Dementia

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Dementia

• Leke Ogunmefun, MD
• Clinical Assistant Professor
• Department of Psychiatry
• University of Maryland School of Medicine

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Definitions

• Dementia is used as an umbrella term to group all
  diseases in which there is some form of memory
  loss.
• Symptoms of dementia emerge slowly, worsen over
  time and restrict your ability to function.
• Because depression can sometimes affect memory
  and cognition, it is often difficult to clearly
  differentiate it from dementia.

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The BRAIN
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Types of Dementia

• Alzheimers Dementia Commonest type of
  dementia. Unknown cause, may occur in families,
  gradual onset
• Vascular Dementia Caused by changes in blood
  supply to the brain. Hypertension, stroke,
  diabetes and high cholesterol may contribute to
  this
• Lewy-body Dementia Dementia and Parkinsons
  disease

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Dementia Subtypes

• Dementia secondary to Gen. Med. Cond.
• Syphilis
• CJD Mad cow disease
• HIV
• Head Trauma with severe memory loss
• Mixed

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Treatable causes

• Less than 5 of a sample of dementia cases have a
  potentially treatable cause. These include
• Hypothyroidism
• Vitamin B1 (thiamine) deficiency
• Vitamin B12, Vitamin A deficiency
• Depressive pseudodementia (note dementia and
  depression can coexist in many patients and can
  be difficult to differentiate.)
• Normal pressure hydrocephalus
• Tumor

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Alzheimers Disease
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Forecast of Alzheimers Disease Prevalence in the
U.S.
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Normal Brain vs Severe Alzheimers Disease Brain
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Dementia and Depression

• Patients with mild dementia are almost always
  depressed. gt80
• Elderly depressed patients are sometimes
  misdiagnosed as Alzheimers dementia.
• Demented patients do poorly in testing due to
  cognitive decline despite excellent motivation.
• Depressed patients do poorly in testing due to
  decline in motivation despite excellent cognitive
  skills.
• Both illnesses are under-diagnosed and
  under-treated.

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Real Symptoms

• Memory loss- Recent gtRemote initially
• Poor night time sleep
• Excessive daytime sleepiness
• Wandering
• Irritable mood because of forgetfulness
• Speech impairment
• Suspiciousness (Paranoia)
• Auditory and/or visual hallucinations
• Physical combativeness
• Weight loss
• DEPRESSION

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Fronto-temporal Dementia
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Symptoms of Dementia

• Marked loss of memory for recent events
• -losing items
• -getting lost in familiar places
• -Missing appointments
• -Trouble with cooking, paying bills, driving
• -Cant understand books, movies or news items

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Symptoms of Dementia

• Substitution of approximate phrases ("Where is
  the thing for sweeping?" for broom)
• Misidentifying people (Confusing sister with
  deceased mother)
• Use of empty phrases ("You know", "That thing")
• Difficulty inhibiting behavior

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Behavior Disturbance

• Wandering, especially at night
• Physical combativeness
• Argumentative with care provider
• Refusing medications
• Dangerousness- Leaving stove on, forgetting to
  turn off faucets, getting lost
• Delusions resulting in suspiciousness of care
  provider, calling the police, bizarre acts
• Disturbed sleep-wake cycle
• Incontinence- Bowel and or bladder
• DRIVING

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Diagnostic Tools

• MMSE at doctors office scored /30
• Clock Drawing
• Animal naming in one minute
• Other tests may be done by the doctor or
  specialist

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Normal Memory Problems

• Occasional memory problems attributable to
  age-related forgetfulness
• Normal finding or misleading info after age 45
• Forgetting keys or where you parked
• Incidental occurrence of misplacing items
• Declining mental performance which can be
  explained by age, stress or medical condition.
• Bereavement and depression

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Normal Brain in Section
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Dementia Brain in Section
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Dementia Treatment

• Start early in treatment and continue
  indefinitely
• Target specific areas Cognition, Behavior and/or
  Function
• Cholinesterase inhibitors indicated for mild to
  moderate disease
• NMDA indicated for moderate to severe
• They can and should be combined

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Treatment of Dementia

• Cholinesterase inhibitors
• -Aricept
• -Exelon
• -Razadyne ER
• NMDA receptor antagonist
• -Namenda
• These medications DO NOT improve memory, they
  only SLOW the decline

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Initial Practical Approaches

• Housing One level, lt 3steps few, large
  furniture low bed or floor mattress burglar
  alarm turned on at all times
• Healthy finger foods and microwave
• Electric stove preferred with controlled access
  to fusebox
• Telephone with large numbers and letters
• Orientation cues LARGE calendar, names and
  pictures of patient and loved ones

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QUESTIONS

• ??????????
• THE END