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Dementiahttp://crisbertcualteros.page.tl
Dementia Is a syndrome encompassing deficits in several  cognitive domains Initial presentation: memory loss over months...
Prevalence Rare: <55yo 5-10%: >65 yo 20%: >80 yo 70%: >100 yo
Diagnosis Good history Timeline of the progression of impaired  cognition/memory What was noticed first How it affects...
Cognitive testing:          abbreviated mental test score Abbreviated Mental Test Score: 6 or < suggests  delirium/dement...
Physical ExamIdentify:physical cause of the cognitive impairmentrisk factorsparkinsonism
Investigation FBC, ESR, U&E, Ca, LFT, TSH,  autoantibodies, B12/Folate, CT/MRI: for vascular damage,  hemorrhage, struc ...
Cause1. AD: most common cause2. Vascular dementia: 25%, cumulative effects of small strokes Sudden onset High BP past ...
Cause3. Lewy Body Dementia 3rd cause Fluctuating cognitive impairment Detailed visual hallucinations Parkinsonism His...
Rare causes Alcohol/drug abuse Repeated head trauma Pellagra Whipple’s disease Huntington’s disease
1. Fronto-temporal dementia Executive impairment Behavioral/ personality change Early preservation of episodic memory &...
management Care coordinator Capacity: can the patient make decisions  on medical/ financial affairs? Who will care for ...
Challenging behavior r/o pain/infection for worsening behavior1. Trazodone 50-300mg ON or Lorazepam 0.5 mg OD – 2mg BD2....
 http://crisbertcualteros.page.tl
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Dementia

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Dementia management

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Dementia

  1. 1. Dementiahttp://crisbertcualteros.page.tl
  2. 2. Dementia Is a syndrome encompassing deficits in several cognitive domains Initial presentation: memory loss over months or years Days: stroke/ infection Weeks: depression Later stages: aggitation, aggresion or apathy
  3. 3. Prevalence Rare: <55yo 5-10%: >65 yo 20%: >80 yo 70%: >100 yo
  4. 4. Diagnosis Good history Timeline of the progression of impaired cognition/memory What was noticed first How it affects the ADL & their ability to cope with task ASK: agitation, aggression, hallucination, wandering, slow repetitious speech, apathy, mood disturbance
  5. 5. Cognitive testing: abbreviated mental test score Abbreviated Mental Test Score: 6 or < suggests delirium/dementia A score of 6 or less suggests delirium or dementia
  6. 6. Physical ExamIdentify:physical cause of the cognitive impairmentrisk factorsparkinsonism
  7. 7. Investigation FBC, ESR, U&E, Ca, LFT, TSH, autoantibodies, B12/Folate, CT/MRI: for vascular damage, hemorrhage, struc pathology Syphilis serology EEG CSF Metabolic, genetic or HIV test
  8. 8. Cause1. AD: most common cause2. Vascular dementia: 25%, cumulative effects of small strokes Sudden onset High BP past strokes focal CNS signs
  9. 9. Cause3. Lewy Body Dementia 3rd cause Fluctuating cognitive impairment Detailed visual hallucinations Parkinsonism Histology: lewy body in brainstem & neocortex
  10. 10. Rare causes Alcohol/drug abuse Repeated head trauma Pellagra Whipple’s disease Huntington’s disease
  11. 11. 1. Fronto-temporal dementia Executive impairment Behavioral/ personality change Early preservation of episodic memory & spatial orientation Disinhibition Hyperorality Stereotyped behavior Emotional unconcern
  12. 12. management Care coordinator Capacity: can the patient make decisions on medical/ financial affairs? Who will care for the care-giver? Care- giver support group
  13. 13. Challenging behavior r/o pain/infection for worsening behavior1. Trazodone 50-300mg ON or Lorazepam 0.5 mg OD – 2mg BD2. Aggitation: quetiapine, respiridone, olanzapine, haloperidol3. Depression: SSRI: Citalopram 10-20mg OD, If severe dep: mirtazapine15-45mg at night
  14. 14.  http://crisbertcualteros.page.tl

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