Post on 19-Nov-2014
transcript
SENILE DEMENTIA
PREPARED BY: RESURRECCION, Carls Burg A.
DEFINITIONS/DISTINCTIONS Dementia is a clinical
syndrome of cognitive deficits that involves both memory impairments and a disturbance in at least one other area of cognition (e.g., aphasia, apraxia, agnosia) and disturbance in executive functioning.
In addition to disruptions in cognition, dementias are commonly associated with changes in function and behavior.
The most common forms of progressive dementia are Alzheimer's disease, vascular dementia, and dementia with Lewy bodies; the pathophysiology for each is poorly understood.
Differential diagnosis of dementing conditions is complicated by the fact that concurrent disease states (i.e., co-morbidities) often coexist.
PREVALENCE Dementia affects about 5% of
individuals 65 and older. Four to five million Americans
have Alzheimer's disease (AD) 13.2 million are projected to
have AD by 2050. Global prevalence of dementia
is about 24.3 million, with 6 million new cases every year.
RISK FACTORS Advanced age Mild cognitive impairment Cardiovascular disease Genetics: family history of
dementia, Parkinson's disease, cardiovascular disease, stroke, presence of ApoE4 allele on chromosome 19
Environment: head injury, alcohol abuse
TYPES OF
DEMENTIA
1.Alzheimer’s disease Alzheimer’s
disease is the most common type of dementia. In patients aged 65 years or older, who have some kind of cognitive decline, it accounts for over 50% of cases. Progression to full dementia may take several years following the signs of mild cognitive impairment (MCI) at the early stage of AD.
Characteristics: Aphasia – loss or impairment of
language caused by brain dysfunction Apraxia – inability to execute learned
movements on command Agnosia – inability to recognize or
associate meaning to a sensory perception
Acalculia – inability to perform arithmetical calculations
Agraphia – inability to write Alexia – inability to read
2.Vascular dementia Vascular dementia is the second most common cause of dementia. It results from vascular or circulatory lesions or from diseases of the cerebral vasculature leading to ischaemia or infarction.
Characteristics:
Presence of clinical dementia
Evidence of cerebrovascular disease
Exclusion of other conditions capable of producing dementia
3.Dementia with Lewy bodies Dementia with Lewy bodies
(DLB) is an increasingly recognized cause of dementia in elderly patients. The typical presenting features of DLB include fluctuating dementia with prominent deficits in attention, frontal executive tasks and visuospatial abilities. The cognitive profile of DLB contains both cortical and subcortical features.
Clinical features: Periods of confusion Fluctuations in cognition
(especially attention and alertness)
Visual hallucinations Spontaneous extrapyramidal
signs such as rigidity or slowing (mild
parkinsonism) Bradykinesia (paucity of
movement)
4.Fronto-temporal dementia Fronto-temporal dementia
(FTD) – sometimes called Pick’s complex – is characterized by focal frontal atrophy with personality and behavioural disturbances, or temporal atrophy with either progressive aphasia or semantic dementia [Hodges, 1992; Neary, 1998]. Onset of FTD is observed in a younger age group than other dementias and diagnosis may be difficult in the early stages of disease.
Routine neuropsychological assessment procedures such as the Mini-Mental State Examination (MMSE) are usually insensitive at detecting frontal abnormalities, therefore more extensive neuropsychological testing is required to establish frontal deficit in patients suspected with FTD. The clock drawing test may be helpful.
Presenting features of FTD include:
Insidious onset and slow progression
Preservation of memory to late-stage disease making diagnosis difficult
Early and prominent personality changes (eg, apathy, irritability, jocularity, euphoria,
loss of personal and social awareness)
Loss of tact and concern Impaired judgement and insight Mental rigidity and inflexibility Hypochondriasis Unrestrained exploration of objects and the
environment (hypermetamorphosis) Distractability and impulsivity, depression
and anxiety Language difficulties (eg, problems with
word recall, circumlocution, word repetition – also known as gramophone syndrome)
Inertia
ANATOMY
CLINICAL MANIFESTATION
Memory loss
Symptoms at the early stage include the following:
Forget recent events and distant memory also fades as the disease progresses
Experience difficulty in reasoning, calculation, and accepting new things
Become confused over time, place and direction
Affect the activity of daily living
Judgment will be reduced Personality will be changed
Become passive and lose initiative.
Symptoms at the middle stage include the following: Lose cognitive ability, such as the
ability to learn, judge, and reason Become emotionally unstable, and
easily lose temper or become agitated
Need help from his or her family with activities of daily living
Confuse night and day, and disturb the family's normal sleeping time.
Symptoms at the later stage include the following: Lose all cognitive ability
Become entirely incapable of self-care, including eating, bathing, and so on
Neglect personal hygiene, and will become incontinent
Lose weight gradually, walk unsteadily and become confined to bed.
DIAGNOSIS
If you think you may be developing dementia, visit your GP. It's very important to seek help early so you can get the support you need.
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may do blood and urine tests to rule out the possibility of other conditions that could cause symptoms similar to dementia.
You may also have a memory test - one that is often used to help find out if you have dementia is the 'mini mental state examination (MMSE)'. In this test, your GP will ask you some questions and test your attention and ability to remember words. How you score in this test indicates how serious your condition is, for example:
-an MMSE score of 20 to 24 indicates mild dementia -a score of 10 to 20 suggests moderate
dementia -a score below 10 implies severe
dementia
TREATMENT
Medicines
donepezil galantamine rivastigmine
Talking therapiesYou may find other therapies helpful,
such as: group activities and discussions -
these aim to stimulate your mind (this is sometimes referred to as cognitive stimulation therapy)
reminiscence therapy - discussing past events in groups, usually using photos or familiar objects to jog your memory, although there are conflicting opinions on whether this is effective
Complementary therapies
It's possible that aromatherapy will help you to feel less agitated. However, there is only a small amount of evidence to support this.