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Dementia. Dr Chandra Prajapati FRCP, FRCPI Consultant Physician. Dementia. a serious loss of global cognitive function in a previously unimpaired person, beyond what might be expected from normal ageing. Delirium. Acute onset and fluctuating course Inattention

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dementia

Dementia

Dr Chandra Prajapati FRCP, FRCPI

Consultant Physician

dementia1
Dementia

a serious loss of global cognitive function in a previously unimpaired person, beyond what might be expected from normal ageing

delirium
Delirium
  • Acute onset and fluctuating course
  • Inattention
    • Difficulty focussing attention
    • Easily distractible
  • Disorganised thinking
    • Disorganised / incoherent / unclear / unpredictable switching
  • Altered level of consciousness
    • Vigilant /hyperactive
    • Drowsy→ comatose /hypoactive
delirium vs dementia
Delirium vs. Dementia
  • Delirium or acute confusional state, is a syndrome presenting as severe confusion and disorientation, developing with relatively rapid onset and fluctuating in intensity.
    • Reversible
    • May last up to six months
  • Dementia is a non-specific syndrome affecting memory, attention, language and problem solving lasting more than six months
    • Later complicated by orientation and behaviour problems
    • 10% may have reversible cause
dementia2
Dementia
  • Currently 35.6 million sufferer worldwide
  • Number likely to increase > 60 million by 2030
  • In UK
    • Currently 800,000
    • By 2021 10,00,000
    • By 2051 17,00,000
  • SASH area
    • Current number is as high as would be expected by 2051 in other areas
dementia3
Dementia
  • Dementia care cost worldwide = IHD+DM+cancer care
  • Dementia care in 2010 @ 604 Billion USD
  • 1% of world GDP
  • If dementia care were a country, it would be 18th largest economy in the world
caide dementia score
CAIDE Dementia score

Likelihoods of Dementia risk in 20 years

ScoreRisk

0-5 1%

6-7 1.9%

8-9 4.2%

10-11 7.4%

12-15 16.4%

When the cut-off was set at 9 points or more, the sensitivity

was 0.77, the specificity was 0.63, and the negative

predictive value was 0.98

dementia types
Dementia types
  • Alzheimer
  • Vascular
  • Lewy Body dementia
  • Fronto-temporal dementia
  • Cortico-basal degeneration
    • PD
    • Alien Hand syndrome
    • Apraxia
    • Aphasia
type of dementia
Type of dementia
  • Fixed memory loss
    • Traumatic brain injury
    • Hypoxic-ischaemic brain injury
    • Alcohol
    • Infections i.e encephalitis
  • Slowly progressive
    • Alzheimer
    • Vascular dementia
    • Post infections
  • Rapidly Progressive
    • CJD
    • Others: Alzheimer, LBD, FTD, CBD, PSP
dementia in younger age group
Dementia in younger age group
  • Uncommon under 65
    • Consider Alzheimer
    • Familial causes i.e. FTD, Huntington’s disease
    • Frequent head trauma i.e. boxers ( dementia pugilistica) and footballers
    • Vascular
      • antiphospholipid syndrome
      • CADASIL(cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)
      • MELAS (mitochondrial encephalopathy, lactic acidosis and stroke like symptoms)
      • Homocysinuria
      • Binswanger disease ( sub cortical white matter atrophy due to small vessel disease)
dementia in younger age group1
Dementia in younger age group

Rare under 40

  • Consider familial Alzheimer
  • Drugs
  • Alcohol
  • Metabolic disorders
  • Infections i.e HIV, Cryptococcal infection, syphilis, Lymes diasease etc
assessment
Assessment
  • Specialist assessment
    • AMTS
    • MMSE
    • Clock draw test
    • Trail making test
  • Exclude other causes i.e. depression, anxiety
  • Consider carer views; DO NOT SOLELY RELY ON ASSESSMENT
diagnostic tests
Diagnostic tests
  • Bloods
    • FBC, Electrolytes and calcium, Glucose, B12,Folate, TFTs, TPHA
  • Radiology
    • CT/MRI
    • Functional Neuroimaging i.e. SPECT or PET
  • Brain Biopsy!
spect
SPECT

Perfusion SPECT scan showing

evidence of biparietal and bitemporal hyperperfusion in a) an Alzheimer's disease case compared to

b) a control subject.

management
Management
  • 10% may have reversible cause – Treat the cause i.e. B12, Folate, Levothyroxine
  • Remaining – NO CURE
  • Pharmacological
    • Acetylcholine esterase inhibitor
      • Donepezil (Aricept)
      • Galantamine (Reminyl)
      • Rivastigmine (Exelon)
    • NMDA (N-Methyl-D-Aspartate) receptor blocker
      • Memantine (Ebixa)
management1
Management
  • Symptom management
  • AVOID ANTIPSYCHOTICS
  • Carer Support
    • Consider carer’s views
  • Dementia support/crisis team
  • Specialist care at home or in care homes
  • Severe dementia – Holistic care, advance care planning, Palliative care
barrier to dementia care
Barrier to dementia care

Stigmata of Dementia

Inactivity in seeking

+

Offering help

False belief

Nothing can be done

False belief

Nothing Available