DEMENTIA ABDULMAJEED ALOLAYAH

What is DEMENTIA ? It is a chronic global impairment of cognitive functions without disturbed consciousness.

Features Describing DEMENTIA The essential feature is a loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning or both. There is two stages of features : – Early stage. – Late stage.

Cont. In early stage cognitive impairment may not be apparent, features include : – Subtle changes in personality. – A decrease in the range of interest and enthusiasm. – Shallow affect, agitation. – Emotional (depressive or anxiety). – Multiple somatic vague psychiatric symptoms. – A gradual loss of social and intellectual skills (first noticed in work setting where high performance is required).

Cont. In late stage cognitive disturbances emerge : – Increasing memory impairment (recent memory first). – Attention impairment (patient become less sharp). – Impaired judgment. – Disorientation: particularly to time, and when severe to place and person. – Significant change in mood and personality. – Behavior: shrinkage of social interaction. – Language: vague and imprecise speech with inappropriate repetition of a same thoughts. – Psychotic features: hallucinations and delusions.

Epidemiology It is primarily a syndrome of the elderly: – If > 65 years = senile dementia. – If < 65 years = presenile dementia. Increasing age is the most important risk factor.

Causes of DEMENTIA 1.Alzheimer’s disease: continuous deterioration of intellectual functioning due to degenerative process affecting the whole cortex, especially cholinergic neurons. 2.Vascular (multi-infarct) dementia: stepwise deterioration of intellectual functioning due to multiple infarct of varying sizes or arteriosclerosis in the main intracranial vessels. It usually occurs in patient with hypertension or diabetes. 3.General medical conditions: e.g. vitamin B12 deficiency, hypothyroidism. 4.Substance induced dementia: e.g. alcoholic dementia. 5.Chronic infections affecting the brain: e.g. T.B.

DDx. 1. Normal aging: age related cognitive decline. But But → the course is not progressively deteriorating, no loss of social or occupational functioning. 2. Depression in the elderly (Pseudo-dementia): cognitive disturbance is relatively of rapid onset and preceded by depressive features. But But → EEG and CT scan are normal in pseudo-dementia. 3. Delirium: But But → the onset rapid and consciousness is impairment.

Diagnosis To diagnose the condition, doctor will review medical history and symptoms and conduct a physical examination. Doctors may order a number of tests to diagnose dementia and rule out other conditions. 1.Cognitive and neuropsychological tests: – In these tests, doctors will evaluate your thinking (cognitive) function. A number of tests measure thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention. – Doctors use these tests to determine whether you have dementia, how severe it is and what part of your brain is affected.

Cont. 2. Neurological evaluation: – In a neurological evaluation, doctors will evaluate movement, senses, balance, reflexes and other areas. 3. Brain scans: – Doctors may order brain scans, such as a CT or MRI, to check for evidence of stroke or bleeding and to rule out the possibility of a tumor.

Cont. 4. Laboratory tests: – Simple blood tests can rule out physical problems that can affect brain function, such as vitamin B- 12 deficiency or an underactive thyroid gland. 5. Psychiatric evaluation: – Meeting with a mental health specialist (psychologist or psychiatrist) who may evaluate whether depression or another psychological condition may be causing your symptoms.

Treatment 1.Supportive measures: A.Provide good physical care (meals, hygiene, …) B.Encourage the family’s involvement. C.Support the care giver. D.Keep the familiar settings if possible to avoid accidents, wandering away, … etc.

Cont. 2. Specific measures: A.Identify and correct any treatable or controllable condition e.g. hypothyroidism, vitamin B12 deficiency, hypertension, diabetes. B.Symptomatic treatment: Agitation, aggression → small doses of major tranquilizers (e.g. Olanzapine 5mg). Insomnia → a sedative antidepressant (e.g. Citalopram 10-20mg). Depression → small dose of antidepressant (e.g. Citalopram 10-20mg).

Cont. C. Cognitive enhancing medications (mainly for alzheimer’s dementia). *cholinesterase inhibitors : Donepezil. Rivastigmine. *memantine : an N-methyl-D-aspartate (NMDA) receptor antagonist, protect neuron from neurodegenerative process induced by glutamate excitotoxicity.

Summary Dementia isn't a specific disease, it is a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily functioning. Memory loss alone doesn't mean you have dementia, because may be that is a normal part of aging. Alzheimer's disease is the most common cause of a progressive dementia. There's no sure way to prevent dementia, but there are steps you can take that might help such as keep mind active, be physically and socially active, quit smoking, lower blood pressure, pursue education, maintain a healthy diet.

References Basic psychiatry, 2 nd edition – 2011 for Prof. Mohammed A. Alsughayir. Mayo clinic on healthy aging, mayo clinic family health book 4 th edition and mayo clinic online website : conditions/dementia/basics/definition/con

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