Dementia

• Acquired disturbance of intellectual function

and memory, that is caused by brain diseases,
and is not associated with disruptions in level
of consciousness
• Deficits in memory and intellectual function
must be severe, influencing daily activities and
social function
 Epidemiology
• Prevalence of dementia among population
above 60 y.o: 5.6%
• 2/3 dementia patients: female
– Female has higher life expectancy
• Most common cause: alzheimer disease
 Etiology
• Degenerative diseases: • Traumatic dementia:
– Alzheimer disease – Cranio-cerebral wound
– Lewy body disease – Pugilistic dementia
– Frontotemporal lobar • Infection:
degeneration – AIDS
– Parkinson’s disease – Opportunistic infection
• Vascular dementia: – Post-encephalitis
– Occlusive dementia
cerebrovascular diseases
– Cerebral emboli
 Pathogenesis
• Alzheimer
– Neuritic plaque: consists of
extracellular b-amyloid which
binds to Apo E, due to
mutation of Amyloid
Precursor Protein in
chromosome
– Senile plaque: neuritic plaque
with inflammation
component. Increased in
elderly
– Neurofibrillary tangles:
intraneuron structure which
consists of
hyperphosphorilated tau
• Vascular dementia
– Multiple infarcts
– Substansia alba abnormality
• Fronto-temporal lobe
dementia
– Atrophy in temporal and/or
frontal lobe
– Microscopic: gliosis, neuron
loss
• Lewy body dementia
– Presence of lewy body in
cortex, amygdala, cingulated
cortex, substansia nigra
Pathogenesis
 Diagnosis
• According to DSM-V: dementia • Neurocognitive disorder 
 major neurocognitive disturbance of:
disorder
• Major neurocognitive
disorder:
– requires evidence of significant
cognitive decline from a
previous level of performance
in one or more of the cognitive
domains outlined above
– the cognitive deficits must be
sufficient to interfere with
independence in activities of
daily living
– the cognitive deficits must not
be attributable to another
mental disorder
 Diagnosis
Anamnesis Physical examination
• Onset, duration, progress of • Alzheimer: does not show
cognitive deficits
• Alzheimer: elderly, progressive motoric deficit (unless late
memory loss stage)
• Fronto-temporal dementia:
personality change, disinhibition, • Fronto-temporal dementia,
increase in body weight lewy body dementia, multi-
• Lewy body dementia: visual infarcts dementia: motoric
hallucination, delirium,
parkinsonism, rapid eye rigidity, hemiparesis,
movement, capgras syndrome parkinsonism, myoclonus
• Multi-infarct dementia: history of
stroke, hypertension, atrial
fibrillation
 Diagnosis
Cognitive & neuropsychiatric Supporting Examination:
examination: • CT/MRI: tumor, infarct
• Mini mental state location, subdural
examination hematome, hydrocephalus,
• Alzheimer: episodic alzheimer
memory, category • SPECT, PET: hypoperfusion,
generation, visuo- hypometabolism
constructive ability
• Fronto-temporal dementia:
language deficit
• Lewy body dementia: visuo-
spatial ability
• Vascular dementia:
 Management
General management: Improve cognitive function:
• Manage the cause of • Cholinesterase
dementia • Antioxidant
• Discontinue sedative • Memantine
agents
• Dementia with
depression: SSRI