A simplified introduction to Dementia for students

1. Dementia
By
Khaled Osama Abo-Shae3ra
Assistant Professor of Neurology
Assiut University

2. Dementia
Dementia
Dementia
Dementia

4. Definition
Sustained and significant deterioration of two or
more domains of cognitive functions, one of which
must be memory, in an alert person.
While Delirium
is fluctuating
Interfere with
normal work or
social function
While MCI not
affect daily activity
While in
Delirium Pt. is
inattentive
Memory
impairment
Executive
dysfunction
Aphasia
Apraxia

6. Etiology
1-Neurodegenerative dementia: e.g. Alzheimer’s
disease.
2-Non degenerative dementia including the following:
- Vascular dementia e.g. Multi-infarct dementia
-Chronic subdural haematoma
- Vitamin B12 deficiency.
-Hypothyroidism.
-Heavy-metal poisoning, e.g. lead.
-Side effects of medicines or drug interactions.
-Some cases of chronic alcoholism.
-Some causes of encephalitis e.g. HIV/AIDS.
-Some brain tumors.
-Normal-pressure hydrocephalus
-Reversible metabolic causes:
e.g. ureamic, hepatic or hypoglycaemic encephlopathy.

7. Investigations
1- Mini-mental state examination.

8. Investigations
2- Laboratory investigations: to search for
reversible causes
3-MRI:
Alzheimer
Dementia
Vascular
Dementia
Subdural
Hematoma

9. Alzheimer dementia

11. Alzheimer dementia
Early Sage Late stage
1.Forgetfulness (repetition of
questions and misplacement
of items) and rapid loss of
memory for recent events
(Amnesia).
2.Language comprehension
and production are impaired
(Aphasia).
3.Minor disorientation to
time and place.
4.Difficulties in calculation.
5.Minor behavioral changes.
6.Social skills and self-care
abilities are normal at this
1.Marked disorientation to
time, places and persons
2.Inability to handle money
and make shopping.
3.Troublesome behavior, as
delusions, hyperactivity,
verbal and physical
aggression and
hallucinations.
4.Total dependence on
others and supervision is
needed for self-care
functions such as dressing,
eating and self-hygiene with

12. Gross pathology
i. Diffuse atrophy of the brain on CT or MRI
ii. Flattened cortical sulci.
iii. Enlarged cerebral ventricles.

13. Microscopic pathology
i. Accumulation of amyloid beta-peptides
(protein fragment).
v. Anatomic changes: to amygdala,
hippocampus, cortex, basal forebrain.
ii. Senile plaques.
iii. Neurofibrillary tangles.
iv. Granulovascular degeneration of the
neurons.

15. Treatment
i. Supportive: including family caregiver education.
ii. Symptomatic especially for behavioural changes.
iii. Reduce environmental changes.
iv. Specific treatment:
Cholinesterase inhibitors,
Rivastigmin, Donepezil hydrochloride
Memantin Hcl.

16. Vascular dementia

17. Alzheimer Dementia Vascular Dementia
Most common (65%) Less common (15%)
Later onset Earlier onset
More in women More in men
Etiology unknown Vascular risk factors as
HTN
Gradual onset, progressive
course
Subacute onset, stepwise
course
General deterioration Patchy deterioration
No Lateralizing signs Lateralizing signs

18. Definition
Decremenrtal or patchy deterioration in cognitive
functioning due to severe cerebrovascular disease
Etiology
i. Vascular disease is present.
ii. Affects small-and medium-sized cerebral
vessels that infarct and produce parenchymal
lesions over wide areas of the brain
Treatment
i. Treatment of underlying condition (hypertension,
diabetes mellitus, hyperlipidemia)
ii. General measures for dementia.

19. Thank you