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Dementia
Progressive, usually irreversible,
global cognitive deficits.
Memory
Dysphasia
Agnosia
Apraxia
Impaired executive function
Personal disintegration
Etiology
Degenerative
Alzheimers, Parkinsons,
Intracranial
Infection
Prion disease, neurosyphilis, HIV,
Endrocrine
Metabolic
Vitamin B12 Deficiency
Toxins - alcohol
Clinical features
Investigations
FBC; LFT; U&E; glucose; erythrocyte
sedimentation
rate (ESR); thyroid-stimulating hormone
(TSH); calcium; magnesium;
phosphate; Venereal Disease Research
Laboratory (VDRL) test for syphilis;
HIV; vitamin B12 and folate; C-reactive
protein; blood culture; LP; EEG;
chest X-ray (CXR); ECG; CT (optima and axial
protocol); MRI; SPECT.
Management
Etiologic:
cholinesterase inhibitors: tacrine,
donepezil, revastigmine, metrifonate
HAART
Treatment of co-morbid conditions:
depression, agitation, psychosis
Adjunctive treatments:
vit.E, hydergine, selegeline, ginkgo
biloba
Alzheimers
DAT dementia of Alzheimer type
Most common cause 70%
A degerative disease of the brain
with prominent cognitive and
behavioral impairment sufficiently
severe to interfere with social and
occupational function
Possible factors : Smoking, estrogen,
NSAID, vit E
Pathophysiology
Amyloid plaques
Neurofibrillary tangles
Genetics 40% have a positive
family history
Clinical features
Early symptoms
Failing memory, changes in behavior wandering, irritability
Middle symptoms
Aphasia, apraxia(awkwardness with the sequence of dressing),
agnosia(trouble locating body parts)
Late symptoms
Fully dependent
Physical deterioration
Incontinence
Psychiatry symptoms
Delusions, hallucinations, depression
Assessment
Detailed history
MSE
Cognitive testing
Physical examination
Blood tests
EEG
Brain imaging
Pharmacological
intervention
First generation AChEIs
Tacrine
SE- GI problems, hepatotoxic
Second generation
Donepezil piperidine derivative, long half life, highly selective
SE- GI, bradycardia, KI-asthma
Dose 1x daily 5-10mg/day
Rivastigmine
Short half life
SE- GI
Dose- start with 1.5mg BD
Galantamine
Selectively inhibit AChE
4-12mg BD
Others
Vit E, selegiline
Clinical features
Dementia, parkinsonism, fluctuating
cognitive performance
Complex hallucinations-visual(60%)
Transient disturbance of
conciousness
Pathological features
Management
No compelling data indicate that
medications can decreaase cognitive
decline
Use drugs with caution!
Vascular dementia
Second common cause after DAT
Risk factors
hypertension, smoking,
hypercholesterolemia, diabetes mellitus,
and cardiovascular and cerebrovascular
disease.
Management
Establish causative factors.