• Dementia

    by  • 10/12/2013 • Psychiatry

    Definition:serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging.

    ***Always consider the difficulties faced by caregivers for pts who have severe mental illness, or cognitive decline ***

    Classification / type of disease:

    1 195x300 Dementia

     

     

    Epidemiology:  it is estimated that about 35 million people have dementia worldwide. They said that figure is likely to double every 20 years, to nearly 66 million in 2030 and 115 million in 2050

    Presenting symptoms / signs:  impaired = memoryattentionlanguage, problem solving, ability to learn, reason, retain, recall, loss of patterns of thoughts, feelings, and activities.. Pt may be disorientated in time, place and person. Typically have comorbidities = Depression (20–30%), anxiety (20%), psychosis may be present. Tend to be advised against driving.

    Diagnostic investigations:

    Cognitive testing: mini mental state exam (MMSE), abbreviated mental test score (AMTS)

    Lab tests:  FBC looking at = Vit B12, folic acidthyroid-stimulating hormone (TSH), C-reactive proteinfull blood count,electrolytescalciumrenal function, and liver enzymes. Abnormalities may suggest vitamin deficiencyinfection that commonly cause symptoms associated with dementia.

    Imaging: CT/MRI head for structure, PET/SPECT head for function.

    Symptoms should be present for >6/12

    Aetiology:

    Fixed cognitive impairment

    Slowly progressive dementia

    Rapidly progressive dementia

    Dementia as a feature of other conditions

     

    2 300x300 Dementia

    Differentials: delirium, depression, psychosis, chronic alcohol/drug use.

    Protective factors = moderate alcohol intake, Mediterranean diet, low BP, being bilingual.

    Treatment:

    Off label

     

    Prognosis:

    • Alzheimers = survive 5-20 years from diagnosis. Main cause of death is infection = pneumonia due to aspiration.
    • Vascular = tx underlying CV RFs = lipids, BP, DM, smoking, alcohol…
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