Dementia is a progressive decline in cognitive abilities without loss of consciousness. It is characterized by impairment in memory, language, perception or executive functioning that interferes with daily life. The most common forms of dementia are Alzheimer's disease, vascular dementia, and frontotemporal dementia. Alzheimer's disease is defined by beta-amyloid plaques and tau neurofibrillary tangles that damage brain cells. Vascular dementia is caused by multiple brain infarcts while frontotemporal dementia involves atrophy of the frontal and temporal lobes. Diagnosis involves ruling out other causes and assessing cognitive impairment through tests like the Mini-Mental State Examination.

1. Dementia and its types
Dr. Rakesh Mehta

2. INTRODUCTION
• Derives from the Latin word dementatus, “out of
one’s mind”
• Progressive global decline in cognitive function
without loss of consciousness.

3. • Dementia is described in the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) as a disorder
• that include memory impairment
• plus one or more of the following:
• aphasia (inability to understand or produce speech)
• apraxia (difficulty with motor planning)
• agnosia (inability recognize and identify objects, persons)
• disturbances in executive functioning (planning, problem-solving)
• accompanied by impairment in social and occupational function.

4. • Diagnostic and Statistical Manual of Mental Disorders (DSM-V) subsumed dementia
under the term major neurocognitive disorder,
• a gradual cognitive decline from a previous level one or more
• complex attention,
• executive function,
• learning and memory,
• language,
• perceptual motor ability,
• social cognition.
• interfere with independent functioning in daily activities

5. ETIOLOGY
• Degenerative Dementia
• Alzheiner’s Disease
• Frontotemporal dementia
• Parkinson’s disease
• Lewy body dementia
• Idiopathic cerebral ferrocalcinosis ( Fahr’s disease)
• Progressive supra nucelar palsy
• Miscellaneous
• Huntington’s disease
• Wilson’s disease

6. • Psychiatric
• Pseudodementia of depression
• Cognitive decline in late life F20
• Metabolic
• Vitamin deficiency ( B12, Folate)
• Hypothyroidims
• Uremia
• Infection
• Prion disease ( Creutzfeldt-jakob disease)
• AIDS
• Syphillis

7. • Cardiac, vascular and anoxia
• Infraction
• Binswanger’s disease ( Subcortical arteriosclerotic encephalopathy)
• Hemodynamic insufficiency
• Multiple Sclerosis
• Drugs & toxins
• Alcohol
• Heavy metals
• CO

9. DEMENTIA OF THE ALZHEIMER'S TYPE
• In 1907, Alois Alzheimer first described the condition
• Most common form of dementia (70%)
• globally, over 24 million people
• 40 % of patients have a family history of dementia of the
Alzheimer’s type
• Alzheimer's type dementia has shown linkage to
chromosomes 1,14, and 21
• On a histologic level, “plaques and tangles” remain the
most conspicuous feature of Alzheimer disease.

10. PATHOLOGY
• Neuritic plaques or senile plaques, consist of an amyloid core surrounded by
abnormal axons and dendrites.
• Most of the amyloid core contains beta-amyloid (Aβ)
• Aβ is formed when beta secretase enzymes cleave Amyloid Precursor Protein
(APP) (APP is encoded by a gene on chromosome 21)
• accumulation of Aβ causes inflammatory and oxidative cerebral damage.
• The most powerful established genetic risk factor, which involves apolipoprotein
E (ApoE), promotes Aβ deposition.

14. • They cluster within hippocampus neurons.
• consist mostly of hyper- phosphorylated forms of tau protein,
• disrupt the normal cytoskeletal architecture.
• death of critical neurons.
Neurofibrillary tangles

16. Acetylcholine
• Under normal circumstances, neurons in the basal nucleus of
Meynert synthesize ACh.
• Neuron loss in the nucleus basalis of Meynert,
• Their loss depletes the neurotransmitter acetylcholine from the
cerebral cortex
Others
• Decreased norepinephrine activity
in Alzheimer's disease
• Decreased concentrations
somatostatin and corticotropin

