Dementia

1. Dementia

2. Dementia • a serious loss of global cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging.

3. Dementia Dementia is not a single disease, but rather a non-specific illness syndrome (i.e., set of signs and symptoms) in which affected areas of cognition may be memory, attention, language, and problem solving. It is normally required to be present for at least 6 months to be diagnosed;[cognitive dysfunction that has been seen only over shorter times, in particular less than weeks, must be termed delirium

4. Causes :Fixed cognitive impairment Various types of brain injury, occurring as a single event, may cause irreversible but fixed cognitive impairment. Traumatic brain injury hypoxic-ischemic injury Strokes Infections prolonged epileptic seizures and acute hydrocephalus alcohol dementia, Wernicke's encephalopathy and/or Korsakoff's psychosis

5. Causes :Slowly progressive dementia Dementia which begins gradually and worsens progressively over several years is usually caused by neurodegenerative disease. Alzheimer's disease Vascular dementia. Dementia with Lewy bodies. Normal pressure hydrocephalus Hypothyroidism

6. Causes :Rapidly progressive dementia dementia which worsens over weeks to months Creutzfeldt-Jakob disease

7. Diagnosis :Cognitive testing Abbreviated mental test score (AMTS) The mini mental state examination (MMSE) Modified Mini-Mental State Examination (3MS), The Cognitive Abilities Screening Instrument (CASI) The Trail-making test And the clock drawing test.

8. Laboratory tests vitamin B12, folic acid, thyroid-stimulating hormone (TSH), C-reactive protein, full blood count, electrolytes, calcium, renal function, and liver enzymes

9. Imaging CT scan or magnetic resonance imaging functional neuroimaging modalities of SPECT and PET

10. Management Medications Acetylcholinesterase inhibitors: Tacrine (Cognex), donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon) N-methyl-D- aspartate (NMDA) receptor blockers: Memantine

11. Delirium Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior.

12. The core features Disturbance of consciousness (that is, reduced clarity of awareness of the environment, with reduced ability to focus, sustain, or shift attention) Change in cognition (e.g., problem-solving impairment or memory impairment) or a perceptual disturbance Onset of hours to days, and tendency to fluctuate. Behavior may be either overactive or underactive, sleep is often disturbed. Thinking is slow and muddled but the content is often complex. Common features also tend to include: Intrusive abnormalities of awareness and affect, such as hallucinations or inappropriate emotional states.

13. Duration The duration of delirium is typically affected by the underlying cause. If caused by a fever, the delirious state often subsides as the severity of the fever subsides. However, it has long been suspected that in some cases delirium persists for months and that it may even be associated with permanent decrements in cognitive function.

14. Causes Delirium is a very general and nonspecific symptom of :organ dysfunction Critical illness Substance withdrawal Gross structural brain disorders Neurological disorders Circulatory Metabolic Medication Drugs Mental illness

15. Diagnosis Delirium may be distinguished from psychosis, in which consciousness and cognition may not be impaired Delirium is distinguished from dementia (chronic organic brain syndrome) which describes an "acquired" (non-congenital) and usually irreversible cognitive and psychosocial decline in function. Dementia usually results from an identifiable degenerative brain disease (for example Alzheimer disease or Huntington's disease). Dementia is usually not associated with a change in level of consciousness, and a diagnosis of dementia requires a chronic impairment.

16. Diagnosis Delirium is distinguished from depression Delirium is distinguished by time-course from the confusion and lack of attention which result from long term learning disorders and varieties of congenital brain dysfunction. Delirium has also been referred to as 'acute confusional state' or 'acute brain syndrome'. The key word in both of these descriptions is "acute"

17. Diagnosis Delirium is not the same as confusion, although the two syndromes may overlap and be present at the same time. However, a confused patient may not be delirious (an example would be a stable, demented person who is disoriented to time and place), and a delirious person may not be confused (for example, a person in severe pain may not be able to focus attention because of the pain, and thus be by definition delirious, but may be completely oriented and not at all confused).

18. Treatment Treatment of the underlying presumed acute cause or causes; secondly, optimising conditions for the brain. This involves ensuring that the patient with delirium has adequate oxygenation, hydration, nutrition, and normal levels of metabolites, Antipsychotics, particularly haloperidol Benzodiazepines