Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine Palmerston North Hospital

Outline the ageing brain basic definitions causes of dementia symptoms of dementia cognitive testing

Ageing

The ageing brain

Case history 1 A 65 year old writer presents with difficulty reading and writing. He has taken to dictating his stories to a PA. He is independent with ADLs. Cognitive testing reveals a normal MMSE, with intact STM. Detailed neuropsychological testing confirms dyslexia and dysgraphia.

Case history 2 An 85 year old man with previous TIAs, hypertension and myocardial infarction is brought to his GP by his wife because of STM loss. He is completely independent with ADLs, socially appropriate and manages household finances well. His MOCA is 20/30 with deficits in recall and executive function.

What is dementia?

Dementia loss of brain function affecting normal social and occupational activities

Mild cognitive impairment loss of brain function does not affect ability to live independently Cognitive Impairment Not Dementia

The significance of MCI prevalence of 3 to 22% >65 years 10 to 15% conversion rate to dementia per year reversion rate 40% over a 5 year period is it possible to prevent/delay progression to dementia?

Causes of dementia 1 brain injury brain tumours chronic alcohol abuse metabolic problems vitamin B12 deficiency normal pressure hydrocephalus

Causes of dementia 2 Alzheimer’s disease dementia with Lewy bodies vascular dementia Parkinson disease dementia fronto-temporal dementia Huntington’s disease HIV and other infections

Brain function – an alternative view

Brain function

Alzheimer’s disease

Alzheimer’s disease – symptoms 1 forgetfulness getting lost on familiar routes misplacing items language problems

Alzheimer’s disease – symptoms 2 difficulty performing tasks that take some thought loss of interest in things previously enjoyed personality changes and loss of social skills difficulty doing basic tasks losing awareness of self poor judgement and insight Behavioural and Psychological Symptoms of Dementia

Vascular dementia

Vascular dementia – symptoms abrupt onset step-wise deterioration and fluctuation memory impairment executive dysfunction personality change and emotional lability incontinence gait disorder

Dementia with Lewy bodies Lewy body

Dementia with Lewy bodies – symptoms fluctuating cogntive function – 50 to 75% recurrent visual hallucinations – 80% REM sleep behaviour disorder apathy parkinsonism autonomic dysfunction

Cognitive screening role which test? MMSE MoCA

Case history 1 A 65 year old writer presents with difficulty reading and writing. He has taken to dictating his stories to a PA. He is independent with ADLs. Cognitive testing reveals a normal MMSE, with intact STM. Detailed neuropsychological testing confirms dyslexia and dysgraphia.

Case history 2 An 85 year old man with previous TIAs, hypertension and myocardial infarction is brought to his GP by his wife because of STM loss. He is completely independent with ADLs, socially appropriate and manages household finances well. His MOCA is 20/30 with deficits in recall and executive function.

Summary diagnosis of dementia is primarily based on the history symptoms of dementia help define the subtype comorbidities help define the subtype MCI is common, its significance uncertain early recognition is vital for appropriate management

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