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Intern
Diagnosis
Management
Its
by: -impairment of intellectual functions -impairment of memory -deterioration of personality with lack of personal care.
Impairment
of judgment, impulse control & abstract thinking. Emotional labiality Catastrophic reaction Thought abnormalities- delusions & perseveration. Disorientation in time (place & person in late stage) Neurological signs depending on underlying cause.
Parechymatous
Toxic
dementia: Bromide intoxication, drugs, heavy metals, alcohol, carbon monoxide, benzodiazepines.
Deficiency
Dementia
due to infections: Neurosyphilis, chronic meningitis, viral encephalitis, AIDS Dementia, SSPE.
Neoplastic
FEATURES
SITE
CORTICAL TYPE
Cortex (frontal & temporo-parietooccipital areas, hippocampus) severe normal
SUBCORTICAL TYPE
Sub cortical grey matter (thalamus, basal ganglia, brain stem) Mild to moderate Dysarthria, tremor, chorea, ataxia, rigidity Complex delusions, rarely mania
OTHER FEATURES
Commonest
enlarged ventricles, widened sulci, cortex shrinkage seen. senile plaques, cortical nerve cell loss seen. decreased AchE & CAT.
Microscopically-
Neurochemically-
Treatment:
Recently
developed drug TACRINE HYDROCHLORIDE (COGNEX) Ach concentration by slowing its degeneration.
Increases
2nd
commonest cause
Multiple cerebral infarction Progressive disruption of brain function Dementia
onset
Fluctuating Presence
diseases.
Previous
On
evaluation: -presence of focal neurological signs -insight in to the illness present -emotional lability present.
Most
Diagnosis Prompt
treatment can reverse dementia & can lead to complete recovery within 2 years of onset of dementia.
50-70%
of AIDS patients exhibit triad of COGNITIVE, BEHAVIOURAL & MOTORIC deficits of SUB CORTICAL DEMENTIA type known as ADC.
AIDS virus neurotropic features Crosses blood brain barrier early in disease Cognitive impairment
According
required: Evidence of decline in both memory & thinking, sufficient to impair personal activities.
Memory
impairment typically affects registration, storage & retrieval of new information(recent memory). Remote memory may be intact till late stages.
Thinking Flow
Presence Duration
NORMAL AGING
PROCESS:
-intellectual impairment is severe enough to interfere with social/occupational functioning SENESENT FORGETFULNESS.
Marked sundowning Usually absent, present, visual hallucinations may illusions & occur hallucinations common
DEMENTIA Rarely C/O cognitive impairment Emphasizes achievement Patient unconcerned Makes mistakes on examination Recent memory impairment Confabulation present No H/O depression
PSEUDODEMENTIA Always C/O impairment Emphasizes disability Communicates distress Dont know answers frequent Preserved Rare Past H/O depression/Mania
INVESTIGATIONS:
CBC,
urine R/E, blood glucose, electrolytes, RFT, TFT, serum B12 & folate levels, serology for syphilis & HIV, CT & MRI scan of brain, psychological tests & drug screen.
Hypertension
Thyroid
in MID
Shunting L-DOPA
Removal
manipulation
of medical complications
of food & personal hygiene care of patient & the family for anxiety(lorazepam &
Supportive
Bezodiazepines
oxazepam)
Depression
can be treated with drugs having low cardiac & anticholinergic toxicity like trazodone. & disruptive behavior with low dose of antipsychotics like haloperidol & trifluperazine. term hospitalization
Psychotic
Short
Institutionalization Specific
in late stages.