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DEMENTIA

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					          Dementia.

Dementia is a clinical syndrome
charactirized by loss of
previously acquired intellectual
functions in the abscence of
impairment of conciousness
   The term dementia is mostly associated with elderly but some
    disorders occur in the mid life, namely Alzheimer's disease,
    Pick's disease, Huntington's Chorea.

   These conditions are also collectively called Pre-senile
    Dementia and have a strong familial disposition.

   Huntington's Chorea is transmitted by an Autosomal
    dominant gene.


 Main features of Dementia
 Loss of general intelligence
 Memory impairment
 Personality changes
 Emotional changes
   The dementia is not necessarily
    irreversible.Progression of dementia
    usually leads to global cognitive
    impairment ,but some dementing
    disorders are more focal in early stages.

   Deterioration of intellect and performance
    may also be a major presenting feature of
    psychiatric disorders ,particularly
    depression;the term pseudodementia is
    generally used in this setting ,and
    recovery occurs with effective treatment
    of depressive illness.
Causes       of dementia:
   Dementia with normal aging :
 There is decline in the cognitive function with
  increasing age.
 Age –related changes, the problem solving
  ,reaction time tests and ability to learn new
  material decline with increasing age.
 Ill health undoubtedly affects cognitive
  performance , chronically raised blood pressure
  causes impairment in of attention memory and
  new learning.
 Effective control of hypertention may delay or
  prevent this cognitive impairment.
 Degenerative   :

-Alzheimer’ disease.
-Huntingtons’chorea.
-Multisystem atrophy.
-Pick’s disease.
-Friedriech’s ataxia and other spino-
  cerebellar degenerations.
-Some patients with parkinson’s disease.
 Vascular: Multiple cerebral infarcts.
  Diffuse small vessel disease. Cerebral
  arteritis.
 Toxic: Alcohol-lead -.
 Drugs: Hypnotic , tranquillisers ,
  barbiturate
 Trauma : Head injury ,including
  subdural haematoma.
 Neoplastic: Frontal tumours ,multiple
  metastases.
 Hydrocephalus: Tumor,or Normal
  pressure hyrocephalus.
 Infection: TB; meningitis,syphilis
  encephalitis; AIDS-related dementia;
  Creutzfeild jakob disease (Cow
  madness).
 Inflamatory: MS, SLE, Sarcoidosis.
 Metabolic: Hypothyroidism , uraemia ,
  hepatic failure, B12 deficiency,
  prolonged hypoglycaemia, prolonged
  hypoxia, Wilson’s disease.
 Pseudodementia in Depression.
Investigation of dementia:
 Full blood count,ESR, B.Glucose, Vitamin
B12.
 Renal function.
 Liver function.
 Treponemal serology.
 CSF [selected pt.]
 Calcium.
 Toxicology.
 Chest X-ray ,ECG
 CT or MRI scan
 EEG [selected pt.]
   Alzheimer’s disease is the commonest
  cause of dementia in people over 60 years
  of age.
 It is primary degenerative disease of brain
  of unknown aetiology of insidious onset
  followed by gradual deterioration and then
  death in about ten years.
 The onset can be in the middle adult life
  [of presenile onset] but the incidence
  is higher in later life.
 Patients at risk of developing Alzheimer’s
  disease are those who have a family
  history , or have Down’s syndrome.
 Clinical features of Alzheimer’s disease:
 Impaired ability to learn new information
  or to recall previously learned
  information.
 A decline in language function and in
  particular, increased difficulty with names
  and understanding what is being said.
 Apraxia : an impaired ability to carry out
  motor activities despite intact motor
  function.
 Agnosia: the failure to recognise or
  identify objects despite intact sensory
  function
   Impairment of executive functioning
    –planning , organizing , and
    sequencing.

 Behavioural changes are common ,
  include wandering , agitation , and
  aggression .
 Paranoia with persecutory delusions
  occurs in up to 50% of patients.
 Depressive symptoms are also
  common , but severe depression is
  unusual.
   Investigations and management Alzheimer’s
    disease :
   There is no single diagnostic test for Alzheimer’s disease .


   The finding of diffuse cerebral atrophy on CT scanning and
    exclusion of other treatable causes of dementia usually leave
    little doubt about the diagnosis.


   Management is largely supportive ,though there is much
    current interest in a possible therapeutic effect of cholinergic
    drugs.


   Tetrahydro-aminoacridine [Tacrine] has been reported to
    produce some improvement of cognitive function in up to 40%
    of patients.
   Pick’s disease : is a rare disease,it
    consists of dementia with selective
    impairment of speech function
    associated with focal atrophy of frontal
    and temporal lobes.It is inherited as an
    autosomal dominant.

   Huntington’s chorea: is a dominant
    inherited condition consisting of chorea
    and progressive dementia of unknown
    cause.
Alzheimer’s disease (brain CT)
Dementia (brain CT)

				
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posted:12/19/2011
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