![Page 1: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/1.jpg)
DementiaDementia
Prof AK DaifProf AK Daif
![Page 2: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/2.jpg)
22
WHAT IS DEMENTIAWHAT IS DEMENTIA??• An acquired syndrome of decline in memory and other
cognitive functions sufficient to affect daily life in an alert patient
• Progressive and disabling
• NOT an inherent aspect of aging
• Different from normal cognitive lapses
![Page 3: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/3.jpg)
![Page 4: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/4.jpg)
Dementias – classificationDementias – classificationBased on siteBased on site
![Page 5: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/5.jpg)
55
DSM-IV DIAGNOSTIC CRITERIA FOR DSM-IV DIAGNOSTIC CRITERIA FOR ADAD
• Development of cognitive deficits manifested by both• impaired memory
• aphasia, apraxia, agnosia, disturbed executive function
• Significantly impaired social, occupational function• Gradual onset, continuing decline• Not due to CNS or other physical conditions (e.g., PD,
delirium)
• Not due to an Axis I disorder (e.g., schizophrenia)
![Page 6: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/6.jpg)
66
NORMAL LAPSES NORMAL LAPSES vs vs
DEMENTIADEMENTIA• Forgetting a name
• Leaving kettle on
• Finding right word
• Forgetting date or day
• Not recognizing family member
• Forgetting to serve meal just prepared
• Substituting inappropriate words
• Getting lost in own neighborhood
![Page 7: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/7.jpg)
77
Mild Cognitive Mild Cognitive ImpairmentImpairment
“Mild Cognitive Impairment (MCI) is a state between normal cognition and dementia, characterized by deficits not
explainable by age, educational background, or medical illness.”
Kryscio RJ, Schmitt FA, et al. Risk factors for transitions from normal to mild cognitive impairment and dementia. Neurology 2006; 66: 828-32.
• MCI is common (5-25%)• MCI carries an increased risk of dementia and of death
– If the deficits exist primarily in memory and executive function, risk of progression to dementia is higher
• 10-15% per yr rate of development of dementia and AD compared to 1-7% per yr for those without MCI
![Page 8: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/8.jpg)
88
DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS FOR DEMENTIAFOR DEMENTIA
• Alzheimer’s disease• Vascular (multi-infarct) dementia• Dementia associated with Lewy bodies• Delirium• Depression• Other (alcohol, Parkinson's disease [PD], Pick’s
disease, frontal lobe dementia, neurosyphilis)
![Page 9: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/9.jpg)
99
ASSESSMENT: ASSESSMENT: HISTORY/PHYSICALHISTORY/PHYSICAL
• Ask both the patient & a reliable informant
• Current condition• Medical history• Current medications • Patterns of alcohol use or
abuse• Living arrangements
• Neurologic status• Functional Status• Mental Status• ie. Folstein, MiniCog, • Neuropsych testing
![Page 10: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/10.jpg)
1010
Evaluation of DementiaEvaluation of Dementia
• Standard laboratory studiesStandard laboratory studies– Complete blood count
• Anemia, infection
– Comprehensive metabolic panel • Glucose, electrolytes, renal or hepatic failure
– Thyroid function tests
• Studies done in suspect casesStudies done in suspect cases– Estimated sedimentation rate – Serology for syphilis, HIV, lyme disease– Screen for heavy metals
![Page 11: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/11.jpg)
1111
ASSESSMENT: BRAIN IMAGINGASSESSMENT: BRAIN IMAGING
• Use imaging when:– Onset occurs at age < 65 years– Symptoms have occurred for < 2 years– Neurologic signs are asymmetric– Clinical picture suggests normal-pressure hydrocephalus
• Consider:– Noncontrast computed topography head scan– Magnetic resonance imaging– Positron emission tomography
![Page 12: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/12.jpg)
1212
Evaluation of DementiaEvaluation of Dementia
• Radiologic/Neuro-Imaging studiesRadiologic/Neuro-Imaging studies• Carotid dopplers • CT Scan, MRI of Brain
– Linear/volumetric measurement is not recommendedLinear/volumetric measurement is not recommended• PET and SPECT imaging not recommended for routine
use in the diagnosis of dementia– “Little evidence to support the routine useroutine use of PET in pts with
suspected or established dementia” JAGs 51: 2003 Clinical criteria accurate in 90%
*PET scan may help clarify Alzheimer’s vs. other types dementias in those *PET scan may help clarify Alzheimer’s vs. other types dementias in those already fully evaluatedalready fully evaluated
