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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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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




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.


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.


What is dementia?


  • Dementia

  • loss of brain function

  • affecting normal social and occupational activities


  • Mild cognitive impairment

  • loss of brain function

  • does not affect ability to live independently

  • Cognitive

  • Impairment

  • Not

  • Dementia


  • 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?


  • Causes of dementia 1

  • brain injury

  • brain tumours

  • chronic alcohol abuse

  • metabolic problems

  • vitamin B12 deficiency

  • normal pressure hydrocephalus


  • 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


Brain function – an alternative view


Brain function – an alternative view



Alzheimer’s disease


  • Alzheimer’s disease – symptoms 1

  • forgetfulness

  • getting lost on familiar routes

  • misplacing items

  • language problems


  • 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



  • Vascular dementia – symptoms

  • abrupt onset

  • step-wise deterioration and fluctuation

  • memory impairment

  • executive dysfunction

  • personality change and emotional lability

  • incontinence

  • gait disorder


Dementia with Lewy bodies

Lewybody


  • Dementia with Lewy bodies – symptoms

  • fluctuating cogntive function – 50 to 75%

  • recurrent visual hallucinations – 80%

  • REM sleep behaviour disorder

  • apathy

  • parkinsonism

  • autonomic dysfunction



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.


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.


  • 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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