🛑 Dementia

🛑 Dementia

🌱 Definition

  • Clinical syndrome, characterize by acquired progressive cognitive impairment

🌱Criteria & clinical features:

Memory impairment (short worse than long term) + one of the following :

  • Apraxia
  • aphasia
  • agnosis
  • abstract and other executive function
  • normal conscious + impair ability to function

**Also may affect

  • personality
  • Visuospatial functioning

** non-cognitive symptoms :

  • mood disorder (coexist of depression which response to antidepressants)
  • Pathological laughter and crying
  • Irritability
  • explosiveness
  • catastrophic reaction (Excessive emotional outbursts that occur after task failure)
  • Delusions or hallucination (in 75%)

** behavior problem

  • agitation, restlessness
  • wandering
  • violence
  • shouting
  • Social and sexual disinhibition
  • impulsiveness
  • Sleep disturbances

📌presenile dementia = dementia in under 65 years

📌Mild cognitive impairment (MCI) = decline in cognitive function + not meet the criteria of dementia -> It progresses to dementia within a year in about 30% of cases.

🌱 Mini Mental State Exam (MMSE) (use as screening)
1- orientation
2- registration
3- attention and calculation
4- recall
5- language
6- copying

**The maximum score is 30;
**23 or lower indicative of impairment.

🌱Investigations
To exclude treatable causes

🌱DDx

  • deafness
  • dysphasia (misinterpreted as confusion)
  • depression (also called pseudo-dementia)
  • delirium
  • other psychiatric disorder like paraphrenia
  • transient global amnesia (loss in memory only)
  • epilepsy – post-ictal state or ongoing temporal lobe epilepsy
  • drugs (specially anticholinergic effect of drugs)

🌱Causes of dementia

📌 Common causes

  • Alzheimer’s disease (50 –60% of cases)
  • Vascular dementia (20 –25%)
  • Dementia with Lewy bodies (10–15%)
  • Other causes account for ~10% of dementias

📌 Degenerative disorders

  • Frontotemporal lobar degeneration
  • Huntington’s disease
  • Prion disease
  • Parkinson’s plus syndromes

📌 Metabolic disorders

  • Alcohol-associated dementia
  • Vitamin B12 deficiency
  • Hypothyroidism
  • Hyperparathyroidism
  • hypercalcaemia

📌 Infections

  • HIV-associated dementia
  • Syphilis

📌Other causes

  • Normal pressure hydrocephalus
  • Intracranial tumours
  • Subdural haematoma
  • Head injury
  • Wilson disease

** reversible or treatable causes of dementia -> some of these causes ‘above’ are treatable -> so we can treat the dementia by treat the underlying cause

🌱Dementia ca n be divide into

  • cortical -> mainly affect the cortex
    *like -> Alzheimer’s, CJD, and Pick’s disease
  • subcortical -> mainly affect basal ganglion, thalamus and deep white matter
    *like -> Huntington’s disease, Parkinson’s disease, NPH, multi-infarct dementia, Wilson’s disease

See the picture 👇🏻

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