Dementia is characterized by progressive deterioration of intellect, behavior, and personality due to diffuse brain disease, especially affecting the cerebral cortex and hippocampus. Memory impairment is required for diagnosis. Common causes include Alzheimer's disease, cerebrovascular disease, Lewy body disease, and frontotemporal dementia. Evaluation involves assessing cognitive function, neurological exam, imaging, and lab tests to identify underlying causes and rule out other conditions. There is no cure for dementia, but some types can be temporarily slowed with medications or treated if potentially reversible causes are identified.
topic on dementia covering all aspects regarding classification,pathophysiology and treatment .Difference between MCI and DEMENTIA .best for post graduates ,house officers and medical students
topic on dementia covering all aspects regarding classification,pathophysiology and treatment .Difference between MCI and DEMENTIA .best for post graduates ,house officers and medical students
Parkinsons Disease Psychosis (PDP) is a multifactorial, progressive disease that presents in the late stages of Parkinsons Disease. Its hallmark features include visual hallucinations and delusions. There are factors related to Parkinsons medications (i.e. L-DOPA, anticholinergics) as well as intrinsic disease-related factors that contribute to the psychosis.
Multiple sclerosis: Introduction, Risk Factors, Diagnosis and TreatmentEnriqueAlvarez93
Introduction about Multiple Sclerosis.
Risk factors affect to Multiple Sclerosis.
When to Suspect Multiple Sclerosis.
Evaluation and Diagnosis of Multiple Sclerosis.
How to treatment of Multiple Sclerosis.
Treatment of Multiple Sclerosis with Monoclonal Antibody.
This presentation consist information about unspoken and less well known variants of GBS as well as CIDP. Also it includes information about diagnosis and management.
The world’s population is ageing rapidly, and with it is coming to a significant increase in the number of
older people with dementia. This increase presents major challenges for the provision of healthcare
generally and for dementia care in particular, for as more people have dementia, there will be more
people exhibiting behavioural and psychological symptoms of dementia (BPSD).
BPSD exact a high price from both the patient and the caregiver in terms of the distress and disability
they cause if left untreated. BPSD is recognisable, understandable and treatable. The recognition and
appropriate management of BPSD are important factors in improving our care of dementia patients
and their caregivers,
This PPT contains all the important guidelines that are needed to manage a patient of Dementia. It involves diagnosis, psychosocial treatment, non-pharmacological management and pharmacological management. This PPT is prepared from NICE, APA and SIGN guidelines.
Neurocognitive disorders includes : Delirium and Dementia.
This presentation focuses on causes, risk factors, management and how to prevent its complication
This presentation contains information about Dementia in Young onset. Also it describes the etiologies, clinical feature of common YOD & their management.
Parkinsons Disease Psychosis (PDP) is a multifactorial, progressive disease that presents in the late stages of Parkinsons Disease. Its hallmark features include visual hallucinations and delusions. There are factors related to Parkinsons medications (i.e. L-DOPA, anticholinergics) as well as intrinsic disease-related factors that contribute to the psychosis.
Multiple sclerosis: Introduction, Risk Factors, Diagnosis and TreatmentEnriqueAlvarez93
Introduction about Multiple Sclerosis.
Risk factors affect to Multiple Sclerosis.
When to Suspect Multiple Sclerosis.
Evaluation and Diagnosis of Multiple Sclerosis.
How to treatment of Multiple Sclerosis.
Treatment of Multiple Sclerosis with Monoclonal Antibody.
This presentation consist information about unspoken and less well known variants of GBS as well as CIDP. Also it includes information about diagnosis and management.
The world’s population is ageing rapidly, and with it is coming to a significant increase in the number of
older people with dementia. This increase presents major challenges for the provision of healthcare
generally and for dementia care in particular, for as more people have dementia, there will be more
people exhibiting behavioural and psychological symptoms of dementia (BPSD).
