Dementia

Geriatric Psychiatry: A Review & Update

Dementia DefinitionDementia Definition Multiple Cognitive Deficits:Multiple Cognitive Deficits:

Memory dysfunction Memory dysfunction At least one additional cognitive deficitAt least one additional cognitive deficit

Cognitive Disturbances:Cognitive Disturbances: Sufficiently severe to cause impairment Sufficiently severe to cause impairment

of occupational or social functioning and of occupational or social functioning and Must represent a decline from a Must represent a decline from a

previous level of functioningprevious level of functioning


Differential Diagnosis: Differential Diagnosis: Top Ten Top Ten

1.1. AAlzheimer Disease (pure ~40%, + mixed~70%)lzheimer Disease (pure ~40%, + mixed~70%)2.2. VVascular Disease, MID (5-20%)ascular Disease, MID (5-20%)3.3. DDrugs, rugs, DDepression, epression, DDeliriumelirium4.4. EEthanolthanol (5-15%) (5-15%)5.5. MMedical / edical / MMetabolic Systemsetabolic Systems6.6. EEndocrine (thyroid, diabetes), ndocrine (thyroid, diabetes), EEars, ars, EEyes, yes,

EEnviron.nviron.7.7. NNeurologic (other primary degenerations, etc.)eurologic (other primary degenerations, etc.)8.8. TTumor, umor, TToxin, oxin, TTraumarauma9.9. IInfection, nfection, IIdiopathic, diopathic, IImmunologicmmunologic10. 10. AAmnesia, mnesia, AAutoimmune, utoimmune, AApnea, pnea, AAAMIAMI


Diagnostic Criteria For Dementia Diagnostic Criteria For Dementia Of The Alzheimer TypeOf The Alzheimer Type

A.A. Multiple Cognitive DeficitsMultiple Cognitive Deficits1. Memory Impairment 1. Memory Impairment 2. Other Cognitive Impairment2. Other Cognitive Impairment

B. Deficits Impair Social/Occupational B. Deficits Impair Social/Occupational C.C. Course Shows Gradual Onset And DeclineCourse Shows Gradual Onset And DeclineD.D. Deficits Are Not Due to:Deficits Are Not Due to:

1. Other CNS Conditions1. Other CNS Conditions2. Substance Induced Conditions2. Substance Induced Conditions

E. Do Not Occur Exclusively during DeliriumE. Do Not Occur Exclusively during DeliriumF. Not Due to Another Psychiatric DisorderF. Not Due to Another Psychiatric Disorder

Causes Causes Reduced synthesis of the Reduced synthesis of the

neurotransmitter acetylcholine.neurotransmitter acetylcholine. Aggregation of amyloid* leading to Aggregation of amyloid* leading to

generalized neuroinflammation.generalized neuroinflammation. Plaques– deposits of the protein beta-Plaques– deposits of the protein beta-

amyloid* that accumulate in the amyloid* that accumulate in the spaces between nerve cells spaces between nerve cells

Tangles – deposits of the protein tau Tangles – deposits of the protein tau that accumulate inside of nerve cellsthat accumulate inside of nerve cells


Taupathy Taupathy Abnormal aggregation of the Abnormal aggregation of the tau proteintau protein. Every . Every

neuron has a neuron has a cytoskeletoncytoskeleton, called , called microtubulesmicrotubules. . A protein called A protein called tautau stabilizes the microtubules stabilizes the microtubules

when when phosphorylatedphosphorylated, and is therefore called a , and is therefore called a microtubule-associated proteinmicrotubule-associated protein. .

In AD, tau undergoes chemical changes, In AD, tau undergoes chemical changes, becoming becoming hyperphosphorylatedhyperphosphorylated; it then begins ; it then begins to pair with other threads, creating to pair with other threads, creating neurofibrillary tangles and disintegrating the neurofibrillary tangles and disintegrating the neuron's system.neuron's system.



