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Dementia
 

Dementia

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  • Course of the dss can be: Static Permanent Reversible: 15% chance. Potential of reversibility related to u/lying pathology and availability of rx. Better b4 irreversible brain damage occur.
  • NEUROFIBRILLARY TANGLES: - not pathognomonic of AD. Can also be found in normal ppl, Down’s syndrome. - location: cortex/hippocampus/substantia nigra/locus ceruleus -components: phosphorylated tau protein 2. SENILE PLAQUES: - more suggestive of AD - aka amyloid plaques - no. of senile plaques correlate with disease severity
  • 1.Treatment goals: treat u/lying cause, if exist provide rehab to mx deficit consider modified living situations or housing options to ensure pt safety provide reassurance, support, and familiarity to the pt 2. Treat the main distressing prob first: evaluate suicidal risk evaluate potential violence recommend adequate supervision prevention of falls minimize hazards of wandering restriction of driving/use of dangerous equipment
  • 1.Treatment goals: treat u/lying cause, if exist provide rehab to mx deficit consider modified living situations or housing options to ensure pt safety provide reassurance, support, and familiarity to the pt 2. Treat the main distressing prob first: evaluate suicidal risk evaluate potential violence recommend adequate supervision prevention of falls minimize hazards of wandering restriction of driving/use of dangerous equipment
  • 1.Treatment goals: treat u/lying cause, if exist provide rehab to mx deficit consider modified living situations or housing options to ensure pt safety provide reassurance, support, and familiarity to the pt 2. Treat the main distressing prob first: evaluate suicidal risk evaluate potential violence recommend adequate supervision prevention of falls minimize hazards of wandering restriction of driving/use of dangerous equipment
  • MOA: inhibit cholinesterase enzyme  inhibit breakdown of acetylcholine  by maintaining Ach level, the drug helps to compensate for the loss of functioning brain cells Adverse effect: nausea, vomiting, muscle cramps, insomnia, brady, dizziness. marked on D2-D4 of initiating rx.

Dementia Dementia Presentation Transcript

  • DEMENTIA NOOR HAFIZAH BT HASSAN 2007287236
  • REFERENCES:
    • Kaplan & Sadock’s Synopsis of Psychiatry
    • Behavioral Sciences/Clinical Psychiatry
    • 10 th edition
    • Clinical Practice Guidelines For Management of Dementia
    • Ministry of Health Malaysia
  • INTRODUCTION
    • Definition: progressive impairment in cognitive function with normal consciousness
    • Essential features: intellectual impairment
      • Memory
      • Thinking
      • Attention
      • Comprehension
    • Other mental function may affected  mood / judgement / social behaviour
  • DSM IV DIAGNOSIS
  • EPIDEMIOLOGY
    • 5 % of population > 65 years old are demented.
    • Prevalence ↑ with increasing age.
    • Dementia shortens life expectancy by 5-9.3 years.
    • M:F equally affected
    • Alzheimer’s disease: 50-60 %
    • Vascular dementia: 15-30 %
  • AETIOLOGY
  •  
  • DEMENTIA OF ALZHEIMER’S TYPE
    • Insidious onset
    • Gradual progression
    • Definitive diagnosis: neuropathological examination
      • Senile plaques
      • Neurofibrillary tangles
    • Pathophysiology:
      • Genetic: 40% has family history
      • Neuropathology: amyloid deposition
      • Neurotransmitter: ↓ Ach and norepinephrine
  • SENILE PLAQUES NUEROFIBRILLARY TANGLES
    • Diffuse cerebral atrophy with enlargement of the ventricle seen on CT scan and MRI
  • DIFFERENTIATING FEATURES ALZHEIMER’S DISEASE VASCULAR DEMENTIA ETIOLOGY
    • Genetic
    • Neuropathology
    • Neurotransmitter
    • Hypertension
    • Other cardiovascular risk
    AGE OF ONSET Usually > 65 y/o Less common in those > 75 y/o ONSET OF SYMPTOMS Insidious Abrupt COURSE OF ILLNESS Steady progression in function decline Worsening dementia PATTERN OF COGNITIVE DEFICIT Global Patchy: depending on the area of the brain affected RADIOLOGICAL FINDINGS Diffuse cerebral atrophy with ventricle enlargement Multifocal infarcts
  • ASSESSMENT OF DEMENTIA
    • HISTORY:
    • Patient’s history:
      • memory: past and
      • recent
    • Caregiver’s history:
      • pre-morbid personality
      • attitude
      • social functioning
      • interest
      • self-care
    PHYSICAL EXAMINATION: - To exclude treatable and reversible causes of dementia
    • MENTAL & COGNITIVE STATE EXAM:
    • Mini mental state exam (MMSE)
    • Clock drawing test
  •  
  • CLOCK DRAWING TEST
    • In the space below, please draw the face of a clock and put the numbers in the correct position
    • Now, draw in the hands at ten minutes after eleven
  • SUMMARY OF MANAGEMENT Non pharmacological intervention Pharmacological treatment General principles
    • Set treatment goals
    • Involve patient and family members in decision making
    • Treat the main distressing problem first
    • Set a frame time: monitor cognitive & non cognitive symptoms
    • Assess success/failure of the intervention
  • SUMMARY OF MANAGEMENT Non pharmacological intervention Pharmacological treatment General principles
    • GENERAL PSYCHOSOCIAL:
    • educate the pt and family
    • optimize function & QOL
    • address family issue: financial, emotional
    • related ethical issue
    • SPECIFIC PSYCHOTHERAPY:
    • behaviour-oriented
    • emotion-oriented
    • cognition oriented
    • stimulation oriented
  • SUMMARY OF MANAGEMENT Non pharmacological intervention Pharmacological treatment General principles
    • COGNITIVE IMPROVEMENT :
    • - Cholinesterase inhibitor: Donepezil / Rivastigmine / Galantamine
    • - NMDA antagonist: Memantine
    • BEHAVIOURAL & PSYCHOLOGICAL SYMPTOMS:
    • - psychosis & agitation
    • - depression
    • - sleep disturbance
  • CHOLINESTERASE INHIBITOR Donepezil (Aricept) 5-10 mg OD - For all stages of Alzheimer’s disease Rivastigmine (Exelon) 6-12 mg BD - For mild to moderate Alzheimer’s disease Galantamine (Reminyl) 16-24 mg BD - For mild to moderate Alzheimer’s disease
  • NMDA INHIBITOR
    • Memantine (Ebixa) 5-20 mg BD
    • M.O.A: inhibit glutamate activity
    • Effective in moderate to severe dementia, including vascular dementia and HIV dementia
  • THANK YOU