BPSD exact a high price from both the patient and the caregiver in terms of the distress and disability
they cause if left untreated. BPSD is recognisable, understandable and treatable. The recognition and
appropriate management of BPSD are important factors in improving our care of dementia patients
and their caregivers,
This PPT contains all the important guidelines that are needed to manage a patient of Dementia. It involves diagnosis, psychosocial treatment, non-pharmacological management and pharmacological management. This PPT is prepared from NICE, APA and SIGN guidelines.
Neurocognitive disorders includes : Delirium and Dementia.
This presentation focuses on causes, risk factors, management and how to prevent its complication
This presentation contains information about Dementia in Young onset. Also it describes the etiologies, clinical feature of common YOD & their management.
Alzheimer's disease is a degenerative
brain disorder of unknown etiology which
is the most common form of dementia, that
usually starts in late middle age or in old
age, results in progressive memory loss,
impaired thinking, disorientation, and
changes in personality and mood. There is
degeneration of brain neurons especially in
the cerebral cortex and presence of
neurofibrillary tangles and plaques
containing beta-amyloid cells
The disease was first described
by Dr. Alois Alzheimer, a German
physician, in 1906. Alzheimer had a
patient named Auguste D, in her
fifties who suffered from what
seemed to be a mental illness. But
when she died in 1906, an autopsy
revealed dense deposits, now called
neuritic plaques, outside and around
the nerve cells in her brain. Inside
the cells were twisted strands of
fiber, or neurofibrillary tangles.
Since Dr. Alois Alzheimer's was the
first person who discovered the
disease, AD was named after him.
Understand the relation of psychiatry and some common cause of organic brain diseases.
Identify common organic causes of psychiatric presentations
Differentiate dementia and delirium
Principle management of dementia
Identify neuro cognitive domains, differences between major and minor neurocognitive disorders
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. Dementia
Progressive deterioration of intellect,
behavior and personality as a
consequence of diffuse disease of the
brain hemispheres, maximally affecting
the cerebral cortex and hippocampus.
Dementia is a symptom of disease
rather than a single disease entity!!!
3. • Memory must be impaired to make the diagnosis of
dementia.
• Loss of memory for recent events is the earlist
feature of dementia.
• Subsequent symptoms include abnormal behavior,
loss of intellect, mood changes, and difficulty
coping with ordinary routes.
• Insight may be retained initially, but is then
usually lost.
• Ultimately, there is loss of self-care, wandering,
incontinence, and often paranoia.
4. Dementia has to be distinguished from
delirium which is an acute disturbance of
cerebral function with impaired conscious
level, hallucinations and autonomic
overactivity as a consequence of toxic,
metabolic or infective conditions.
Depression can mimic the initial phases of
dementia and it is termed
’pseudodementia’ (which is amenable to
antidepressant medication).
5. Dementia may occur at any age but is more
common in the elderly, accounting for 40% of
long-term psychiatric in-patients over the age of
65 years.
The prevalence in persons aged between 50 and
70 years is about 1% and in those approaching 90
years reaches 50%.
An annual incidence rate is 190/100 000 persons.
6. Clinical course:
The rate of progression depends upon
the underlying cause.
The duration of history helps establish the cause of
dementia: Alzheimer‘s disease is slowly progressive over
years, whereas encephalitis may be rapid over weeks.
Dementia due to cerebrovascular disease appears to occur
’stroke by stroke‘.
7. Dementias – classification
Based on cause
• Alzheimer‘s disease (~60% of all dementias)
• Cerebrovascular (multiinfarct state,
subcortical small vessel, amyloid
angiopathy,…) (~20%)
• Neurodegenerative (DLB, Pick‘s disease, Huntington‘s
chorea, Parkinson‘s disease)
• Infectious (Creutzfeld-Jakob disease, HIV infection,
progressive multifocal leucoencephalopathy)
• Normal pressure hydrocephalus TREATABLE!