Vascular DementiaVascular DementiaA.A. Multiple Cogntive ImpairmentsMultiple Cogntive Impairments

B.B. Deficits Impair Social/OccupationalDeficits Impair Social/Occupational

C.C. Focal Neurological Signs and Focal Neurological Signs and Symptoms or Laboratory Evidence Symptoms or Laboratory Evidence Indicating Cerebrovascular Disease Indicating Cerebrovascular Disease Etiologically Related to the DeficitsEtiologically Related to the Deficits

D.D. Not Due to DeliriumNot Due to Delirium


Factors Associated with Multi-infarct Factors Associated with Multi-infarct DementiaDementia

History of stroke (especially in Nursing History of stroke (especially in Nursing Home)Home)

Step-wise deteriorationStep-wise deterioration Cardiovascular disease – HTD & Atrial FibCardiovascular disease – HTD & Atrial Fib Depression (left anterior strokes), Depression (left anterior strokes),

personality changepersonality change More gait problems than in ADMore gait problems than in AD Binswanger’s disease*Binswanger’s disease* SPECT / PET show focal areas of dysfunctionSPECT / PET show focal areas of dysfunction Neuropsychological dysfunctions are patchyNeuropsychological dysfunctions are patchy

Binswanger's diseaseBinswanger's disease Also known as subcortical Also known as subcortical

leukoencephalopathy, is a form of leukoencephalopathy, is a form of small vessel vascular dementia small vessel vascular dementia caused by damage to the white brain caused by damage to the white brain matter. White matter atrophy can be matter. White matter atrophy can be caused by many circumstances caused by many circumstances including chronic hypertension as including chronic hypertension as well as old agewell as old age



Post-Cardiac SurgeryPost-Cardiac Surgery 53% post-surgical confusion at discharge 53% post-surgical confusion at discharge

(delirium)(delirium) 42% impaired 5 years later42% impaired 5 years later May be related to anoxic brain injury, apneaMay be related to anoxic brain injury, apnea May be related to narcotic/other medicationMay be related to narcotic/other medication May occur in those patients who would have May occur in those patients who would have

developed dementia anyway (? genetic risk)developed dementia anyway (? genetic risk) Cardio-vascular disease and stress may start Cardio-vascular disease and stress may start

Alzheimer pathologyAlzheimer pathology Any surgery may have a similar effect related to Any surgery may have a similar effect related to

peri-op or post-op anoxia or vascular stressperi-op or post-op anoxia or vascular stress

Newman et al., 2001, NEJMNewman et al., 2001, NEJM


Drug InteractionsDrug Interactions Anticholinergics: amitriptyline, atropine, Anticholinergics: amitriptyline, atropine,

benztropine, scopolamine, hyoscyamine, benztropine, scopolamine, hyoscyamine, oxybutynin, diphenhydramine, oxybutynin, diphenhydramine, chlorpheniramine, many anti-histaminicschlorpheniramine, many anti-histaminics May aggravate Alzheimer pathologyMay aggravate Alzheimer pathology

GABA agonists: benzodiazepines, GABA agonists: benzodiazepines, barbiturates, ethanol, anti-convulsantsbarbiturates, ethanol, anti-convulsants

Beta-blockers: propranololBeta-blockers: propranolol Dopaminergics: l-dopa, alpha-methyl-Dopaminergics: l-dopa, alpha-methyl-

dopadopa Narcotics: may contribute to dementiaNarcotics: may contribute to dementia


Delirium DefinitionDelirium Definition Disturbance of consciousnessDisturbance of consciousness

i.e., reduced clarity of awareness of i.e., reduced clarity of awareness of the environment with reduced ability the environment with reduced ability to focus, sustain, or shift attentionto focus, sustain, or shift attention

Change in cognition (memory, Change in cognition (memory, orientation, language, perception)orientation, language, perception)

Development over a short period Development over a short period (hours to days), tends to fluctuate(hours to days), tends to fluctuate

