This document is a presentation on dementia given by Dr Devavrat Harshe from the Department of Psychiatry at D.Y. Patil Medical College, Hospital & Research Centre. The presentation covers topics such as the difference between normal aging and dementia, common causes and risk factors for dementia, how dementia progresses, diagnostic evaluation, and management strategies which include pharmacological treatments to improve cognition as well as supportive measures for patients and caregivers.

1. D.Y. Patil Education Society Deemed to be University
Dr Devavrat Harshe, M.D.
Assistant Professor, Department Of Psychiatry
DY Patil Medical College, Hospital & Research
Centre
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Dementia
PSYCHIATRY
DEPARTMENT OF
DY Patil Medical College, Hospital & Research Centre
Kolhapur

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DEMENTIA:
LEARNING OBJECTIVES
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
• Understand the difference between normal, age related
forgetfulness and dementias.
• Learn and understand, presenting features of dementia
• Learn about various management strategies for
dementia
At the end of this presentation, students shall

3. 3
HOW DOES THE HUMAN
BRAIN AGE?
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
• Everyone starts losing neurons from the age of 20-25.
• There is almost 0.5% neuronal loss per year, after the
age of 40.
• Therefore, as we start to age,
– We start forgetting minor things and events.
– We become clumsy.
– Our reflexes become less accurate.

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HOW DEMENTIA’S DIFFER
FROM NORMAL AGING?
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
• Everyone starts losing neurons from the age of 20-
25.
• There is almost 0.5% neuronal loss per year, after
the age of 40.
• In Dementia, however, the rate of neuronal cell
loss is exacerbated suddenly.
• In patients with Alzheimer’s dementia, neuronal
loss can be in the range of as high as 40-50% in
frontal lobes.

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WHAT ARE
DEMENTIA’S
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
• Literally, “de-mentum”, means loss of mind.
• Normal functions of the mind:
• Emotions
• Language
• Memory
• Thinking
• Impulse control
• Personality
• Fine motor movements
• Recognition

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HOW COMMON ARE
DEMENTIA’S
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
• There are around 80 or more causes of
dementias.
• Studies show, a lifetime prevalence of
up to 4% in India.
• Commonest causes for dementia:
• Alzheimer’s disease
• Vascular dementia
• Dementia with Lewy bodies
0
7.5
15
22.5
30
55-59 60-64 65-69 70-74
Age and gender wise
incidence rates for
dementia
Males Females

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COMMON
AETIOLOGIES FOR
DEMENTIA
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
54%
16%
30%
AD
VaD
34%
18%12%
10%
7%
5%
14%
AD VaD
FTD ALC
DLB HD
Others
Late Onset Early Onset

8. 8
COMMON
AETIOLOGIES FOR
DEMENTIA
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
Degenerative Toxic Metabolic Tumor Trauma
Alzheimer’s Alcohol
Vitamin B12
deficiency
Primary
tumors
SDH
Frontotemporal
Heavy
Metals
Hypothyroidism
Metastatic
tumours
Prion diseases
Parkinson’s
Drug
induced
Uraemia Syphilis
DementiaWith
Lewy Bodies
Wilson’s AIDS
Common Causes For Dementia From Each Aetiological Group

9. 9
DEMENTIA:
HOW DOES NEURODEGENERATIONTAKE
PLACE?
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
Pathways for neurodegeneration in common aetiologies for
dementia
AD
VaD
DLB
Apo E
Aß
deposits
NFT’s
Stroke/CV
A
Cerebral
Infarct
Neuronal
Death
Lewy
bodies
Neuro-degeneration
Neuronal
loss
AD; Alzheimer’s disease. ApoE; Apolipoprotein E, Aß; Aß Amyloid, NFT;
Neurofibrillary tangles,VaD;Vascular dementia, DLB; Dementia with Lewy bodies.

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DEMENTIA SYMPTOM DOMAINS:
MEMORY
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
SHORT TERM MEMORY
 Forgetting day-to-day activities and events.
 Forgetting daily chores and developments.
 Problems in memories going back minutes to hours.
e.g. forgetting what he/she had for breakfast.
LONG TERM MEMORY
– Forgetting activities and events from the past.
– Forgetting autobiographical information.
– Problems in memories going back months to years.
e.g. forgetting where he/she had his/her primary education.