17. NEUROPSYCHIATRIC MANIFESTATIONS
• majority of show apathy or agitation
• May show dysphoria and abnormal behavior.
• Simple delusions in 20% to 40%
• hallucinations are usually visual, but sometimes auditory or even olfactory
• Disruptive behavior – wandering, verbal outbursts, physical agitation, and
restlessness – occurs in almost 50%
• sleep becomes fragmented

18. VASCULAR DEMENTIA
• formerly referred to as multi- infract dementia
• account for 15 to 30 % of all dementia (2nd most common)
• most commonly is seen in men (age 60-70)
• The disorder affects primarily small- and medium-sized cerebral vessels,
• stepwise deterioration of cognitive function
• preexisting hypertension or other cardio vascular risk factors.
• Binswanger’s disease
• characterized by the presence of many small infarctions of the white matter that spare the
cortical regions

19. FRONTO TEMPORAL DEMENTIA ( PICK’S DISEASE)
• atrophy in the fronto-temporal regions.
• These regions also have neuronal loss; gliosis; and neuronal Pick's bodies
• The cause of Pick's disease is unknown,
• 5 % of all irreversible dementias.
• most common in men,
• approximately half of the cases of Pick's disease are familial
• early stages: personality and behavioral changes, with relative preservation of other cognitive
functions.
• hyper sexuality, placidity, and hyperorality
• Subtypes of FTD include one characterized by behavioral disturbances and others with progressive
aphasia

20. CRITERIA FOR A “POSSIBLE” DIAGNOSIS
SHOW THREE OF SIX DISTURBANCES:
1. Disinhibition
2. Apathy
3. Loss of sympathy
4. Perseverative or compulsive behaviors
5. Hyperorality (excessive – sometime compulsive –talking, eating, or cigarette
smoking)
6. Impaired executive ability.

22. LEWY BODY DEMENTIA
• similar to Alzheimer's disease and often characterized by hallucinations (visual),
parkinsonian features, and extrapyramidal signs but little or no tremor
• Lewy inclusion bodies are found in the cerebral cortex (its core contains α-synuclein)
• (Substantia nigra in BG in PD)
• may be confused with delirium, as fluctuating cognitive impairment is frequently
observed
• These patients often have Capgras syndrome
• Sensitive to neuroleptics
• REM behavior disorder

23. HUNTINGTON’S DISEASE
• The dementia seen in this disease is the subcortical type of dementia,
• characterized by more motor abnormalities and fewer language abnormalities
in early stage
• Late stage high incidence of depression and psychosis in addition to the classic
choreoathetoid movement disorder.

24. PARKINSON'S DISEASE
• parkinsonism is a disease of the basal ganglia
• 20 to 30 % of patients with Parkinson's disease have dementia
• 30 to 40 % have measurable impairment in cognitive abilities.

25. HIV-Related Dementia
• AIDS dementia complex
• Encephalopathy in HIV infection is associated with dementia
• 14 % of patients infected with HIV experience dementia
Head Trauma-Related Dementia
• punch drunk syndrome (dementia pugilistica) occurs in boxers
• emotional lability, dysarthria (slurred or slow speech), and impulsivity

27. MENTAL STATUS TESTING
• Screening Tests
• Mini-Mental State Examination (MMSE)
• Alzheimer Disease Assessment Scale (ADAS)
• greater sensitivity than the MMSE
• Montreal Cognitive Assessment (MoCA)
• less influenced by educational level and language skills

28. REFRENCES
1. Sadock BJ. Kaplan & Sadock's synopsis of psychiatry: behavioral
sciences/clinical psychiatry.
2. Kaufman DM, Milstein MJ. Kaufman's Clinical Neurology for Psychiatrists E-
Book. Elsevier Health Sciences; 2012 Dec 5.
3. American Psychiatric Association, American Psychiatric Association. Diagnostic
and statistical manual of mental disorders: DSM-5. Arlington, VA. 2013.
4. David A, Fleminger S, Kopelman M, Mellers J, Lovestone S. Lishman's organic
psychiatry: a textbook of neuropsychiatry.