. 19. Alzheimer’s Disease <ul><li>Aetiology </li></ul><ul><li>Genetic predisposition- </li></ul><ul><li>Chromosome 21 APP specific mutations </li></ul><ul><li>Apolipoprotein e4-encoded in chr.19 (A stronger risk factor ) </li></ul><ul><li>Abnormality in presenilin pn 1 chr.14 </li></ul><ul><li>(Early onset AD ) </li></ul>
  17. 20. Alzheimer’s Disease Aetiology – continued Presenelin 2 in chr . 1 Early onset AD Aluminium toxicity (Infectious agent,repeated trauma)
  18. 21. Acetylcholine Transferase Activity
  19. 22. Risk <ul><li>< 65 - 1/1000 </li></ul><ul><li>>65 - 1/50 </li></ul><ul><li>>80 - 1/5 </li></ul>
  20. 23. Macroscopic appearance <ul><li>Often low brain weight </li></ul><ul><li>Gyral atrophy and sulcal widening </li></ul><ul><li>Enlargement of lateral ventricals </li></ul><ul><li>Possibly pallor of locus coeruleus </li></ul>
  21. 24. Microscopic appearance <ul><li>Plaques- central amyloid core </li></ul><ul><li>Tangles-paired helical filaments (abnormal cytoskeleton) </li></ul><ul><li>Granulo-vacuoles </li></ul><ul><li>Hirano bodies </li></ul><ul><li>Neuronal loss </li></ul>
  22. 28. Vascular dementias <ul><li>Stepwise progression </li></ul><ul><li>TIAs or strokes </li></ul><ul><li>Labile affect </li></ul><ul><li>Associated neurological symptoms </li></ul><ul><li>Hypertension,Diabetes </li></ul><ul><li>Small infarcts or lacunes in deep white matter </li></ul>
  23. 29. Other dementias (mainly presenile) <ul><li>Pick’s disease </li></ul><ul><li>Huntington’s disease </li></ul><ul><li>Creutzfeld-Jacob disease </li></ul><ul><li>Parkinson’s disease </li></ul><ul><li>AIDS dementia complex </li></ul><ul><li>Alcohol brain damage </li></ul><ul><li>Neurosyphilis </li></ul>
  24. 30. <ul><li>Hypothyroidism </li></ul><ul><li>Vitamin deficiencies </li></ul><ul><li>Normal pressure hydrocephalus </li></ul><ul><li>Subdural haematoma, </li></ul><ul><li>Tumours </li></ul><ul><li>Fronto- temporal dementia </li></ul><ul><li>Dementia with Lewy Bodies (DLB) </li></ul><ul><li>Prion dementias </li></ul><ul><li>Primary progressive dysphasia </li></ul>Other dementias- continued
  25. 31. Dementia with Lewy Bodies <ul><li>Visual hallucinations - common </li></ul><ul><li>Memory , language ,reasoning ,attention problems </li></ul><ul><li>Parkinsonian symptoms </li></ul><ul><li>Frequent falls </li></ul><ul><li>Fluctuation of symptoms </li></ul><ul><li>Neuroleptics & anti-cholinergics may worsen the symptoms </li></ul><ul><li>Some response to dopamine replacement drugs and cholinesterase inhibitors </li></ul>
  26. 32. Mild Cognitive Impairment (MCI) <ul><li>Transitional state between normal ageing and mild dementia </li></ul><ul><li>Most common type – Amnestic type </li></ul><ul><li>Objective memory impairment </li></ul><ul><li>Normal general cognitive function </li></ul><ul><li>Intact daily living activities </li></ul><ul><li>Not demented </li></ul>
  27. 33. Screening tests in dementia <ul><li>CAMDEX (Cambridge examination for mental disorder in the elderly) </li></ul><ul><li>Mini mental state examination </li></ul><ul><li>Newcastle 37 item test </li></ul><ul><li>Blessed dementia scale </li></ul><ul><li>Hachinski ischaemic score </li></ul><ul><li>CAPE (Clifton Assessment Procedure for the elderly) </li></ul>
  28. 34. Investigations in all cases <ul><li>F.B.C. </li></ul><ul><li>E.S.R. </li></ul><ul><li>Urea & Electrolytes </li></ul><ul><li>LFT’s / bone chemistry </li></ul><ul><li>Random / fasting blood glucose </li></ul><ul><li>Blood serology </li></ul><ul><li>Thyroid function tests </li></ul>
  29. 35. Investigations in all cases - continued <ul><li>B12 and Folate levels </li></ul><ul><li>M.S.S.U. </li></ul><ul><li>Chest X-ray </li></ul><ul><li>ECG in those with cardiac problems and those with functional disorders </li></ul><ul><li> CT Scan </li></ul><ul><li>Other investigations may be arranged following discussion with the team </li></ul>
  30. 36. Management of Dementia <ul><li>Assessment </li></ul><ul><li>Treat primary cause if found </li></ul><ul><li>Correct nutritional deficiencies </li></ul><ul><li>Attend to associated psychological symptoms </li></ul><ul><li> - depression up to 30% - Antidepressants eg SSRI </li></ul><ul><li>- paranoid symptoms,delusions & hallucinations-30% - Antipsychotics </li></ul>
  31. 37. Management of Dementia - continued <ul><li>Be aware of dangers of anti cholinergics </li></ul><ul><li>Multi disciplinary approach </li></ul><ul><li>Reality orientation </li></ul><ul><li>Simplify the environment </li></ul><ul><li>Occupational therapy/physiotherapy </li></ul><ul><li>Day care /respite care </li></ul><ul><li>Home care ,CPN, meals on wheels </li></ul><ul><li>Caring for carers </li></ul>
  32. 38. Drug treatment NICE (National Institute of Clinical Excellence) <ul><li>Acetyl Cholinesterase inhibitors </li></ul><ul><li>- Galantamine </li></ul><ul><li>- Donepezil hydrochloride </li></ul><ul><li>- Rivastigmine </li></ul><ul><li>- Tacrine </li></ul><ul><li>(Metrifonate ,Physostigmine) </li></ul><ul><li>Non - anticholinesterases </li></ul><ul><li>Memantine (NMDA antagonist) </li></ul>
  33. 39. Drug treatment - continued <ul><li>Disease modifying agents </li></ul><ul><li>- Vitamin E </li></ul><ul><li>- Selegiline </li></ul><ul><li>- Oestrogen </li></ul><ul><li>- NSAIDS </li></ul><ul><li>- Ginkgo biloba </li></ul><ul><li>Chelation </li></ul><ul><li>desperioxamine (doubtful benefits) </li></ul><ul><li>Nootropic drugs ( enhance learning abilities and reverse learning impairment ) </li></ul>
  34. 40. Future strategies <ul><li>Neuropeptides (eg. Somatostatin analogues) </li></ul><ul><li>Growth factors (eg. Gangliosides ) </li></ul><ul><li>Transplantation </li></ul>
  35. 41. Multi infarct dementia <ul><li>Attend to hypertension </li></ul><ul><li>Anti platelet drugs </li></ul><ul><li>Drugs improving red cell deformability and </li></ul><ul><li>decreasing blood viscosity </li></ul>
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×