Evidence of medical etiologyEvidence of medical etiology


EthanolEthanol Accidents, Head InjuryAccidents, Head Injury Dietary DeficiencyDietary Deficiency

Thiamine – Wernicke-Korsakoff Thiamine – Wernicke-Korsakoff syndromesyndrome

Hepatic EncephalopathyHepatic Encephalopathy Withdrawal Damage (seizures) Withdrawal Damage (seizures)

Delayed Alcohol WithdrawalDelayed Alcohol Withdrawal Watch for in hospitalized patientsWatch for in hospitalized patients

Chronic NeurodegenerationChronic Neurodegeneration Cerebellum, gray matter nucleiCerebellum, gray matter nuclei


Medical / EndocrineMedical / Endocrine Thyroid dysfunctionThyroid dysfunction

Hypothyoidism – elevated TSHHypothyoidism – elevated TSH Compensated hypothyroidism may have normal T4, Compensated hypothyroidism may have normal T4,

FTIFTI HyperthyroidismHyperthyroidism

Apathetic, with anorexia, fatigue, weight loss, Apathetic, with anorexia, fatigue, weight loss, increased T4increased T4

DiabetesDiabetes Hypoglycemia Hypoglycemia (loss of recent memory since episode)(loss of recent memory since episode) HyperglycemiaHyperglycemia HypercalcemiaHypercalcemia Nephropathy, UremiaNephropathy, Uremia Hepatic dysfunction (Wilson’s disease)Hepatic dysfunction (Wilson’s disease) Vitamin Deficiency (B12, thiamine, niacin)Vitamin Deficiency (B12, thiamine, niacin)

Pernicious anemia – B12 deficiency, ?Pernicious anemia – B12 deficiency, ?homocysteinehomocysteine


Eyes, Ears, Eyes, Ears, EnvironmentEnvironment

Must consider sensory deficits might Must consider sensory deficits might contribute to the appearance of the contribute to the appearance of the patient being dementedpatient being demented

Central Auditory Processing Deficits Central Auditory Processing Deficits (CAPD)(CAPD)

Hearing problems are socially isolatingHearing problems are socially isolating Environmental stress factors can Environmental stress factors can

predispose to a variety of conditionspredispose to a variety of conditions Nutritional deficiencies (tea & toast Nutritional deficiencies (tea & toast

syndrome)syndrome)


Neurological Neurological ConditionsConditions

Primary Neurodegenerative DiseasePrimary Neurodegenerative Disease Diffuse Lewy Body Dementia (? 7 - 50%)Diffuse Lewy Body Dementia (? 7 - 50%) Fronto-temporal dementia (tau gene)Fronto-temporal dementia (tau gene)

Focal cortical atrophyFocal cortical atrophy Primary progressive aphasia (many causes)Primary progressive aphasia (many causes) Unilateral atrophy, hypofunction on EEG, Unilateral atrophy, hypofunction on EEG,

SPECT, PETSPECT, PET Normal pressure hydrocephalusNormal pressure hydrocephalus

Dementia with gait impairment, incontinence Dementia with gait impairment, incontinence Suggested on CT, MRI; need tap, Suggested on CT, MRI; need tap,

ventriculographyventriculography Other Neurologic ConditionsOther Neurologic Conditions


Tumor Tumor ToxinsToxins TraumaTrauma


Infectious Conditions Infectious Conditions Affecting the BrainAffecting the Brain

HIVHIV NeurosyphilisNeurosyphilis Viral encephalitis (herpes)Viral encephalitis (herpes) Bacterial meningitisBacterial meningitis Fungal (cryptococcus)Fungal (cryptococcus) Prion (Creutzfeldt-Jakob disease); (mad Prion (Creutzfeldt-Jakob disease); (mad

cow disease)cow disease)


