🛑 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 👇🏻
