Dementia ?? Jie Ming Shen, M.D., Ph.D. Department of Neurology Ruijin Hospital, SSMU

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Dementia??Jie Ming Shen, M.D., Ph.D.
Department of Neurology Ruijin Hospital, SSMU
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Defenition

• A syndrome of acquired cognitive and behavioral
  impairment to markedly interfere with social and
  occupational functioning.

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Manifestation

• Memory
• Language
• Visuospatial skills
• Cognition
• Behavior psychiatric syndrome
• Eexecutive functionsxecutive functions

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Types

• Degeneration
• Alzheimer disease
• Frontotemporal dementia Picks disease
• Dementia with Lewy body
• Non-Degeneration
• Vascular dementia

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Alzheimer Disease??????
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??

• A progressive degeneration with unknown
  pathogenesis
• memory, cognitive and behavioral impairment
• cortic atrophy
• lose of neurons

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pathogenesis

• Cause unknown
• hereditary
• environment
• metabolic abnormality
• ß- amyloid deposition in the brain
• decrease in acetylcholine
• other

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Pathogenesis

• neurotoxic properties
• formation of NFTs and SPs

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Pathogenesis

• Gene mutation
• amyloid precursor protein (APP, on chromosome
  21),
• presenilin I (on chromosome 14)
• presenilin II (on chromosome 1)
• lipoprotein E-epsilon 4 genotype

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Pathology

• cerebrocortical atrophy
• temporal lobe
• front lobe
• parietal lobe

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Pathology

• senile plaques (SPs)
• neurofibrillary tangles
• lose of neurons
• granulovacular degeneration
• cerebral amyloid angiopathy

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Pathology

• neurofibrillary tangles
• microtubule-associated protein
• tau-hyperphosphorylated.

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Pathology

• lose of neurons
• granulovacular degeneration
• cerebral amyloid angiopathy

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Clinic

• MF
• gt65 y-o 5
• gt85 y-o 20
• sporadic 90
• familial history 5

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Clinic

• Abnornalities in
• ability of daily living
• behaviour
• cognition
• mismanagement of funds or serious lapses in their
  family, social, and occupational responsibilities

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Clinic

• Early stage
• slowly progressive memory loss of insidious onset
  in a fully consciousness, trouble remembering
  recent events or activities
• orientation disturbance
• language disorders with communication

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Clinic

• Early stage
• inability to solve simple arithmetic problems
• impairment in their visuospatial skills

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Clinic

• Early stage
• problems with activities of daily living
• frontal gait
• walk away from home and get lost
• difficulty recognizing familiar people or things
• Greater risk of falls and accidents
• cognition

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Clinic

• Late
• more serious symptoms
• psychiatric syndromes
• Loss of mobility
• behaviour

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Clinic

• Late
• epilepsy
• extrapyramid sign
• clonus
• pyramid sign
• fecal incontinence

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WORK-UP

• Imaging Studies
• CT MRIcerebrocortic atrophy
• Lab Studies
• CSF tau protein Aß
• cognic scales
• gene detection
• APP, PS-1, ApoE4

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Psychology assessment scale

• MMSE
• WAISRC
• CDR
• BBS
• HIS

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Diagnosis

• Age 40-90 y-o
• clinic manifestation of dementia psychology
  assessment scale
• progressive memory mental disturbance
• cognition disturbance
• no consciousness problem
• excluding encephalopathy

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Differential diagnosis

• Mild cognitive impairment
• Depression
• Vascular dementia
• Frontotemporal dementia
• Dementia with Lewy body

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Vascular dementia

• the second most common cause of dementia
• Cause atherosclerosis, lacular infarctions in
  subcortic, basal ganglia and thalamus
• related to high blood pressure, high cholesterol,
  heart disease, diabetes, and related conditions.
  Treating those conditions can slow the progress
  of vascular dementia

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Treatment

• cholinesterase inhibitors (ChEIs) the avoidance
  of centrally acting anticholinergic medications
• psychotropic medications behavioral
  interventions Risperidone
• neuroprotect agents
• N-methyl-D-aspartate (NMDA) antagonists
• anti-inflammatory agents
• clioquinoline, an antibiotic

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Treatment

• Centrally cholinesterase inhibitors (ChEIs)
• tacrine
• Aricept
• 5 mg PO qn for 3-4 wk, the 10 mg PO qd
• Exelon
• 1.5 mg PO bid for 1 mo, 3 mg PO bid for 1 mo, 4.5
  mg PO for 1 mo, then 6 mg PO bid
• Galantamine
• 4-12 mg PO bid bid

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ChEIs

• adverse effects
• nausea
• vomiting
• diarrhea
• dizziness.

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Neuroprotective agents

• Free-radical scavengersVitamin E 1000 IU PO bid
• MAO-BI selegillin
• gingko biloba
• duxil

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Patient education

• patient education
• Both physical and mental activities are
  recommended
• cognitive retraining