Amnesic DisordersAmnesic Disorders

AmnesiaAmnesia Dissociative: localized, selective, generalizedDissociative: localized, selective, generalized Organic - damage to hippocampus Organic - damage to hippocampus

thiamine deficiency (WKE), hypoglycemia, hypoxiathiamine deficiency (WKE), hypoglycemia, hypoxia Epileptic eventsEpileptic events

Partial complex seizuresPartial complex seizures Specific brain diseasesSpecific brain diseases

Transient global amnesiaTransient global amnesia Multiple sclerosisMultiple sclerosis


Age-Associated Memory Age-Associated Memory ImpairmentImpairment

vsvsMild Cognitive ImpairmentMild Cognitive Impairment

Memory declines with ageMemory declines with age Age - related memory decline corresponds Age - related memory decline corresponds

with atrophy of the hippocampuswith atrophy of the hippocampus Older individuals remember more complex Older individuals remember more complex

items and relationshipsitems and relationships Older individuals are slower to respondOlder individuals are slower to respond Memory problems predispose to Memory problems predispose to

development of Alzheimer’s diseasedevelopment of Alzheimer’s disease

Advances in Advances in Alzheimer’s DiseaseAlzheimer’s Disease Uncovering etiologyUncovering etiology Understanding Understanding pathophysiologypathophysiology Better screening toolsBetter screening tools Improved diagnosisImproved diagnosis Developing interventions Developing interventions


EtiologyEtiology

Age - therefore - design and stressAge - therefore - design and stress Genetics (amyloid related)Genetics (amyloid related) Relation to vascular factors, Relation to vascular factors,

cholesterol, BPcholesterol, BP Education (? design vs protection)Education (? design vs protection) Environment - Environment - diet, exercise, diet, exercise,

smokingsmoking


Neuropathology of ADNeuropathology of AD Senile plaquesSenile plaques Neurofibrillary tanglesNeurofibrillary tangles Neurotransmitter lossesNeurotransmitter losses Inflammatory responsesInflammatory responses

New Neuropath New Neuropath MechanismsMechanisms

Amyloid PreProtein (APP - ch21)Amyloid PreProtein (APP - ch21) Tau phosphorylation (relation to Tau phosphorylation (relation to

dementia)dementia)


Biopsychosocial Systems Biopsychosocial Systems Affected by ADAffected by AD(all related to neuroplasticity)(all related to neuroplasticity)

Social SystemsSocial Systems Basic ADLs - LateBasic ADLs - Late

Psychological SystemsPsychological Systems Primary Loss Of Memory Primary Loss Of Memory Later Loss Of Learned SkillsLater Loss Of Learned Skills

Neuronal Memory Systems Neuronal Memory Systems Cortical Glutamatergic StorageCortical Glutamatergic Storage Subcortical (acetylcholine, norepi, serotonin)Subcortical (acetylcholine, norepi, serotonin) Cellular Plastic Processes Cellular Plastic Processes

APP metabolism – early, broad cortical distributionAPP metabolism – early, broad cortical distribution TAU hyperphosphorylation – late, focal effect, TAU hyperphosphorylation – late, focal effect,

dementia relateddementia related


Why Diagnose AD Why Diagnose AD Early?Early?

Safety (driving, compliance, cooking, etc.)Safety (driving, compliance, cooking, etc.) Family stress and misunderstanding (blame, Family stress and misunderstanding (blame,

denial) denial) Early education of caregivers of how to handle Early education of caregivers of how to handle

patient (choices, getting started)patient (choices, getting started) Advance planning while patient is competent Advance planning while patient is competent

(will, proxy, power of attorney, advance (will, proxy, power of attorney, advance directives)directives)

Patient’s and Family’s right to knowPatient’s and Family’s right to know Specific treatments now available, may delay Specific treatments now available, may delay

nursing home placement longer if started earliernursing home placement longer if started earlier


Need for Better Need for Better ScreeningScreening

and Assessment Tools and Assessment Tools Genetic vulnerability testingGenetic vulnerability testing Early recognition (10 warning signs)Early recognition (10 warning signs) Screening tools (6th vital sign in elderly)Screening tools (6th vital sign in elderly) Positive diagnostic testsPositive diagnostic tests

