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1. Nabina Paneru
Dementia

3. Introduction
• Dementia is a term used to describe a cluster of symptoms
including:
 Forgetfulness (progressive)
 Difficulty doing familiar tasks
 Confusion
 Poor judgement
 Decline in intellectual functioning

4. Contd.
• Dementia is a syndrome in which there is deterioration in
memory, thinking, behavior and the ability to perform
everyday activities.
• Dementia is one of the major causes of disability and
dependency among older people worldwide.

5. Prevalence
• Alzheimer disease is the most common form of dementia
and may contribute to 60–70% of cases.
• Although dementia mainly affects older people, it is not a
normal part of ageing.
• Worldwide, around 50 million people have dementia,
with nearly 60% living in low- and middle-income
countries. Every year, there are nearly 10 million new
cases.

6. Contd.
• The estimated proportion of the general population aged
60 and over with dementia at a given time is between 5-
8%.
• The total number of people with dementia is projected to
reach 82 million in 2030 and 152 in 2050. Much of this
increase is attributable to the rising numbers of people
with dementia living in low- and middle-income
countries.

8. Risk factors
Age: risk goes up
significantly with
advancing age
Genetics/ Family
History
Cholesterol: High
levels of low –
density (LDL)
lipoprotein
increase a person’s
risk of developing
vascular dementia
Diabetes Smoking and
Alcohol use

9. Etiology
• Degenerating and irreversible causes
 Alzheimer's disease (most common in all dementing
illness)
 Pick’s disease (atrophy in the frontal and temporal lobes
of the brain)
 Huntington’s chorea (damage in the area of the basal
ganglia and the cerebral cortex)
 Parkinson’s disease

10. Contd.
• Reversible causes
 Lesions in intracranial space
 Metabolic disorder: Hepatic failure, renal failure
 Endocrine disorder: Myxedema, Addison’s disease
 Infections: AIDS, Meningitis, encephalitis

11. Reversible causes Contd.
 Intoxication: Alcohol, heavy metal (lead, arsenic),
chronic barbiturate poisoning
 Anoxia: Anemia, post anesthesia, chronic respiratory
failure
 Vitamin deficiency: Thiamine and nicotine
 Miscellaneous: Heatstroke, epilepsy electric injury

12. Signs and symptoms
• Forgetfulness
• Losing track of the time
• Becoming lost in familiar places
Early stage
• Becoming forgetful of recent events
and people’s name
• Becoming lost at home
• Having increasing difficulty with
communication
• Needing help with personal care
• Experiencing behavior changes,
including wandering and repeated
questioning
Middle Stage
• Near total dependence and inactivity
• Becoming unaware of the time and
place
• Memory disturbances are serious
and the physical signs and
symptoms become more obvious
• Having difficulty recognizing
relatives and friends
• Having an increasing need for
assisted self-care
• Having difficulty walking
• Experiencing behaviour changes that
may escalate and include aggression.
Late Stage

14. Diagnostic Criteria for Dementia (DSM-V)
Memory Impairment: impaired ability to learn new information or to recall old
information
One or more of the following:
Aphasia: (language disturbances)
Apraxia: (impaired ability to carry out motor activities despite intact motor function)
Disturbance in executive functioning: impaired ability to plan, organize, sequence, abstract
The cognitive deficits result in functional impairment (social/occupational)
The cognitive deficits do not occur exclusively solely during a delirium
Not due to other medical or psychiatric conditions

15. Investigations
Routine Evaluation Optional focused tests Occasionally Helpful Tests
History taking Psychometric testing EEG
Physical examination Chest X-ray Parathyroid function
Laboratory tests Lumbar puncture Adrenal function
Thyroid function (TSH) Liver function Urine heavy metals
Vitamin B12 Renal function RBC sedimentation rate
Complete blood count Urine toxin screen Angiogram
Electrolytes HIV Brain biopsy
CT/MRI VDRL Lab screen for auto
antibodies

17. Contd.
• Maximum score on the MMSE is 30 points
• Score of <24 points is suggestive of dementia or delirium
• The test is not sensitive for mild dementia, scores may be
influenced by age & education, as well as language,
motor and visual impairments

18. Types of Dementia
1. Cortical Dementia
Dementia where the brain damage primarily affects the
brain’s cortex, or outer layer. Cortical dementias tens to
cause problems with memory, language, thinking, and
social behavior.

19. Contd.
2. Subcortical dementia:
Dementia that affects parts of the brain below the cortex.
Subcortical dementia tends to cause changes in emotions
and movement in addition to problems with memory.

20. Contd.
3. Progressive dementia
Dementia that gets worse over time, gradually interfering
with more and more cognitive abilities.

21. Contd.
4. Primary dementia
Dementia such as Alzheimer’s disease, in which the
dementia itself is the major signs of some organic brain
diseases not directed related to any organic illness.

22. Contd.
5. Secondary dementia
Dementia that occurs as a result of a physical disease or
injury, such as HIV diseases or cerebral trauma.

23. Treatment
The principal goals for dementia care:
• early diagnosis in order to promote early and optimal
management
• optimizing physical health, cognition, activity and well-
being

24. Goals contd.
• identifying and treating accompanying physical illness
• detecting and treating challenging behavioural and
psychological symptoms
• providing information and long-term support to carers.

25. Contd.
Symptomatic treatment: including pharmacological
interventions, attention to the environment, and family
support.
Drugs used for symptomatic relief:
 Cholinesterase inhibitors (e.b. donepezil 5 – 10 mg per
oral once a day, rivastigmine 1.5 – 6 mg per oral BD,
galantamine 4-12 mg per oral BD)

26. Drugs used for symptomatic relief contd.
 Benzodiazepines for insomnia and anxiety
 Antidepressants for depression
 Antipsychotics to alleviate hallucinations and delusions
 Anticonvulsants to control seizures

27. Difference between dementia and delirium
S.N Features Delirium Dementia
a. Onset Usually active Usually insidious
b. Course Usually recover in 1 week Usually Protracted
c. Clinical features
1. Consciousness Clouded Usually normal
2. Orientation Grossly disturbed, disoriented Usually normal, Disturbed
only in late stage
3. Memory Immediate retention and recall
disturbed
Immediate retention and
recall normal
Recent memory disturbed
Remote memory disturbed
only in late stage

28. Contd.
S.N Features Delirium Dementia
c. Clinical features
5. Sleep wake cycle Grossly disturbed Usually normal
6. Attention and
concentration
Grossly disturbed Usually normal
7. Diurnal variation Marked, Sun downing present Usually absent
8. Perception Visual illusion and hallucination
present
Hallucination may occur
9. Other features Asterixis, multifocal myoclonus Catastrophic reactions