CPG Dementia

8/13/2019 CPG Dementia

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DEMENTIA

a syndrome characterised by diverse behavioural,

cognitive and emotional impairments.

The Royal College of Physicians of London,

defined dementia as an acquired global

impairment of higher cortical functions including

memory, capacity to solve problems, learned

percepto-motor skills, social skills, language andcommunication, and control of emotion, in the

absence of clouding of consciousness.


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INCIDENCE AND PREVALENCE

It is estimated that there are 24.3 million people withdementia worldwide, with 4.6 million new cases eachyear.

The number of people affected is expected to double

every 20 years. The forecasted rate of increase is estimated to be more

than 300% in India, China and their South Asian andWestern Pacific neighbours.

About 6.1% of the population 65 years of age andolder, suffer from dementia (about 0.5% of theworldwide population).

Fifty nine percent of PWD are females.


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SUBTYPES

Alzheimers disease the most common typeof the primary degenerative dementia (60-80%) of

cases.

Characterised by progressive deterioration of short term memory and otherhigher cortical functions. Motor skills are generally preserveduntil late in thedisease. Supportive features include altered behaviourand inability to carry

out activities of daily living (ADL). predominantly affects the older age group (> 65 years), but early onset can

occur.

A clinical diagnosis of AD can be made accurately in 90% of cases,

Diagnosis can only be confirmed on brain biopsy by the presence of neuriticplaques (NPs), which are the accumulated deposits of amyloid B40 and

amyloid B42, and neurofibrillary tangles (NFTs), the hyperphosphorylated tauproteins.

severity of the cognitive decline is more closely related to the NFTs burden.

still unknownwhat triggers the changes in the neurons.


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SUBTYPES

Vascular Dementia

a heterogeneous disease with diverse vascularpathologies, such as strategic infarcts, multiple

cortical infarcts, and subcortical ischaemic lesions. Major cardiovascular risk factors are independent

risk factors for the development of atherosclerosisand vascular dementia.

These risk factors also predispose to acute stroke,which is a well established factor for thedevelopment of VaD.


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SUBTYPES

Lewy Body Diseases

Parkinson disease dementia (PDD) Lewy bodies is found primarily in the subcortical regions of the brain,

the midbrain, substantia nigra and locus ceruleus.

usually a 10 to 15 year lag time between the Parkinson diagnosis and

the onset of dementia Dementia with LB

Lewy bodies in the subcortical and cortical (frontotemporal) regions ofthe brain. Amyloid plaques can also be found in DLB.

The cardinal features of dementia with Lewy bodies are: dementia,delirium (fluctuating cognition), early and vivid visual hallucinations

and Parkinsonism. Any two of the supportive features of repeated falls, syncope,

transient disturbances of consciousness, neuroleptic sensitivity,systematised delusions and/or hallucinations in other modalities,further strengthens the diagnosis.


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SUBTYPES

Frontotemporal Dementia a frequent cause of dementia in younger individuals with

disease onset


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SUBTYPES

Mixed Dementia

In autopsy

coexisting vascular pathology occurs in 24% to 28% of

AD cases.

Pathological Parkinson disease is present in 20% of

patients with AD

50% of patients with DLB have AD pathology.


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DIFFERENTIAL DIAGNOSIS


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CLOCK DRAWING TEST


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INVESTIGATIONS


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PHARMACOLOGICAL INTERVENTIONS

Cognitive enhancers

Eg. Donepezil, galantamine, rivastigmine

Mechanism:

augmenting the levels of acetylcholinein the brain to

compensate for the losses of cholinergic function.

continuous stimulation of NMDA receptors by

glutamate which triggers a cascade of biochemical

events that damage and kill surrounding neurones.

Recommended for mild to moderate dementia.

Only Donepezil apporoved for severe dementia.


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CPG Dementia

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