recognition of dementia syed zaman consultant physician geriatric medicine
DESCRIPTION
Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine Palmerston North Hospital. Outline the ageing brain basic definitions causes of dementia symptoms of dementia cognitive testing. Ageing. The ageing brain. Case history 1 - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/1.jpg)
Recognition of Dementia
Syed ZamanConsultant PhysicianGeriatric MedicinePalmerston North Hospital
![Page 2: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/2.jpg)
Outline
• the ageing brain
• basic definitions
• causes of dementia
• symptoms of dementia
• cognitive testing
![Page 3: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/3.jpg)
Ageing
![Page 4: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/4.jpg)
The ageing brain
![Page 5: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/5.jpg)
Case history 1
A 65 year old writer presents with difficulty reading and writing.
He has taken to dictating his stories to a PA. He is independent
with ADLs.
Cognitive testing reveals a normal MMSE, with intact STM.
Detailed neuropsychological testing confirms dyslexia and
dysgraphia.
![Page 6: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/6.jpg)
Case history 2
An 85 year old man with previous TIAs, hypertension
and myocardial infarction is brought to his GP by his wife
because of STM loss. He is completely independent with ADLs,
socially appropriate and manages household finances well.
His MOCA is 20/30 with deficits in recall and executive function.
![Page 7: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/7.jpg)
What is dementia?
![Page 8: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/8.jpg)
![Page 9: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/9.jpg)
Dementia
• loss of brain function
• affecting normal social and occupational activities
![Page 10: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/10.jpg)
Mild cognitive impairment
• loss of brain function
• does not affect ability to live independently
Cognitive
Impairment
Not
Dementia
![Page 11: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/11.jpg)
The significance of MCI
• prevalence of 3 to 22% >65 years
• 10 to 15% conversion rate to dementia per year
• reversion rate 40% over a 5 year period
• is it possible to prevent/delay progression to dementia?
![Page 12: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/12.jpg)
Causes of dementia 1
• brain injury
• brain tumours
• chronic alcohol abuse
• metabolic problems
• vitamin B12 deficiency
• normal pressure hydrocephalus
![Page 13: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/13.jpg)
Causes of dementia 2
• Alzheimer’s disease
• dementia with Lewy bodies
• vascular dementia
• Parkinson disease dementia
• fronto-temporal dementia
• Huntington’s disease
• HIV and other infections
![Page 14: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/14.jpg)
Brain function – an alternative view
![Page 15: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/15.jpg)
Brain function – an alternative view
![Page 16: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/16.jpg)
Brain function
![Page 17: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/17.jpg)
Alzheimer’s disease
![Page 18: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/18.jpg)
Alzheimer’s disease – symptoms 1
• forgetfulness
• getting lost on familiar routes
• misplacing items
• language problems
![Page 19: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/19.jpg)
Alzheimer’s disease – symptoms 2
• difficulty performing tasks that take some thought
• loss of interest in things previously enjoyed
• personality changes and loss of social skills
• difficulty doing basic tasks
• losing awareness of self
• poor judgement and insight
• Behavioural and Psychological Symptoms of Dementia
![Page 20: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/20.jpg)
Vascular dementia
![Page 21: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/21.jpg)
Vascular dementia – symptoms
• abrupt onset
• step-wise deterioration and fluctuation
• memory impairment
• executive dysfunction
• personality change and emotional lability
• incontinence
• gait disorder
![Page 22: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/22.jpg)
Dementia with Lewy bodies
Lewy body
![Page 23: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/23.jpg)
Dementia with Lewy bodies – symptoms
• fluctuating cogntive function – 50 to 75%
• recurrent visual hallucinations – 80%
• REM sleep behaviour disorder
• apathy
• parkinsonism
• autonomic dysfunction
![Page 24: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/24.jpg)
Cognitive screening
• role
• which test?
• MMSE
• MoCA
![Page 25: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/25.jpg)
![Page 26: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/26.jpg)
Case history 1
A 65 year old writer presents with difficulty reading and writing.
He has taken to dictating his stories to a PA. He is independent
with ADLs.
Cognitive testing reveals a normal MMSE, with intact STM.
Detailed neuropsychological testing confirms dyslexia and
dysgraphia.
![Page 27: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/27.jpg)
Case history 2
An 85 year old man with previous TIAs, hypertension
and myocardial infarction is brought to his GP by his wife
because of STM loss. He is completely independent with ADLs,
socially appropriate and manages household finances well.
His MOCA is 20/30 with deficits in recall and executive function.
![Page 28: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/28.jpg)
Summary
• diagnosis of dementia is primarily based on the history
• symptoms of dementia help define the subtype
• comorbidities help define the subtype
• MCI is common, its significance uncertain
• early recognition is vital for appropriate management
![Page 29: Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine](https://reader035.vdocument.in/reader035/viewer/2022062315/568160c4550346895dcfef30/html5/thumbnails/29.jpg)
Thank you for listening