*SPECT scan may help identify early dementia but studies are limited*SPECT scan may help identify early dementia but studies are limited
![Page 13: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/13.jpg)
1313
Potential Reversible CausesPotential Reversible Causes
• Neoplasms• Metabolic disorders• Trauma • Toxins• Infections• Autoimmune
disorders• Drugs
• Nutritional disorders• Psychiatric disorders• Normo-pressure
Hydrocephalius (NPH)
![Page 14: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/14.jpg)
1414
Distinguishing DementiaDistinguishing Dementia
• Delirium versus Dementia– Acute onset– Cognitive fluctuations over hours or days– Impaired consciousness and attention– Altered sleep cycles
• Depression versus Dementia– Demonstrate motivation during cognitive testing– Express cognitive complaints that exceed measured
deficits– Maintain language and motor skills
![Page 15: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/15.jpg)
1515
SPECIFIC SPECIFIC DEMENTIAS…DEMENTIAS…
![Page 16: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/16.jpg)
1616
Alzheimer’s DementiaAlzheimer’s Dementia
• Dementia NOT caused by other medical/mood or CNS disorder– Definitive diagnosis is on brain biopsy/autopsy
• Neurofibrillary tangles and senile plaques• Reduced cerebral production of choline acetyl transferase• Decreased Acetylcholine synthesis• Marked cholinergic deficit
– DSM-IV criteria• Cognitive deficits including impaired memory, executive function and
aphasia/apraxia/agnosia• Gradual onset, continuing decline; impaired social/occupational
function
![Page 17: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/17.jpg)
1717
SYMPTOMS & SIGNS OF ADSYMPTOMS & SIGNS OF AD
• Memory impairment• Gradual onset, progressive cognitive decline• Behavior and mood changes• Difficulty learning, retaining new information• Aphasia, apraxia, disorientation, visuospatial dysfunction• Impaired executive function, judgment• Delusions, hallucinations, aggression, wandering
![Page 18: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/18.jpg)
Alzheimer's diseaseAlzheimer's disease
• CT scanning aids diagnosis by excluding multiple infarction or a mass lesion.
• MRI shows bilateral temporal lobe atrophy.
• SPECT usually shows temporoparietal hypoperfusion.
![Page 19: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/19.jpg)
The brain in ADThe brain in AD
microscopic view:
neurofibrillary tangles and protein deposits
macroscopic view:
neuronal loss appears as atrophy
![Page 20: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/20.jpg)
2020PET scan in Alzheimer’s disease
![Page 21: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/21.jpg)
2121
PROGRESSION OF ADPROGRESSION OF AD
Mild Impairment• Disorientation for date• Naming difficulties• Recent recall problems• Mild difficulty copying
figures• Decreased insight• Social withdrawal• Irritability• Mood change• Problems managing
finances
Moderate• Disorientation for date and
place• Comprehension difficulties• Impaired new learning,
calculating skills• Getting lost in familiar areas,
wandering• Not cooking, shopping, banking• Delusions, hallucinations• Agitation, restlessness, anxiety,
aggression• Depression• Problems with dressing and
grooming• Aphasia and apraxia
![Page 22: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/22.jpg)
2222
PROGRESSION OF ADPROGRESSION OF AD
Severe Impairment• Nearly unintelligible verbal output• Remote memory gone• Unable to copy or write• Unable to feed*• No longer grooming or dressing• Incontinent• Unable to Walk
![Page 23: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/23.jpg)
2323
Other Dementias……..Other Dementias……..
![Page 24: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/24.jpg)
2424
DSM-IV DIAGNOSTIC CRITERIA DSM-IV DIAGNOSTIC CRITERIA FOR VASCULAR DEMENTIAFOR VASCULAR DEMENTIA
• Development of cognitive deficits manifested by both
• impaired memory• aphasia, apraxia, agnosia, disturbed executive function
• Significantly impaired social, occupational function• Focal neurologic symptoms & signs or evidence of
cerebrovascular disease• Stepwise Deterioration (after each event)
![Page 25: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/25.jpg)
2525
![Page 26: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/26.jpg)
Multi-infarct dementia Multi-infarct dementia (MID)(MID)
• This is an overdiagnosed condition which accounts for less than 10% of cases of dementia.
• MID is caused by multiple strokes - SILENT STROKES• Dementia occurs ’stroke by stroke‘, with progressive focal
loss of function.• Clinical features of stroke profile – hypertension,
diabetes, etc. – are present. More often in males.• Diagnosis is obtained from the history
and confirmed by CT or MRI scan (the presence of multiple areas of infarction).