CSF – tau levels elevated, amyloid levels lowCSF – tau levels elevated, amyloid levels low Brain scan – PET – DDNP, Congo-red derivativesBrain scan – PET – DDNP, Congo-red derivatives

Dementia severity assessmentsDementia severity assessments Tracking progression rate, prediction of Tracking progression rate, prediction of

changechange


Alzheimer Warning SignsAlzheimer Warning SignsTop TenTop Ten

Alzheimer AssociationAlzheimer Association

1. Recent memory loss affecting job1. Recent memory loss affecting job2. Difficulty performing familiar tasks2. Difficulty performing familiar tasks3. Problems with language3. Problems with language4. Disorientation to time or place4. Disorientation to time or place5. Poor or decreased judgment5. Poor or decreased judgment6. Problems with abstract thinking6. Problems with abstract thinking7. Misplacing things7. Misplacing things8. Changes in mood or behavior8. Changes in mood or behavior9. Changes in personality 9. Changes in personality 10. Loss of initiative10. Loss of initiative


AssessmentAssessment

History Of The Development Of History Of The Development Of The DementiaThe Dementia

Physical ExaminationPhysical Examination Neurological ExaminationNeurological Examination


Neurological ExamNeurological Exam Cranial NervesCranial Nerves Sensory DeficitsSensory Deficits Motor Motor Deep tendonDeep tendon PathologicalPathological


Laboratory TestsLaboratory TestsROUTINEROUTINE

Routine – Blood tests & UrinalysisRoutine – Blood tests & Urinalysis EKGEKG Chest X-RayChest X-Ray Anatomical Brain Scan – CT (cheapest), MRIAnatomical Brain Scan – CT (cheapest), MRI

SPECIAL SPECIAL Functional Brain Imaging (SPECT, PET)Functional Brain Imaging (SPECT, PET) EEG, Evoked Potentials (P300)EEG, Evoked Potentials (P300) Reaction Times Reaction Times CSF Analysis - Routine StudiesCSF Analysis - Routine Studies Heavy Metal Screen (24 hr urine)Heavy Metal Screen (24 hr urine) GenotypingGenotyping


Justification for Brain Justification for Brain Scan in Dementia Scan in Dementia

DiagnosisDiagnosis Differential Diagnosis: Tumor, Stroke, Differential Diagnosis: Tumor, Stroke,

Subdural Hematoma, Normal Pressure Subdural Hematoma, Normal Pressure Hydrocephalus, EncephalomalaciaHydrocephalus, Encephalomalacia

Confirmation of atrophy patternConfirmation of atrophy pattern Estimation of severity of brain atrophyEstimation of severity of brain atrophy MRI shows T2 white matter changesMRI shows T2 white matter changes

Periventricular, basal ganglia, focal vs Periventricular, basal ganglia, focal vs confluentconfluent

These may indicate vascular pathologyThese may indicate vascular pathology SPECT, PET - estimation of regions of SPECT, PET - estimation of regions of

physiologic dysfunction, areas of infarctionphysiologic dysfunction, areas of infarction Helps family to visualize problemHelps family to visualize problem


INTERVENTIONSINTERVENTIONS Only successful intervention – Only successful intervention –

Cholinesterase Inhibition Cholinesterase Inhibition (1st double blind study - Ashford et al., 1981)(1st double blind study - Ashford et al., 1981)

Available Interventions – Available Interventions – Not yet proven or unconvincing effectsNot yet proven or unconvincing effects

Promising InterventionsPromising Interventions


Other Medical Other Medical ConditionsConditions

Chronic pain syndromeChronic pain syndrome Medical consultation-liaisonMedical consultation-liaison