• Nutritional (thiamine deficiency in alcoholics!, B12 deficiency,
folate deficiency)
• Metabolic (hepatic disease, thyroid d., parathyroid d.,
Cushing‘s syndrome)
• Chronic inflammatory (MS, …)
• Trauma (head injury, ’Punch drunk‘ syndrome)
• Tumour (e.g. subfrontal meningioma)
9. Dementias – history and
clinical examination
• When obtaining a history from a demented
person and relative, establish: rate of intellectual
decline, impairment of social function, general
health and relevant disorders (e.g. stroke, head
injury), nutrition status, drug history, family
history of dementia.
• Tests to assess intellectual function are
designed to check: memory, abstract thought,
judgement, specific focal cortical functions.
The Mini Mental State Examination (MMSE)
• On neurological examination note: focal signs,
involuntary movements, pseudobulbar signs, gait
disorder.
10. Dementias – further
investigation
• Blood tests (to exclude hypothyroidism, vitamin
B12, thiamine and folate deficiency, Lyme disease,
HIV infection, metabolic disorders and
inflammatory diseases).
• Cranial imaging (CT or/and MRI) (tu, NPH)
• PET and SPECT?
• EEG (slowing in AD, normal in pseudodementia,
periodic complexes in CJD)
• Genetic testing (rarely – Huntington mutation,
apolipoprotein E4 mutation in AD)
• Brain biopsy (if treatable cause is suspected)
11. Alzheimer's disease
• The commonest cause of dementia.
• The disorder rarely occurs under the age
of 45 years.
• The incidence increases with age.
• The cause of AD is not known (neurodegenerative d.).
• Up to 30% of cases are familial (the loci
were found on chromosome 21 and 19).
• Pathology – the presence of senile plaques and
neurofibrillary tangles in the brain.
• Diagnosis of AD may be established during
life by early memory failure, slow
progression and exclusion of other causes.
12. Alzheimer's disease
• CT scanning aids diagnosis by excluding
multiple infarction or a mass lesion.
• MRI shows bilateral temporal lobe atrophy.
• SPECT usually shows temporoparietal
hypoperfusion.
13. Alzheimer's disease -
treatment
- Acetylcholinesterase inhibitors (Donepezil [Aricept],
Rivastigmine [Exelon], Galantamine [Reminyl]) have
been shown to enhance cognitive performance in early
disease. Memantine [Ebixa, Axura, Namenda] is
approved for moderate disease. However they do not
cure!
- Treat concurrent depression, anxiety and sleep
disorders. Neuroleptic use may be required for
behavioral disturbance.
- Mangement of AD requires careful advice and
counseling of the patient and family and shared care
involving the family, caregivers, GPs, hospital specialist,
and community psychiatric services.
- Long-term residential care is ofte required.
14. Multi-infarct dementia (MID)
• This is an overdiagnosed condition which accounts for less than
10% of cases of dementia.
• MID is caused by multiple strokes - SILENT STROKES
• Dementia occurs ’stroke by stroke‘, with progressive focal loss
of function.
• Clinical features of stroke profile – hypertension, diabetes, etc.
– are present. More often in males.
• Diagnosis is obtained from the history
and confirmed by CT or MRI scan
(the presence of multiple areas of
infarction).
• Treatment: Maintain adequate blood
pressure control, anti-platelet
aggregants (aspirin).
15. Frontotemporal dementia
(Pick's disease)
• This progressive condition accounts for 5% of all dementias.
• Usually sporadic, it more commonly affect women between
40 and 60 years.
• Personality and behaviour are initially more affected than
memory.
• Frontal lobe dysfunction predominates with apathy, lack of
initiative and personality changes.
• CT or MRI scans show frontal (and/or temporal) atrophy,
often asymmetrical.
• SPECT reveal anterior hypoperfusion, EEG is usually normal.
• The disorder is characterized pathologically by argyrophylic
inclusion bodies within the cytoplasm of cells of the
frontotemporal cortex.
• There is no treatment, death occuring within 2-3 years of
the onset.
16. Primary progressive aphasia
• This condition is one of a group of disorders
characterized by asymmetrical cortical
degeneration.
