Dementia is a collective term for various medical conditions that result in cognitive decline, impacting daily life and independent functioning, primarily affecting older adults. With approximately 47 million affected globally, this number is projected to rise significantly, particularly in developing countries. The document outlines types, symptoms, risk factors, stages, diagnosis methods, and management strategies for dementia, emphasizing the need for rehabilitation and support.

1. MRS. M.PRADEEPA MPT (NEURO)
VICE PRINCIPAL
PPG COLLEGE OF PHYSIOTHERAPY
COIMBATORE,TAMILNADU

2. INTRODUCTION
 The term dementia derives from the Latin root demens,
which means being out of one’s mind.
 Dementia is one of the major causes of disability and
dependency among older people worldwide
 Dementia is not a single disease; it’s an overall term that
covers a wide range of specific medical conditions,
including Alzheimer’s disease.
 Disorders grouped under the general term “dementia” are
caused by abnormal brain changes.
 These changes trigger a decline in cognitive abilities,
severe enough to impair daily life and independent
function.
 They also affect behavior, feelings and relationships.

3. DEFINITION
 Progressive deterioration of intellect, behaviour and
personality as a consequence of diffuse disease of
the cerebral hemispheres, maximally affecting the
cerebral cortex and hippocampus.

4. Epidemiology
 Dementia affects about 47 million people worldwide .
 According to World Alzhemier’s report 2015, the
number of people affected by dementia is expected
to increase to 131 million in 2050, where majority
would be in developing countries.
 Dementia may occur at any age but is more common
in the elderly, increasing with age - approximate
prevalence 1% in 60s, 5% in 70s, 15% in 80s.
 Rates are slightly higher in women than men at ages
65 and greater.

5. Classification - Based on etiology:
 1. DEGENERATIVE
 A. Pure dementia
Alzheimer’s disese (~60%)
Frontotemporal/Pick’s disease (~5%)
 B. Dementia plus syndromes
Dementia with Lewy bodies (~10%)
Parkinson’s disease with dementia
 2. CORTICOBASAL DEGENERATION
Progressive supranuclear palsy
Huntington’s disease
 3.CEREBROVASCULAR DISEASES (20%)
Multiple infarct dementia
Subcortical ischaemic vascular dementia
Chronic subdural haematomas
Cerebral amyloid angiopathy
 4. STRUCTURAL DISORDERS
Normal pressure hydrocephalus

6. Based on etiology
 5. INFECTIONS
Syphilis
HIV
 6.NUTRITIONAL
Wernicke Korsakoff (thiamine deficiency)
B12 deficiency
 7. METABOLIC
Hepatic disease
Thyroid disease
 8. CHRONIC INFLAMMATORY
Multiple sclerosis
Vasculitis
 9. TRAUMA
Head injury
 10. NEOPLASIA AND PARANEOPLASIA
Frontal tumour
Limbic encephalitis

7. Classification - Based on site
ANTERIOR POSTERIOR SUB CORTICAL CORTICAL
Frontal premotor
cortex
Parietal and
temporal lobes
Behavioural
changes/loss of
inhibition,
antisocial
behaviour, facile
and irresponsible
Disturbance of
cognitive function
(memory and
language) without
marked changes
in behaviour
Apathetic
Forgetful and
slow, poor ability
to use knowledge
Associated with
other neurological
sign and
movement
disorders
Higher cortical
abnormalities –
dysphasia,
agnosia, apraxia
e.g.
Frontotemporal
dementia
Alzheimer’s
disease
e.g. Parkinson’s
disease, AIDS
dementia complex
Alzheimer’s
disease

8. Risk factors
 Smoking
 Alcohol consumption
 Sedentary life style, obseity
 High blood pressure
 Hyperlipidemia
 Hypercholesterolemia
 Depression
 Heart diseases
 Prior stroke

9. Pathology
 Loss of neurons
 Neurofibrillary tangles
 Senile plagues
 Amyloid angiopathy are seen especially within the
frontal, temporal and parietal cortex hippocampi,
substantia nigra and locus coeruleus