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DEMENTIA SYMPTOM DOMAINS:
MEMORY
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
PROCEDURAL MEMORY
 Forgetting skills and facts learned over years.
 Affected very late in the course of the illness.
e.g. forgetting how to ride a bike.
SPATIAL MEMORY
– Memory related to one’s place and position in 3
dimensional space.
– Affected very late.
e.g. forgetting the way to one’s home, forgetting the position of
various rooms in the house

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DEMENTIA SYMPTOM DOMAINS:
MEMORY
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
AUTOBIOGRAPHICAL MEMORY
 Forgetting details of one’s own identity.
 Inability to identify oneself in photographs and mirrors.

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DEMENTIA SYMPTOM DOMAINS:
PERSONALITY:
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
PERSONALITY CHANGES
 Previous personality traits may get accentuated.
 Unconcerned about their symptoms and behaviour.
 Suspiciousness, paranoid.
 Hostile and aggressive.
 Also depend upon the site of degeneration.

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DEMENTIA SYMPTOM DOMAINS:
PSYCHIATRIC CHANGES:
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
PSYCHIATRIC CHANGES
 Hallucinations, delusions and aggression.
 Sadness of mood, depressive disorders, rapid mood
swings.
 Disinhibition.

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DEMENTIA SYMPTOM DOMAINS:
NEUROLOGICAL CHANGES:
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
NEUROLOGICAL CHANGES
 Aphasias; language disturbances.
 Agnosias; problems with cortical sensations.
 Apraxias; problems with fine motor movements.
 Focal neurological signs.
Eg: problems in daily activities such as walking, eating.

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HOW DOES DEMENTIA
PROGRESS?
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
 SUBJECTIVE MEMORY DEFICITS
 Patients start noticing minor deficits in memory
 MILD COGNITIVE IMPAIRMENT
 Subjective memory deficits
 Mild cognitive impairment
 No functional impairment
 DEMENTIA
 Cognitive decline
 Functional deficit

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WHAT ARETHE RISK
FACTORS FOR DEMENTIA?
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
Traumatic brain injury
Obesity
Hypertension
Smoking
Diabetes
Depression
More years of formal
education
Physical activity
Mediterranean diet
Cognitive training
HigherRiskofdementia
LowerRiskofdementia

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DEMENTIA:
DIAGNOSTIC FORMULATION
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
 Clinical suspicion
 Detailed neurological and psychiatric exam
 Routine blood investigations: CBC, sugars, electrolytes, HIV, B12
 CT/MRI
 Memory and cognitive functions testing
 Aß Scans for confirmation

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DIFFERENTIATING DEMENTIA FROM
AGE RELATED COGNITIVE DECLINE
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
Dementia
Physiological age related
cognitive decline
Patients rarely complain about
cognitive decline
Patients usually complain
about cognitive decline
Patients indifferent Patients distressed
Errors on cognitive
performance
Do not know answers more
common
Recent memory, remote
memory, procedural memory
affected
Only recent memory affected

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DEMENTIA:
MANAGEMENT
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
 Cholinergic medications. Improve cholinergic transmissions.
 Donepezil
 Memantine
 Rivastigmine
 Work in mild-moderate cases, as long as pre-frontal cholinergic
neurons are not affected.
 Antipsychotics and antidepressants for psychosis and mood disorders.

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DEMENTIA:
SUPPORTIVE MANAGEMENT
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
 Caregiver stress management.
 Vital as caregivers are prone to stress, depression and
burnout
 Peer support.
 Problem solving.
 Legal and spiritual needs

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DEMENTIA:
LIFESTYLE MODIFICATIONS
DEPARTMENT OF PSYCHIATRY, D Y Patil Medical College, Hospital & Research Centre
D Y Patil Education Society, Deemed to be University. Kolhapur
 Making modifications in home and surrounding
environment
 Guard rails
 Visible light strips
 Signs denoting directions
 Wheelchair ramps
 Dementia identifying signs and bracelets.

23. D. Y. PATIL EDUCATION SOCIETY
DEEMED TO BE UNIVERSITY
KOLHAPUR
Department Of Psychaitry
Thank You
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