بسم الله الرحمن الرحیم

Dementia Dementia is a condition characterised by a progressive decline of mental abilities accompanied by changes in personality and behaviour. There is a loss of memory and skills that are needed to carry out everyday activities.

Dementia is a complex syndrome Psychological / psychiatric symptoms Behavioral Behavioral disturbances Amnesia Apraxia AgnosiaAphasia Functional Cognitive Instrumental ADL Personal ADL

Differential diagnosis : 1- functional Disorders: 2-Other Dementias 3-Medical (NPH)…….. 4-Delirium 5-MCI Medical (NPH)……..

Differential diagnosis Functional : Mania,hypomania (in the most patients The symptoms and signs of functional illness are clear) Cognitive impairment ccurs in percent of symptomatic bipolar elderly Attention,executive function and memory Poor prognosis, prodrome of dementia

Differential diagnosis Functional: Schizophrenia( early onset and late onset) Rarly very late onst sch. cognitive symptoms increase than normal aging

Differential diagnosis Functional : depression DePression with reversible dementia Isolation,memory loss, …… prodrome of dementia(20 percent per yer) 9

Differential diagnosis :depression Onset Response Risk factors Fh Other symptoms

Differential diagnosis Depression –executive dysfunction syndrome (damage to frontostriatal circuits) executive dysfunction,psychomotor retardation reduced interest in activities and response to antidepresants

Differential diagnosis 2-Other Dementias: Vascular dementia (10-20 percent of the Old age dementia) Frontotemporal dementia Lewy body dementia

Acute onset Stepwise Risk factors Gait Neurological Gradual onset Memory loss Normal examination Hallucinations Fluctuations Visuospatial Parkinsonism Behavioural Language Family hx Young onset Vascular Dementia Alzheimer’s Disease Lewy Body Dementia Frontotemporalal Dementia

Medical NPH Endocrine: hypothroidism,cushing Tumour, Toxin, Trauma Infection, Immunologic, Drugs;anticholinergic agents Metabolic Nutritional

Mild Cognitive Impairment functioning well and do not meet clinical criteria for dementia atients who are memory impaired but are otherwise are classified as having MCI Symptoms include Memory complaint Objective memory impairment Normal general cognitive function Intact activities of daily living Not demented Patients with MCI should be recognized and monitored for cognitive and functional decline due to their increased risk for subsequent dementia

delirium Syndrome of : Disturbed consciousness,cognition and with perception and behavioral symptoms Acute onset Flactuative course History for dementia Subtypes:hyperactive and hypoactive

Dementia ? Reversible causes ? Depression ?Delirium ? MCI ?? Acute onset Stepwise Risk factors Gait Neurological Gradual onset Memory loss Normal examination Hallucinations Fluctuations Visuospatial Parkinsonism Behavioural Language Family hx Young onset Frontotemporal Dementia Lewy Body Dementia Alzheimer’s Disease Vascular Dementia

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