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Dementia

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Dementia

  1. 1. DEMENTIA NOOR HAFIZAH BT HASSAN 2007287236
  2. 2. REFERENCES: <ul><li>Kaplan & Sadock’s Synopsis of Psychiatry </li></ul><ul><li>Behavioral Sciences/Clinical Psychiatry </li></ul><ul><li>10 th edition </li></ul><ul><li>Clinical Practice Guidelines For Management of Dementia </li></ul><ul><li>Ministry of Health Malaysia </li></ul>
  3. 3. INTRODUCTION <ul><li>Definition: progressive impairment in cognitive function with normal consciousness </li></ul><ul><li>Essential features: intellectual impairment </li></ul><ul><ul><li>Memory </li></ul></ul><ul><ul><li>Thinking </li></ul></ul><ul><ul><li>Attention </li></ul></ul><ul><ul><li>Comprehension </li></ul></ul><ul><li>Other mental function may affected  mood / judgement / social behaviour </li></ul>
  4. 4. DSM IV DIAGNOSIS
  5. 5. EPIDEMIOLOGY <ul><li>5 % of population > 65 years old are demented. </li></ul><ul><li>Prevalence ↑ with increasing age. </li></ul><ul><li>Dementia shortens life expectancy by 5-9.3 years. </li></ul><ul><li>M:F equally affected </li></ul><ul><li>Alzheimer’s disease: 50-60 % </li></ul><ul><li>Vascular dementia: 15-30 % </li></ul>
  6. 6. AETIOLOGY
  7. 8. DEMENTIA OF ALZHEIMER’S TYPE <ul><li>Insidious onset </li></ul><ul><li>Gradual progression </li></ul><ul><li>Definitive diagnosis: neuropathological examination </li></ul><ul><ul><li>Senile plaques </li></ul></ul><ul><ul><li>Neurofibrillary tangles </li></ul></ul><ul><li>Pathophysiology: </li></ul><ul><ul><li>Genetic: 40% has family history </li></ul></ul><ul><ul><li>Neuropathology: amyloid deposition </li></ul></ul><ul><ul><li>Neurotransmitter: ↓ Ach and norepinephrine </li></ul></ul>
  8. 9. SENILE PLAQUES NUEROFIBRILLARY TANGLES
  9. 10. <ul><li>Diffuse cerebral atrophy with enlargement of the ventricle seen on CT scan and MRI </li></ul>
  10. 11. DIFFERENTIATING FEATURES ALZHEIMER’S DISEASE VASCULAR DEMENTIA ETIOLOGY <ul><li>Genetic </li></ul><ul><li>Neuropathology </li></ul><ul><li>Neurotransmitter </li></ul><ul><li>Hypertension </li></ul><ul><li>Other cardiovascular risk </li></ul>AGE OF ONSET Usually > 65 y/o Less common in those > 75 y/o ONSET OF SYMPTOMS Insidious Abrupt COURSE OF ILLNESS Steady progression in function decline Worsening dementia PATTERN OF COGNITIVE DEFICIT Global Patchy: depending on the area of the brain affected RADIOLOGICAL FINDINGS Diffuse cerebral atrophy with ventricle enlargement Multifocal infarcts
  11. 12. ASSESSMENT OF DEMENTIA <ul><li>HISTORY: </li></ul><ul><li>Patient’s history: </li></ul><ul><ul><li>memory: past and </li></ul></ul><ul><ul><li>recent </li></ul></ul><ul><li>Caregiver’s history: </li></ul><ul><ul><li>pre-morbid personality </li></ul></ul><ul><ul><li>attitude </li></ul></ul><ul><ul><li>social functioning </li></ul></ul><ul><ul><li>interest </li></ul></ul><ul><ul><li>self-care </li></ul></ul>PHYSICAL EXAMINATION: - To exclude treatable and reversible causes of dementia <ul><li>MENTAL & COGNITIVE STATE EXAM: </li></ul><ul><li>Mini mental state exam (MMSE) </li></ul><ul><li>Clock drawing test </li></ul>
  12. 14. CLOCK DRAWING TEST <ul><li>In the space below, please draw the face of a clock and put the numbers in the correct position </li></ul><ul><li>Now, draw in the hands at ten minutes after eleven </li></ul>
  13. 15. SUMMARY OF MANAGEMENT Non pharmacological intervention Pharmacological treatment General principles <ul><li>Set treatment goals </li></ul><ul><li>Involve patient and family members in decision making </li></ul><ul><li>Treat the main distressing problem first </li></ul><ul><li>Set a frame time: monitor cognitive & non cognitive symptoms </li></ul><ul><li>Assess success/failure of the intervention </li></ul>
  14. 16. SUMMARY OF MANAGEMENT Non pharmacological intervention Pharmacological treatment General principles <ul><li>GENERAL PSYCHOSOCIAL: </li></ul><ul><li>educate the pt and family </li></ul><ul><li>optimize function & QOL </li></ul><ul><li>address family issue: financial, emotional </li></ul><ul><li>related ethical issue </li></ul><ul><li>SPECIFIC PSYCHOTHERAPY: </li></ul><ul><li>behaviour-oriented </li></ul><ul><li>emotion-oriented </li></ul><ul><li>cognition oriented </li></ul><ul><li>stimulation oriented </li></ul>
  15. 17. SUMMARY OF MANAGEMENT Non pharmacological intervention Pharmacological treatment General principles <ul><li>COGNITIVE IMPROVEMENT : </li></ul><ul><li>- Cholinesterase inhibitor: Donepezil / Rivastigmine / Galantamine </li></ul><ul><li>- NMDA antagonist: Memantine </li></ul><ul><li>BEHAVIOURAL & PSYCHOLOGICAL SYMPTOMS: </li></ul><ul><li>- psychosis & agitation </li></ul><ul><li>- depression </li></ul><ul><li>- sleep disturbance </li></ul>
  16. 18. CHOLINESTERASE INHIBITOR Donepezil (Aricept) 5-10 mg OD - For all stages of Alzheimer’s disease Rivastigmine (Exelon) 6-12 mg BD - For mild to moderate Alzheimer’s disease Galantamine (Reminyl) 16-24 mg BD - For mild to moderate Alzheimer’s disease
  17. 19. NMDA INHIBITOR <ul><li>Memantine (Ebixa) 5-20 mg BD </li></ul><ul><li>M.O.A: inhibit glutamate activity </li></ul><ul><li>Effective in moderate to severe dementia, including vascular dementia and HIV dementia </li></ul>
  18. 20. THANK YOU

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