Dementia F Etessam MD Dementia A progressive impairment

Dementia F. Etessam. MD

Dementia A progressive impairment of cognitive functions occurring in clear consciousness.

Dementia Global impairment of intellect n n n Memory Attention Comprehension Language orientation learning n n n Mood Thinking Perception Problem solving Personality Social behavior

Epidemiology n n 5 % in general population older than 65 years of age 20 – 40 % in general population older than 85 years of age 15 – 20 % in outpatients general medical practices 50 % in chronic care facilities

Etiology Degenerative dementias n NPH n Deficiency n Metabolic n Tumor n Traumatic n Infection n vascular n Anoxia n Demyelinating dis. n Drugs and toxins n Endocrine n

Head trauma n n n n Delirium Amnesia Personality change Emotional symptoms Headache Insomnia Decreased concentration

NPH n n Impaired memory Ataxia Retardation Incontinency

Ischemic Brain Disease n n Cognitive Impairment Personality change Depressed mood Mood instability

Dementia Common Etiologies n n n n Alzheimer s Disease Vascular Dementia Head Trauma Alcohol – related Dementias Huntington's Disease Parkinson's Disease Pick's Disease Lewy Body disease

Clinical features Cognitive impairment n Language n Praxis n Gnosis n Executive functioning n

Psychiatric Changes n n n Personality changes Behavioral disturbance Psychotic symptoms Sleep disturbances Affective and anxiety disturbances

Neurological signs n n n n Seizures Primitive reflexes Myoclonic jerks Focal neurological signs Pseudobulbar palsy Dysarthria dysphagia

AD Prognosis n Alzheimer’s has a slowly progressive decline. These meds can slow the progression, NOT halt it. Function Time

Diagnosis n n n History/MSE Neurological Examination Labs : CBC, Serum Electrolytes, Renal Function, LFT, TFT, Glucose, Albumin, Vit B 12 Imaging Neuropsychological Testing Psychiatric Evaluation

diagnosis n n n History/MSE Pathology Laboratory evaluation

Compare central sulcus of Alzheimer’s patient with normal 81 year old woman From Whole Brain Atlas at http: //www. med. harvard. edu/AANLIB/home. html

Normal vs AD Brain Normal brain Alzheimer’s brain

Interventions n n Pharmacologic Nonpharmacologic

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