Other Neurological Other Neurological ConditionsConditions

Parkinson’s diseaseParkinson’s disease Guillan Barre syndromeGuillan Barre syndrome Huntington’s diseaseHuntington’s disease Seizure disorders – partial complex Seizure disorders – partial complex

seizuresseizures


Parkinson’s DiseaseParkinson’s Disease Increases steadily after 50 years of Increases steadily after 50 years of

ageage PathophysiologyPathophysiology Concomitant conditionsConcomitant conditions Parkinson signsParkinson signs Symptomatic treatmentSymptomatic treatment


Behavioral Problems In Behavioral Problems In Dementia PatientsDementia Patients

Mood Disorders – depression – early Mood Disorders – depression – early in ADin AD

Psychotic DisordersPsychotic Disorders Particularly paranoia, e.g, people Particularly paranoia, e.g, people

stealing thingsstealing things AgitationAgitation Meal Time BehaviorsMeal Time Behaviors Sleep DisordersSleep Disorders


Neuropsychiatric Neuropsychiatric TreatmentsTreatments

First treat medical problemsFirst treat medical problems Second environmental Second environmental

interventionsinterventions Third neuropsychiatric Third neuropsychiatric

medicationsmedications

Dementia with Lewy Dementia with Lewy BodiesBodies

clinically defined by the presence of clinically defined by the presence of dementia, prominent hallucinations and dementia, prominent hallucinations and delusions (yet sensitive to antipsychotic delusions (yet sensitive to antipsychotic medications), fluctuations in alertness, medications), fluctuations in alertness, and gait/balance disorder and gait/balance disorder (McKeith et al., (McKeith et al., Neurology 1996;47:1113-1124)Neurology 1996;47:1113-1124)

Accounts for up to 20-30% of Accounts for up to 20-30% of degenerative dementias degenerative dementias (Hansen et al., (Hansen et al., Neurology 1990;40:1-8)Neurology 1990;40:1-8)Second in occurrence behind ADSecond in occurrence behind AD


Abnormal clumps of a protein called Abnormal clumps of a protein called alpha-synuclein. These clumps, alpha-synuclein. These clumps, called Lewy bodies, are found in called Lewy bodies, are found in nerve cells throughout the outer nerve cells throughout the outer layer of the brain (the cerebral layer of the brain (the cerebral cortex) and deep inside the midbrain cortex) and deep inside the midbrain and brainstem. and brainstem.


cases presenting for autopsy have cases presenting for autopsy have Lewy Bodies (LB) in neocortex and Lewy Bodies (LB) in neocortex and brainstembrainstem

Most also AD changesMost also AD changes Typically include pure dementia Typically include pure dementia

cases with cortical Lewy Bodies and cases with cortical Lewy Bodies and those those with AD+LB under those those with AD+LB under Dementia with Lewy BodiesDementia with Lewy Bodies


Core Core Has two of the following core features for Has two of the following core features for

probable and one for possible DLBprobable and one for possible DLB Fluctuating cognition with pronounced Fluctuating cognition with pronounced

variations in attention and alertnessvariations in attention and alertness Occurs in 80-90% of DLB, only 20% of ADOccurs in 80-90% of DLB, only 20% of AD Recurrent visual hallucinations that are Recurrent visual hallucinations that are

typically well formed and detailedtypically well formed and detailed Spontaneous motor features of Spontaneous motor features of

parkinsonismparkinsonismGeriatric Psychiatry: A Review & Update

Features supportive of Features supportive of the diagnosisthe diagnosis

Repeated fallsRepeated falls SyncopeSyncope Transient loss of consciousnessTransient loss of consciousness Neuroleptic sensitivityNeuroleptic sensitivity Systematized delusionsSystematized delusions Hallucinations in other modalitiesHallucinations in other modalities


motor symptoms- Nonpharmacologic motor symptoms- Nonpharmacologic interventions, including physical, interventions, including physical, occupational and speech therapy, occupational and speech therapy, community resources and assistance community resources and assistance with home care treated with with home care treated with dopaminergic therapies. These dopaminergic therapies. These medications are usually helpful in medications are usually helpful in decreasing the severity of motor decreasing the severity of motor symptoms.. symptoms..


