Post on 04-Jun-2018
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DEMENTIA
a syndrome characterised by diverse behavioural,
cognitive and emotional impairments.
The Royal College of Physicians of London,
defined dementia as an acquired global
impairment of higher cortical functions including
memory, capacity to solve problems, learned
percepto-motor skills, social skills, language andcommunication, and control of emotion, in the
absence of clouding of consciousness.
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INCIDENCE AND PREVALENCE
It is estimated that there are 24.3 million people withdementia worldwide, with 4.6 million new cases eachyear.
The number of people affected is expected to double
every 20 years. The forecasted rate of increase is estimated to be more
than 300% in India, China and their South Asian andWestern Pacific neighbours.
About 6.1% of the population 65 years of age andolder, suffer from dementia (about 0.5% of theworldwide population).
Fifty nine percent of PWD are females.
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SUBTYPES
Alzheimers disease the most common typeof the primary degenerative dementia (60-80%) of
cases.
Characterised by progressive deterioration of short term memory and otherhigher cortical functions. Motor skills are generally preserveduntil late in thedisease. Supportive features include altered behaviourand inability to carry
out activities of daily living (ADL). predominantly affects the older age group (> 65 years), but early onset can
occur.
A clinical diagnosis of AD can be made accurately in 90% of cases,
Diagnosis can only be confirmed on brain biopsy by the presence of neuriticplaques (NPs), which are the accumulated deposits of amyloid B40 and
amyloid B42, and neurofibrillary tangles (NFTs), the hyperphosphorylated tauproteins.
severity of the cognitive decline is more closely related to the NFTs burden.
still unknownwhat triggers the changes in the neurons.
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SUBTYPES
Vascular Dementia
a heterogeneous disease with diverse vascularpathologies, such as strategic infarcts, multiple
cortical infarcts, and subcortical ischaemic lesions. Major cardiovascular risk factors are independent
risk factors for the development of atherosclerosisand vascular dementia.
These risk factors also predispose to acute stroke,which is a well established factor for thedevelopment of VaD.
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SUBTYPES
Lewy Body Diseases
Parkinson disease dementia (PDD) Lewy bodies is found primarily in the subcortical regions of the brain,
the midbrain, substantia nigra and locus ceruleus.
usually a 10 to 15 year lag time between the Parkinson diagnosis and
the onset of dementia Dementia with LB
Lewy bodies in the subcortical and cortical (frontotemporal) regions ofthe brain. Amyloid plaques can also be found in DLB.
The cardinal features of dementia with Lewy bodies are: dementia,delirium (fluctuating cognition), early and vivid visual hallucinations
and Parkinsonism. Any two of the supportive features of repeated falls, syncope,
transient disturbances of consciousness, neuroleptic sensitivity,systematised delusions and/or hallucinations in other modalities,further strengthens the diagnosis.
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SUBTYPES
Frontotemporal Dementia a frequent cause of dementia in younger individuals with
disease onset
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SUBTYPES
Mixed Dementia
In autopsy
coexisting vascular pathology occurs in 24% to 28% of
AD cases.
Pathological Parkinson disease is present in 20% of
patients with AD
50% of patients with DLB have AD pathology.
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DIFFERENTIAL DIAGNOSIS
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CLOCK DRAWING TEST
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INVESTIGATIONS
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PHARMACOLOGICAL INTERVENTIONS
Cognitive enhancers
Eg. Donepezil, galantamine, rivastigmine
Mechanism:
augmenting the levels of acetylcholinein the brain to
compensate for the losses of cholinergic function.
continuous stimulation of NMDA receptors by
glutamate which triggers a cascade of biochemical
events that damage and kill surrounding neurones.
Recommended for mild to moderate dementia.
Only Donepezil apporoved for severe dementia.
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