• Dominant hemisphere perisylvian atrophy is
associated with loss of language, which, after
many years, becomes a more widespread dementia.
• Pathologically non-specific cell loss, Pick’s
pathology or spongiform changes are described.
• MRI and SPECT confirm focal changes.
17. Dementia with Lewy bodies (DLB)
• One of the most common types of progressive dementia.
• Progressive cognitive decline, combined with three additional
defining features: (1) pronounced “fluctuations” in alertness
and attention; (2) recurrent visual hallucinations, and (3)
parkinsonian motor symptoms, such as rigidity and the loss
of spontaneous movement.
• The symptoms of DLB are caused by the build-up of Lewy
bodies – accumulated bits of alpha-synuclein protein - inside
the nuclei of neurons in areas of the brain that control
particular aspects of memory and motor control. Lewy bodies
are often also found in the brains of people with Parkinson's
and Alzheimer’s diseases.These findings suggest that either
DLB is related to these other causes of dementia or that an
individual can have both diseases at the same time.
• DLB usually occurs sporadically, in people with no known
family history of the disease. However, rare familial cases
have occasionally been reported.
18. Normal pressure hydrocephalus
= term applied to the triad of:
1. Dementia
2. Gait disturbance
3. Urinary incontinence
occuring in conjunction with hydrocephalus and normal CSF
pressure.
Two types:
- NPH with a preceding cause (SAH, meningitis,
trauma, radiation-induced).
- NPH with no known preceding cause – idiopathic
(50%).
19. Normal pressure hydrocephalus
Aetiology is unclear.
It is presumed that at some preceding period, impedence to
normal SCF flow causes raised intraventricular pressure and
ventricular dilatation. Compensatory mechanisms permit a
reduction in CSF pressure yet the ventricular dilatation persists
and causes symptoms.
20. Normal pressure hydrocephalus
Diagnosis is based on clinical picture plus CT scan/MRI
evidence of ventricular enlargement.
NPH must be differentiated from pts whose ventricular
enlargement is merely the result of shrinkage of the
surrounding brain, e.g. AD. These pts do not respond to CSF
shunting, whereas a proportion of NPH pts (but not all) show a
definitive improvement with ventriculo-peritoneal shunting.
21. AIDS dementia complex
• Approximately two-thirds of persons with AIDS
develop dementia, mostly due to AIDS dementia
complex.
• In some patients HIV is found in the CNS at
postmortem. In others an immune mechanism or an
unidentified pathogen is blamed.
• Dementia is initially of a "subcortical " type.
• CT - atrophy; MRI - increased T2 signal from
white matter.
• Treatment with Zidovudine (AZT) halts and
partially revers neuropsychological deficit.
22. Trauma
• Reduction of intellectual function is common after
severe head injury.
• Chronic subdural haematoma can also present as
progressive dementia, especially in the elderly.
• Punch-drunk encephalopathy (dementia pugilistica)
is the cumulative result of repeated cerebral
trauma. It occurs in both amateur and professional
boxers and it manifests by dysarthria, ataxia and
expy signs associated with ’subcortical‘ dementia.
There is no treatment for this progressive
syndrome.
23. Tumour
• Dementia rarely may be due to intracranial
tumour, especially when tumours occur in certain
anatomical sites.
• Mental or behavioral changes occur in 50-70% of
all brain tumours as distinct from dementia which
is associated with frontal lobe tumours, III
ventricle tumours and corpus callosum tumours.
• Cognitive impairment also occurs as a non
metastatic complication of systemic malignancy.
25. Mild cognitive impairment (MCI)
• MCI is a relatively recent term, used to describe
people who have some problems with their
memory but do not actually have dementia.
• Some people (80%?) will be in the early stages of
Alzheimer’s disease or another dementia. Others,
however, will have MCI as a result of stress,
anxiety, depression, physical illness or just an ‘off
day’.
• It is estimated that 15% of the population may
be experiencing MCI.
• Currently extensive research on MCI is ongoing.
• At the moment there is not enough evidence to
recommend any specific treatments.