• Treatment: Maintain adequate blood pressure control, anti-platelet aggregants (aspirin).
![Page 27: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/27.jpg)
2727
DEMENTIA ASSOCIATED WITH DEMENTIA ASSOCIATED WITH
LEWY BODIESLEWY BODIES• Dementia
• Visual hallucinations
• Parkinsonian signs
• Alterations of alertness or attention
![Page 28: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/28.jpg)
2828
DLB-Other FeaturesDLB-Other Features
• Neuroleptic Sensitivity (ie Olanzapine)
• Falls
• Early incontinence
![Page 29: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/29.jpg)
2929
OTHER DEMENTIASOTHER DEMENTIAS• Alcoholic Dementia
– Direct effects of alcohol, Secondary effects of alcohol,Wernicke-korsakoff syndrome
• Toxic Metal and Gas Exposure– Common exposures: lead, mercury, manganese, arsenic,
carbon monoxide & carbon disulfide
• Vitamin Deficiencies– Vitamins B12, folate, niacin, and thiamine
– More severe B12 deficiency: subacute combined degeneration
![Page 30: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/30.jpg)
3030
Organic causes of dementiaOrganic causes of dementia
• Organ Failure (liver, kidneys)
• Endocrine (hypothyroidism, diabetes)
• Inflammatory (Lupus)
• Neurodegenerative causes (multiple sclerosis & Huntington’s Chorea)
![Page 31: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/31.jpg)
3131
• May appear similar to Alzheimer’s…..• Early treatment may reverse cognitive
changes before they become permanent• Triad of symptoms: gait instability, urinary
incontinence and dementia – Wide-based, shuffling gait with poor coordination– Incontinence follows gait change, includes urgency– Slow thinking/response, decreased spontaneity
• Enlarged ventricles on MRI– But no evidence of atrophy: Alzheimer’s shows large
ventricles due to brain atrophy
Normal-Pressure Normal-Pressure HydrocephalusHydrocephalus
![Page 32: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/32.jpg)
3232
Parkinson DementiaParkinson Dementia
• Age Onset: 50 to 80; survival 8-15 yrs• Dementia occurs later in the disease, mild to
mod.• Slowness of thought• Neuropsychiatric symptoms common• Dysphagia, dysphonia
![Page 33: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/33.jpg)
3333
Frontotemporal DementiaFrontotemporal Dementia
• Diagnostic criteria similar to Alzheimer’sBUTBUT
• Onset typically younger (less than 65 years)• Predominant changes/disturbances in behavior
– Personality change is a hallmark– Changes occur early and progress
• Non-fluent, expressive aphasia common– Words remain but are presented in nonsensical format
• Frontal and/or temporal atrophy on MRI• Early absence of neurologic signs, neurologic signs occur
with progression
![Page 34: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/34.jpg)
3434
Structural Structural Changes in Changes in MRI:MRI:
Fronto-Fronto-temporal temporal dementiasdementias
![Page 35: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/35.jpg)
3535
Parkinson Plus DementiasParkinson Plus Dementias
• Dementia occurs early
Additional physical symptoms
• More frontal lobe features
• Earlier onset, more rapid course
• Frontal lobe features
• Poor response to levodopa
• Rapidly accelerates
![Page 36: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/36.jpg)
3636
Multisystem AtrophyMultisystem Atrophy
• Onset 55; survival 6-7 years
• Autonomic dysfunction (incontinence, impotence, orthostasis)
• Ataxia, dysarthria, contractures, dystonia• Mild to moderate dementia• Less tremor
![Page 37: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/37.jpg)
3737
Progressive Supranuclear Palsy: Progressive Supranuclear Palsy: Dudley Moore (1935-2002Dudley Moore (1935-2002))
• Initially presents similar to Parkinsons (earlier age)
• Difficulty with vision• Falls• Unable to look down• Dysarthria/dysphagia• Lifespan 6 years
![Page 38: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/38.jpg)
3838
Progressive Supranuclear PalsyProgressive Supranuclear Palsy
• Onset: late 50 to mid 60, survival 10 years• Mental slowness, frontal lobe dysfunction,
pseudobulbar symptoms• “surprised look”• Dysarthria, dysphagia• Often misdiagnosed:late onset of eye sx, missed
gait and posture instability
![Page 39: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/39.jpg)
3939
![Page 40: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/40.jpg)
AIDS dementia complexAIDS dementia complex• Approximately two-thirds of persons with AIDS
develop dementia, mostly due to AIDS dementia complex.
