2. Types of Dementia Dr Bernie Coope Associate Medical Director/Honorary Senior Lecturer, Worcester University Association for Dementia Studies

3. Syndrome and pathology Dementia is a clinical syndrome of change in mental abilities caused by diseases of the brain Subject of this talk is the different pathological processes that may cause dementia

4. What’s the point...? Different clinical presentations Different treatments Different risk of harm from other drugs Different prognosis and course Different rates of physical disability It matters to our patients to get it right!

5. Alzheimer’s Disease The most common cause of dementia Can occur at a young age but most patients >80yrs Amyloid plaques and neurofibrillary tangles Medial temporal pathology early

6. Features of Alzheimer's Disease (early) Registration of new memories- forgetting, repetition and mislaying. Memory retrieval (often underestimated) Executive dysfunction (planning and monitoring) Subtle language errors (anomia, circumlocutions) Attention and concentration commonly good.

7. More advanced Alzheimer's Disease Progression of earlier symptoms-memory and communication Greater reliance on others for simple daily living activities Loss of skills Changes in behaviour and mood Psychosis Motor changes impact on feeding and mobility Death

8. Vascular dementia Variable pathology-critical infarcts or diffuse ischemia Cortical and sub-cortical Variable loss and retention of skills Emotion Onset and progress may be discrete-eg after a stroke History of vascular events and risk factors

9. Alzheimer’s and vascular disease- how important is the distinction? Both common Shared aetiology eg genetic risks One will contribute to the other Alzheimer's pathology present in a high proportion of people with vascular changes Impact on treatment.

10. Dementia with Lewy Bodies First described in substantia nigra in Parkinson's disease 10 % of dementia “Dementia in Parkinson's Disease” and DLB only differ in first presentation Younger onset than AD, faster progression

11. Clinical feature of DLB Cognitive impairments-esp visuospatial skills, eg dressing, cooking Fluctuation day to day Parkinsonism-bradykinesia Falls-gait and autonomic instability Visual hallucinations REM Sleep disturbance

12. Frontotemporal dementias Younger onset Preservation of parietal and occipital lobes 3 clinical variants Sometimes associated with PD, MND

13. Three Variants Behavioural Variant-poor judgement, lack of empathy, out of character behaviour, apathy Progressive non-fluent aphasia- effortful speech with frequent word and grammar errors, embarrassment and depression common Semantic Dementia- loss of semantic knowledge stores. Fluent speech of little meaning, can copy words or pictures but not describe use and meaning. Tendency to merge as dementia progresses

14. Conclusion Many serious brain conditions lead to dementia syndrome. Giving the right advice, support and treatment depends on getting the diagnosis right. A good history is more use than a good brain scan.