Cognitive symptoms Cognitive symptoms treated with cholinesterase inhibitors (e.g., treated with cholinesterase inhibitors (e.g.,

Rivastigmine®, Aricept®). These medications Rivastigmine®, Aricept®). These medications can improve the attention deficits, cognitive can improve the attention deficits, cognitive fluctuations, neuropsychiatric symptoms (e.g., fluctuations, neuropsychiatric symptoms (e.g., hallucinations, apathy, anxiety), and sleep hallucinations, apathy, anxiety), and sleep disturbances by boosting acetylcholine in the disturbances by boosting acetylcholine in the brain, a neurotransmitter that is severely brain, a neurotransmitter that is severely reduced by these diseases. Memantine has reduced by these diseases. Memantine has also been tried for treatment of cognitive also been tried for treatment of cognitive impairment in Lewy body dementias. impairment in Lewy body dementias.


Depression is very common in Lewy Depression is very common in Lewy body dementias and can be treated body dementias and can be treated with antidepressant medications.with antidepressant medications.


psychotic symptoms psychotic symptoms If non-responsive to psychosocial If non-responsive to psychosocial

interventions (e.g., making changes in interventions (e.g., making changes in the patient’s environment) or the patient’s environment) or cholinesterase inhibitor treatment, cholinesterase inhibitor treatment, atypical second generation antipsychotic atypical second generation antipsychotic medications such as risperidone medications such as risperidone (Risperdol®) and quetiapine (Risperdol®) and quetiapine (Seroquel®) can be tried but must be (Seroquel®) can be tried but must be used cautiously due to the risk of motor used cautiously due to the risk of motor and cognitive side effects. and cognitive side effects.


Older, first generation antipsychotic Older, first generation antipsychotic drugs such as haloperidol or drugs such as haloperidol or chlorpromazine should be avoided chlorpromazine should be avoided because of ??because of ??


FRONTO-TEMPORALFRONTO-TEMPORALclinicopathologic condition clinicopathologic condition

consisting of deterioration of consisting of deterioration of personality and cognition assoc. with personality and cognition assoc. with prominent frontal and temporal lobe prominent frontal and temporal lobe atrophyatrophy

Accounts for up to 3-20% of Accounts for up to 3-20% of dementiasdementiasThird behind AD and Lewy Body Third behind AD and Lewy Body

Dementia in neurodegenerative Dementia in neurodegenerative dementing illnessesdementing illnesses


Core features Core features

Insidious onset and slow progressionInsidious onset and slow progression Early decline of Early decline of Social interpersonal conductSocial interpersonal conduct Regulation of personal conductRegulation of personal conduct InsightInsight Early emotional bluntingEarly emotional blunting


Supportive featuresSupportive features

Decline in personal hygiene and Decline in personal hygiene and groominggrooming

Mental rigidity and inflexibilityMental rigidity and inflexibility Distractibility and impersistenceDistractibility and impersistence HyperoralityHyperorality Perseverative behaviorPerseverative behavior Speech and language Speech and language


Treatment Treatment Options for pharmacotherapy are Options for pharmacotherapy are

limited. The available evidence is limited. The available evidence is derived largely from small, open derived largely from small, open label studies or case reports. Open label studies or case reports. Open label studies have shown no clear label studies have shown no clear symptomatic benefit for symptomatic benefit for cholinesterase inhibitors or cholinesterase inhibitors or memantine.*memantine.*


Reference Reference Seltman RE, Matthews BR. Seltman RE, Matthews BR.

Frontotemporal lobar degeneration: Frontotemporal lobar degeneration: epidemiology, pathology, diagnosis epidemiology, pathology, diagnosis and management. CNS and management. CNS Drugs2012;26:841-70.Drugs2012;26:841-70.


Dementia

Health & Medicine

Transcript of Dementia