Dementia Care overview Sture Eriksson V¨sterbotten L¨ns Landsting a a 29 maj 2012
Cognitive disorders Group of symptoms I Cognitive symptoms I Functionell decline (ADL) I BPSD (Behavoiural and Psychic Symptoms in Dementia)
Cognitive disorders Classiﬁcation I Mild cognitiv impairment (MCI) I Dementia disorders I Confusional syndrome I Mnestiska syndrome
Mild cognitiv impairment Deﬁnition 1. Subjectiv memory decline 2. Pathology in delay recall (16 word test) 80% develops manifest dementia disorder within 5 year No established pharmacological treatment.
Dementia disorders Classiﬁcation I Alzheimer’s disease I Dementia of Lewy body typ I Vaskular dementia I Dementia in Parkinson’s disease I Other forms of dementia disorders
What is dementia? Deﬁnition 1. Development of memory decline 2. Afasi, agnosi, apraxi or exekutiva disturbances 3. Severe enough to interfere with occupational and/or social abilities 4. Not only confusional state
Alzheimer’s disease Deﬁnition 1. Dementia syndrome 2. Incidious onset and progressive course 3. Other disorders excluded Patogenes: Pathological metabolism av -amyloid giving for example disturbances of signal substances Low levels of acetylcholine, serotonin, dopamin and other Increase of glutamat.
Diagnostic methods in cognitive decline I Auto- and heteroanamnesis I Clincal assessement I Testing including neuropsylogical assessment I Laboratory investigment I Occupational and social assessments I Imageing such as I CT-scan, MRI, SPECT, PET-scan
Treatment in deﬁcits of acetylcholine Cholinergic deﬁcients in for example I Alzheimer’s disease I Dementia av Lewy body type I Dementia vid Parkinsons disease
Cholinerga drugs Acetylkolinesteras inhibitors I donezepil 5-10 mg/dygn I rivastigmin 3 - 12 mg/dygn I galantamin 8 - 16 mg/dygn
E↵ect of cholinergic drugs Symptomatic e↵ect I Attention I Stability I Cognitiv improvement E↵ects during long term treatment!