dementia

1. Approarch to deementia
Swayang Sudha Panda

2. • 46 yr of male
• Family history positive for FTD genetically
proven
• Forgets the names of people
• Instrumental and basic activities of daily living
intact.
• Torca
• Memory immediated recall 18/30

3. Diagnosis
• Specific diagnosis
• Stage the disease
• Identify any systemic illnesses, psychiatric
conditions, or delirium that might be
contributing.
• Ruling out other disease

4. • V
• I
• T
• A
• M
• I
• N
• S

5. Diagnosis
• A comprehensive history
• a neurologic examination, an objective neurocognitive
assessment, and a formal neuropsychologic
• AD- National Institute on Aging-Alzheimer’s Association
(NIA-AA) established clinical criteria that defines it as
clinical syndrome with biomarkers for amyloid and
neurodegeneration.2
• The most recent version of the framework from 2018
defines AD as a biologic entity defined by positive
biomarkers for amyloid and tau, and defines the clinical
spectra independently.6

6. Diagnostic criteria for various
dementia

7. Demographics
• Age at onset of dementia- (Early-onset
dementia <65)
• Women have a higher incidence of dementia
• Minoritized racial and ethnic groups.
• Low levels of education

8. Cognitive Symptoms
• A major neuro-cognitive disorder or dementia (DSM-5)
• It is characterized by a significant decline in cognition compared with a previously known cognitive
baseline.
• The decline should involve at least 1 of the following cognitive domains:
– learning and memory
– language
– executive functions and attention
– perceptual motor
– social cognition
• The cognitive deficits must be significant enough to interfere with activities of daily living.
• MCI -

10. Behavioural symptoms
• Behavioral and psychiatric symptoms of
dementia (BPSD) - delusions, hallucinations,
agitation/aggression, depression, anxiety,
elation, apathy, disinhibition, irritability,
aberrant motor behaviors, sleep disturbances,
and eating disturbances.
• Neuropsychiatric Inventory (NPI)

11. Drugs used for BPSD

12. Medical History
• Reversible and/or treatable medical codition.
• Individuals with stroke risk factors - vascular
dementia.
• Parkinson disease (PD), stroke, cancer, HIV
infection, autoimmune disorders, depression
and mental illness, and all current and past
medications (anti-cholinergic medication)

13. • Apolipoprotein E (ApoE)
• age-dependent risk and age of AD
• major risk factor for AD.
• ApoE ε4 genotype increases amyloid β aggregation and reduces amyloid clearance.
Lifetime risk of AD at 65
men women
No e4 4.6 9.3
E4/ex 12 23
E4/e4 35 53
Liu CC, Liu CC, Kanekiyo T, Xu H, Bu G. Apolipoprotein E and Alzheimer disease: risk, mechanisms and
therapy. Nat Rev Neurol. 2013 Feb;9(2):106-18. doi: 10.1038/nrneurol.2012.263.
Liddel et al , Journal of Psychiatry
2001
Family History and Genetics Risk
Factors

14. Family History and Genetics Risk
Factors
• AD- Mutations that increase Aβ or the
Aβ42/40 ratio, including mutations in amyloid
precursor protein (APP), including
the APP Arctic mutation (protofibril
increase), presenilin 1, and presenilin 2.
• APP gene triplication reduces α-secretase -
Down syndrome.
• Protective genes- reduce α-secretase which
reduces Aβ aggregation and

15. Social History
• Drug and alcohol use or smoking

16. Neurologic Examination
• Physical and neurologic exam - focal deficits,
parkinsonian symptoms, abnormal
movements, gait and balance disturbances,
apraxia, frontal release signs, neglect, and
other perceptual disturbances.

17. Cognitive, Behavioral, and Functional
Assessments
• Mental status examinations
• Baseline and longitudinal assessments
• Mini-Mental State Examination (MMSE),18 the Montreal
Cognitive Assessment (MoCA)
• Longer - 45 to 50 minutes to administer is the Consortium
to Establish a Registry for Alzheimer’s Disease (CERAD)
battery.21
• Standardized neuropsychologic testing typically takes 2
hours to complete.
• Standardized questionnaires assessing function, mood, and
behaviors such as activities of daily living scales and the
Neuropsychiatric Inventory22 also help with early diagnosis
and treatment

18. Management

19. Lifestyle Modifications
• Regular exercise-aerobic32
• The Mediterranean diet and a variant of it
termed the Mediterranean-DASH Intervention
for Neurodegenerative Delay (MIND Persons
with dementia may also benefit from cognitive
stimulation.
• Better control of hypertension and
dyslipidemia may also delay the onset of AD
and prevent worsening of vascular dementia.