DEMENTIA

What is it? Progressive decline of cognitive function

Consciousness is not clouded
Affects 10% of age >65 years, affects 20% of age >80 years
Commonest AD
causes Fronto temporal dementia
Vascular (multi infarct) dementia
Dementia with Lewy bodies
Vitamin deficiency: B12, thiamin
Hypothyroidism
Intracranial mass: subdural haematoma, hydrocephalus, tumour
Chronic traumatic encephalopathy eg punch drunkenness
Infections: neurosyphillis, Creutzfeldt-Jakob disease, HIV
Huntingtons disease
Parkinsons disease
*Alzheimers What is it? Primary degenerative cerebral disease of unknown
disease aetiology
>65% of dementia
Characteristic pathological fractures: neuronal
reduction, neurofibrillary tangles, argentophile
plaques consisting of amyloid protein,
granulovacuolar bodies
Clinical Steady progression over years
features Early sx: short term memory loss disintegration of
personality and intellect
Decline in language, visuospacial skills, apraxia
(impaired ability to carry out skilled motor tasks),
agnosia (failure to recognize objects)
DDX to Delirium
consider Depression
Drugs
Normal age associated memory problems
Investigations MMSE: 25 and above (normal), 18-24 (mild to
moderate), 17 or below (serious impairment)
Abbreviated Mental Test Score
Blood test: FBC, liver biochemistry, TFT, vit b12, folate
Brain CT scan: if younger patient and atypical
presentation
Take note of social and family history
*Management Treatment for anxiety and depression
Reduce cerebral production of choline acetyl
transferase and decrease in acetylcholine synthesis:
 o Give acetylcholinesterase inhibitors to inhibit
cholinesterase enzyme at the synaptic cleft
(donepezil, rivastigmine, galantamine)
Manage patient in community
Supportive interventions for patient and carers
Home care, day care, respite care, sitter services
Long term institutional care in residential or nursing
home
*Prognosis Progressive decline
8-10 years survival
*Vascular What is it? Second most common dementia
(multi- Stepwise deterioration with declines followed by
infarct) short periods of stability
dementia Usually there is a history of TIA
May follow succession of acute CVA or single major
stroke
May be evidence of arteriopathy
Dementia What is it? Fluctuating cognition with pronounced variation in
with Lewy attention and alertness
bodies Prominent or persistent memory loss may not occur
in the early stages
Impairment in attention, frontal, subcortical, and
visuospatial ability is often prominent
Depression and sleep disorder
Recurrent formed visual hallucinations eg strange
faces, frightening creatures
Parkinsonism (eg slowing, rigidity) is common, with
repeated falls
Delusions, LOC
At autopsy: cortical Lewy bodies are prominent
Do not use neuroleptic drugs