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
Main features of Dementia
Loss of general intelligence
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
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
Effective control of hypertention may delay or
prevent this cognitive impairment.
-Friedriech’s ataxia and other spino-
-Some patients with parkinson’s disease.
Vascular: Multiple cerebral infarcts.
Diffuse small vessel disease. Cerebral
Toxic: Alcohol-lead -.
Drugs: Hypnotic , tranquillisers ,
Trauma : Head injury ,including
Neoplastic: Frontal tumours ,multiple
Hydrocephalus: Tumor,or Normal
Infection: TB; meningitis,syphilis
encephalitis; AIDS-related dementia;
Creutzfeild jakob disease (Cow
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
CSF [selected pt.]
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
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
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
Agnosia: the failure to recognise or
identify objects despite intact sensory
Impairment of executive functioning
–planning , organizing , and
Behavioural changes are common ,
include wandering , agitation , and
Paranoia with persecutory delusions
occurs in up to 50% of patients.
Depressive symptoms are also
common , but severe depression is
Investigations and management Alzheimer’s
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
Tetrahydro-aminoacridine [Tacrine] has been reported to
produce some improvement of cognitive function in up to 40%
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
Huntington’s chorea: is a dominant
inherited condition consisting of chorea
and progressive dementia of unknown
Alzheimer’s disease (brain CT)
Dementia (brain CT)