• In some patients HIV is found in the CNS at postmortem. In others an immune mechanism or an unidentified pathogen is blamed.
• Dementia is initially of a "subcortical " type.• CT - atrophy; MRI - increased T2 signal from
white matter.• Treatment with Zidovudine (AZT) halts and
partially revers neuropsychological deficit.
![Page 41: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/41.jpg)
Dementia – diagnostic approachDementia – diagnostic approach
![Page 42: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/42.jpg)
4242
MANAGEMENT……….MANAGEMENT……….
![Page 43: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/43.jpg)
4343
SYMPTOM MANAGEMENTSYMPTOM MANAGEMENT
• Sundowning
• Psychoses (delusions, hallucinations)
• Sleep disturbances
• Aggression, agitation
![Page 44: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/44.jpg)
4444
NONPHARMACOLOGICNONPHARMACOLOGIC
• Cognitive enhancement
• Individual and group therapy
• Regular appointments
• Communication with family, caregivers
• Environmental modification
• Attention to safety
![Page 45: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/45.jpg)
4545
PHARMACOLOGICPHARMACOLOGIC• Cholinesterase inhibitors: Inhibit cholinesterase at the
synaptic cleft
• Offer a small improvement : cognition and activities of daily
living
• Examples: • donepezil, rivastigmine,
galantamine
• Memantine: (Namenda): N-Methyl-D-Aspartate
• Antagonist: A receptor activated by glutamate: decr nmda
• excessive nmda: • excitotoxicity and neurotransmittter
damage
• Memantine is neuroprotective & disease modifying;
• for moderate to severe dementia
• alone or in combination
• Other cognitive enhancers: estrogen, NSAIDs, ginkgo, vit. E
![Page 46: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/46.jpg)
4646
IMPROVEMENT w/ NAMENDAIMPROVEMENT w/ NAMENDA
![Page 47: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/47.jpg)
4747
TREATING PSYCHOSIS IN TREATING PSYCHOSIS IN DEMENTIADEMENTIA
Antipsychotic medications (side effects):• Higher potency: haloperidol (extrapyramidal symptoms)• Lower potency: thioridazine (anticholinergic effects,
sedation, hypotension, constipation, urine retention)• Atypical antipsychotics: clozapine, risperidone, olanzapine Beware new prescribing information on some of the atypical
antipsychotics!
![Page 48: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/48.jpg)
4848
ANTIPSYCHOTICS USED IN ANTIPSYCHOTICS USED IN DEMENTIADEMENTIA
Drug Starting Dose Peak Effective Dose
Clozapine 12.5-25 mg twice daily 100 mg daily
Haloperidol 0.25 at bedtime 3-5 mg daily
Olanzapine 1.25-2.5 mg at bedtime 5 mg daily
Risperidone 0.25-0.5 mg at bedtime 1-1.5 mg daily
Note: Start low, go slow.
![Page 49: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/49.jpg)
4949
MANAGING SLEEP MANAGING SLEEP DISTURBANCESDISTURBANCES
• Improve sleep hygiene (e.g, consistent bedtime, comfortable setting)
• Provide daytime activity, prevent daytime sleeping
• Use bright-light therapy
• Treat associated depression, delusions
• If the above do not succeed, consider:• trazodone 25-150 mg• nefazodone 100-500 mg• zolpidem 5-10 mg
• Avoid benzodiazepines or antihistamines
![Page 50: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/50.jpg)
5050
MANAGING AGITATIONMANAGING AGITATION• Behavioral interventions: distraction,
supervision, routine, structure
• Behavior modification using rewards
• Pharmacologic interventions: antipsychotics, antidepressants, mood stabilizers, buspirone, -blockers
• Avoid physical restraints
![Page 51: Dementia Prof AK Daif. 2 WHAT IS DEMENTIA ? An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in](https://reader036.vdocument.in/reader036/viewer/2022062314/56649d795503460f94a5cb8d/html5/thumbnails/51.jpg)
5151
RESOURCES RESOURCES FOR MANAGEMENTFOR MANAGEMENT
• Specialist referral to:
• geriatric psychiatrist
• Neuropsychologist
• Social worker
• Physical therapist
• Attorney• Day Care, Respite
Care• Alzheimer’s
Association• Meals on Wheels