12-Dementia.ppt

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12-Dementia.ppt

  1. 1. Definition of dementia <ul><li>an acquired persistent impairment of intellectual function with compromise in memory and at least two other cognitive domains such as language, visuospatial skills or executive function </li></ul>
  2. 2. Prevalence of dementia 0 5 10 15 20 Prevalence Rate (%) 1 85+ 80-84 75-79 70-74 65-69 60-64 60-64 65-69 70-74 75-79 80-84 85+ AGE
  3. 3. Causes of dementia <ul><li>Neurodegenerative disorders </li></ul><ul><ul><li>Alzheimer’s disease </li></ul></ul><ul><ul><li>Pick’s disease </li></ul></ul><ul><li>Vascular (multi-infarct) dementia </li></ul><ul><li>Reversible causes </li></ul>
  4. 4. Alzheimer’s disease Vascular dementia Other causes
  5. 6. Alzheimer’s disease <ul><li>cognitive deficits </li></ul><ul><ul><li>profound memory loss (anterograde/retrograde) </li></ul></ul><ul><ul><li>language - anomic, empty, circumlocutory </li></ul></ul><ul><ul><li>visuospatial disturbance </li></ul></ul><ul><li>behavioral deficits </li></ul><ul><ul><li>no significant early changes in personality </li></ul></ul><ul><ul><li>unawareness or denial of illness </li></ul></ul><ul><ul><li>psychosis </li></ul></ul><ul><li>no sensory or motor deficits </li></ul>
  6. 9. Cortical atrophy Normal brain
  7. 10. Cortical atrophy
  8. 11. Cortical atrophy - MRI scan Alzheimer’s disease
  9. 12. Normal Alzheimer’s
  10. 13. Neurofibrillary tangles (tau protein) Amyloid plaques Pathology of Alzheimer’s disease
  11. 14. Degeneration of the basal forebrain cholinergic system Pathology of Alzheimer’s disease
  12. 16. Treatment of Alzheimer’s disease <ul><li>Cholinergic replacement </li></ul><ul><li>Anti-amyloid agents </li></ul>
  13. 17. Pick’s disease/frontal dementias <ul><li>cognitive deficits </li></ul><ul><ul><li>profound executive dysfunction </li></ul></ul><ul><ul><li>good memory, language, visuospatial skills </li></ul></ul><ul><li>behavioral deficits </li></ul><ul><ul><li>early prominent personality changes </li></ul></ul><ul><ul><li>poor judgment, insight, disinhibited, labile, euphoric, socially inappropriate, sexual indiscretions </li></ul></ul><ul><li>frontal release signs on neurological exam but no senory or motor deficits </li></ul>
  14. 18. Cortical atrophy
  15. 19. Cortical atrophy - MRI scan Pick’s disease
  16. 20. PET scan of Pick’s disease
  17. 21. Pick’s bodies Pathology of Pick’s disease
  18. 22. Alzheimer’s Pick’s

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