10. Signs and symptoms
 Neuropsychiatric symptoms - termed as
Behavioural and psychological symptoms of
dementia (BPSD). These can include problems with:
 Balance
 Tremor
 Speech and language
 Eating/swallowing
 Memory
 Wandering or restlessness
 Visual perception

11. Signs and symptoms
 Behavioral and psychological symptoms of dementia
almost always occur in all types of dementia and may
manifest as:
 Agitation
 Depression
 Anxiety
 Abnormal motor behavior
 Elated mood
 Irritability
 Apathy
 Delusions (often believing people are stealing from them)
or hallucinations
 Changes in sleep or appetite

12. Stages of Dementia - According to WHO
 3 stages are stated:
 Early stage
 Middle stage
 Late stage

13. Early stage:
 The onset is gradual. Common symptoms include:
a. Memory difficulty include some word-finding
problems (anomia) and problems with planning and
organizational skills
b. Losing track of the time
c. Becoming lost in familiar places.
d. Repeating things, personality changes, social
withdrawal and difficulties at work
e. MMSE scores are between 20 and 25.

14. Middle stage:
 The signs and symptoms become clearer and more
restricting, these include:
a. Severely impaired in solving problems and their
social judgment
b. Becoming forgetful of recent events and people's
names
c. Becoming lost at home
d. Having increasing difficulty with communication
e. Needing help with personal care
f. Experiencing behaviour changes, including
wandering and repeated questioning
g. MMSE between scores of 6–17

15. Late stage:
 Near total dependence and inactivity. Memory
disturbances are serious and the physical signs and
symptoms become more obvious. Symptoms
include:
a. Becoming unaware of the time and place
b. Having difficulty recognizing relatives and friends
c. Having an increasing need for assisted self-care
d. Often eat pureed diets, thickened liquids, and
require assistance in eating
e. Having difficulty walking
f. Experiencing behaviour changes that may escalate
and include aggression

16. Diagnosis
 Cognitive and neuropsychological tests
 Mini mental scale
 Rating Anxiety in Dementia
 The Dementia Quality of Life Instrument
 The disability assessment for dementia
 CT or MRI. These scans can check for evidence of
stroke or bleeding or tumor or hydrocephalus.

17.  PET scans. These can show patterns of brain
activity and whether the amyloid protein, a hallmark
of Alzheimer's disease, has been deposited in the
brain.
 Laboratory tests
 Simple blood tests can detect physical problems that
can affect brain function, such as vitamin B-12
deficiency or an underactive thyroid gland.
 The spinal fluid is examined for infection,
inflammation or markers of some degenerative
diseases.

18. Differential diagnosis
 Dementia can have different causes, and the
following conditions need to be treated and/or
excluded first:
 Vitamin B12 deficiency
 Hormone deficiencies (e.g. thyroid problems)
 Depression
 Medication side-effects
 Alcohol abuse
 Overmedication
 Infections
 Brain tumours

19. Medical Management
 Most types of dementia can't be cured, but there are
ways to manage your symptoms.
 Cholinesterase inhibitors: including donepezil
(Aricept), rivastigmine (Exelon) and galantamine
(Razadyne) — work by boosting levels of a chemical
messenger involved in memory and judgment.
 Memantine: Memantine (Namenda) works by
regulating the activity of glutamate, another chemical
messenger involved in brain functions, such as
learning and memory. In some cases, memantine is
prescribed with a cholinesterase inhibitor.

20. Rehabilitation
 Physiotherapy: plays an essential part in promoting
and maintaining mobility for people with dementia,
and particularly has a vital role in end of life care, by
managing positioning, seating and painful
contractures.
 Occupational therapy: teaches coping behaviors.
The purpose is to prevent accidents, such as falls;
manage behavior; and prepare you for the dementia
progression.

21.  Modifying the environment. Reducing clutter and
noise can make it easier for someone with dementia
to focus and function. Monitoring systems can alert
you if the person with dementia wanders.
 Simplifying tasks. Break tasks into easier steps
and focus on success, not failure. Structure and
routine also help reduce confusion in people with
dementia