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Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine

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Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine Palmerston North Hospital. Outline the ageing brain basic definitions causes of dementia symptoms of dementia cognitive testing. Ageing. The ageing brain. Case history 1

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slide1

Recognition of Dementia

Syed Zaman

Consultant Physician

Geriatric Medicine

Palmerston North Hospital

slide2

Outline

  • the ageing brain
  • basic definitions
  • causes of dementia
  • symptoms of dementia
  • cognitive testing
slide5

Case history 1

A 65 year old writer presents with difficulty reading and writing.

He has taken to dictating his stories to a PA. He is independent

with ADLs.

Cognitive testing reveals a normal MMSE, with intact STM.

Detailed neuropsychological testing confirms dyslexia and

dysgraphia.

slide6

Case history 2

An 85 year old man with previous TIAs, hypertension

and myocardial infarction is brought to his GP by his wife

because of STM loss. He is completely independent with ADLs,

socially appropriate and manages household finances well.

His MOCA is 20/30 with deficits in recall and executive function.

slide9

Dementia

  • loss of brain function
  • affecting normal social and occupational activities
slide10

Mild cognitive impairment

  • loss of brain function
  • does not affect ability to live independently
  • Cognitive
  • Impairment
  • Not
  • Dementia
slide11

The significance of MCI

  • prevalence of 3 to 22% >65 years
  • 10 to 15% conversion rate to dementia per year
  • reversion rate 40% over a 5 year period
  • is it possible to prevent/delay progression to dementia?
slide12

Causes of dementia 1

  • brain injury
  • brain tumours
  • chronic alcohol abuse
  • metabolic problems
  • vitamin B12 deficiency
  • normal pressure hydrocephalus
slide13

Causes of dementia 2

  • Alzheimer’s disease
  • dementia with Lewy bodies
  • vascular dementia
  • Parkinson disease dementia
  • fronto-temporal dementia
  • Huntington’s disease
  • HIV and other infections
slide18

Alzheimer’s disease – symptoms 1

  • forgetfulness
  • getting lost on familiar routes
  • misplacing items
  • language problems
slide19

Alzheimer’s disease – symptoms 2

  • difficulty performing tasks that take some thought
  • loss of interest in things previously enjoyed
  • personality changes and loss of social skills
  • difficulty doing basic tasks
  • losing awareness of self
  • poor judgement and insight
  • Behavioural and Psychological Symptoms of Dementia
slide21

Vascular dementia – symptoms

  • abrupt onset
  • step-wise deterioration and fluctuation
  • memory impairment
  • executive dysfunction
  • personality change and emotional lability
  • incontinence
  • gait disorder
slide23

Dementia with Lewy bodies – symptoms

  • fluctuating cogntive function – 50 to 75%
  • recurrent visual hallucinations – 80%
  • REM sleep behaviour disorder
  • apathy
  • parkinsonism
  • autonomic dysfunction
slide24

Cognitive screening

  • role
  • which test?
  • MMSE
  • MoCA
slide26

Case history 1

A 65 year old writer presents with difficulty reading and writing.

He has taken to dictating his stories to a PA. He is independent

with ADLs.

Cognitive testing reveals a normal MMSE, with intact STM.

Detailed neuropsychological testing confirms dyslexia and

dysgraphia.

slide27

Case history 2

An 85 year old man with previous TIAs, hypertension

and myocardial infarction is brought to his GP by his wife

because of STM loss. He is completely independent with ADLs,

socially appropriate and manages household finances well.

His MOCA is 20/30 with deficits in recall and executive function.

slide28

Summary

  • diagnosis of dementia is primarily based on the history
  • symptoms of dementia help define the subtype
  • comorbidities help define the subtype
  • MCI is common, its significance uncertain
  • early recognition is vital for appropriate management
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