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PREPARED BY:
RESURRECCION, Carls Burg A.
 


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@ Dementia is a clinical syndrome
of cognitive deficits that involves
both memory impairments and a
disturbance in at least one other
area of cognition (e.g., aphasia,
apraxia, agnosia) and disturbance
in executive functioning.
@ In addition to disruptions in
cognition, dementias are
commonly associated with changes
in function and behavior.
@ The most common forms of
progressive dementia are
Alzheimer's disease, vascular
dementia, and dementia with Lewy
bodies; the pathophysiology for
each is poorly understood.
@ Differential diagnosis of
dementing conditions is
complicated by the fact that
concurrent disease states (i.e.,
co-morbidities) often coexist.
  

@ Dementia affects about 5% of
individuals 65 and older.
@ Four to five million Americans have
Alzheimer's disease (AD)
@ 13.2 million are projected to have AD
by 2050.
@ Global prevalence of dementia is
about 24.3 million, with 6 million new
cases every year.
 m 
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@ Advanced age
@ Mild cognitive impairment
@ Cardiovascular disease
@ Genetics: family history of dementia,
Parkinson's disease, cardiovascular
disease, stroke, presence of ApoE4
allele on chromosome 19
@ Environment: head injury, alcohol
abuse
  m


 

Π
Alzheimerǯs disease is the
most common type of dementia. In
patients aged 65 years or older, who
have some kind of cognitive decline, it
accounts for over 50% of cases.
Progression to full dementia may take
several years following the signs of
mild cognitive impairment (MCI) at
the early stage of AD.
m


@ Aphasia Ȃ loss or impairment of language
caused by brain dysfunction
@ Apraxia Ȃ inability to execute learned
movements on command
@ Agnosia Ȃ inability to recognize or associate
meaning to a sensory perception
@ Acalculia Ȃ inability to perform arithmetical
calculations
@ Agraphia Ȃ inability to write
@ Alexia Ȃ inability to read
º 
0ascular dementia is the
second most common cause of
dementia. It results from
vascular or circulatory lesions
or from diseases of the
cerebral vasculature leading to
ischaemia or infarction.


@ Presence of clinical dementia

@ Evidence of cerebrovascular
disease
@ Exclusion of other conditions
capable of producing dementia
£   ! "#
Dementia with Lewy bodies (DLB)
is an increasingly recognized cause of
dementia in elderly patients. The typical
presenting features of DLB include
fluctuating dementia with prominent
deficits in attention, frontal executive
tasks and visuospatial abilities. The
cognitive profile of DLB contains both
cortical and subcortical features.
$
@ Periods of confusion
@ Fluctuations in cognition (especially
attention and alertness)
@ 0isual hallucinations
@ Spontaneous extrapyramidal signs
such as rigidity or slowing (mild
parkinsonism)
@ Bradykinesia (paucity of movement)
 ##%&#
Fronto-temporal dementia (FTD) Ȃ
sometimes called Pickǯs complex Ȃ is
characterized by focal frontal atrophy with
personality and behavioural disturbances, or
temporal atrophy with either progressive
aphasia or semantic dementia [Hodges, 1992;
Neary, 1998]. Onset of FTD is observed in a
younger age group than other dementias and
diagnosis may be difficult in the early stages of
disease.
 Routine neuropsychological
assessment procedures such as the Mini-
Mental State Examination (MMSE) are
usually insensitive at detecting frontal
abnormalities, therefore more extensive
neuropsychological testing is required to
establish frontal deficit in patients
suspected with FTD. The clock drawing
test may be helpful.
@
'$#$ 

@ Insidious onset and slow progression
@ Preservation of memory to late-stage
disease making diagnosis difficult
@ Early and prominent personality
changes (eg, apathy, irritability,
jocularity, euphoria,
loss of personal and social
awareness)
@ Loss of tact and concern
@ Impaired judgement and insight
@ Mental rigidity and inflexibility
@ Hypochondriasis
@ Unrestrained exploration of objects and the
environment (hypermetamorphosis)
@ Distractability and impulsivity, depression and
anxiety
@ Language difficulties (eg, problems with word
recall, circumlocution, word repetition Ȃ also
known as gramophone syndrome)
@ Inertia



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 !'
 

@ Forget recent events and distant

memory also fades as the disease
progresses
@ Experience difficulty in reasoning,
calculation, and accepting new
things
@ Become confused over time, place
and direction
@ Affect the activity of daily
living
@ Judgment will be reduced
@ Personality will be changed
@ Become passive and lose
initiative.

 '
 
@ Lose cognitive ability, such as the
ability to learn, judge, and reason
@ Become emotionally unstable, and
easily lose temper or become
agitated
@ Need help from his or her family with
activities of daily living
@ Confuse night and day, and disturb
the family's normal sleeping time.

 '
 
@ Lose all cognitive ability
@ Become entirely incapable of self-
care, including eating, bathing, and so
on
@ Neglect personal hygiene, and will
become incontinent
@ Lose weight gradually, walk
unsteadily and become confined to
bed.
(

mm
@ If you think you may be developing
dementia, visit your GP. It's very
important to seek help early so you
can get the support you need.
@ Your GP will ask about your symptoms
and examine you. He or she may also
ask you about your medical history.
Your GP may do blood and urine tests
to rule out the possibility of other
conditions that could cause symptoms
similar to dementia.
@ You may also have a memory test - one that is
often used to help find out if you have
dementia is the 'mini mental state examination
(MMSE)'. In this test, your GP will ask you
some questions and test your attention and
ability to remember words. How you score in
this test indicates how serious your condition
is, for example:
-an MMSE score of 20 to 24 indicates mild
dementia
-a score of 10 to 20 suggests moderate dementia
-a score below 10 implies severe dementia
 



@ donepezil
@ galantamine
@ rivastigmine
)'&
You may find other therapies helpful, such
as:
@ group activities and discussions - these
aim to stimulate your mind (this is
sometimes referred to as cognitive
stimulation therapy)
@ reminiscence therapy - discussing past
events in groups, usually using photos or
familiar objects to jog your memory,
although there are conflicting opinions on
whether this is effective
#&!&

@ It's possible that aromatherapy

will help you to feel less agitated.
However, there is only a small
amount of evidence to support
this.
 *


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