1. Dementia Dr.Mansour K. Alzahrani

2.  Define the dementia  Discuss the prevalence of dementia  Discuss the impact of dementia on the individual and the family  Evaluate the patient with suspecting dementia  Discuss the diagnostic criteria of dementia  Explain the common types of dementia  Discuss the pharmacological and non-pharmacological management of dementia Objectives:

3.  Dementia is chronic deterioration of cognitive function characterized by multiple cognitive deficits and deterioration of global intellectual ability. Define the dementia

4.  Chronic deterioration of cognitive function  The dysfunction involves memory, behavior, personality, judgment, attention, language, abstract thought, and other executive functions  The deficits seen in dementia interfere with the person's occupational and social functioning  Memory impairment is generally a prominent early symptom

5.  AS MANY AS 26 MILLION PEOPLE AROUND THE WORLD ARE LIVING WITH ALZHEIMER’S DISEASE.  THE SIXTH-LEADING CAUSE OF DEATH IN THE WORLD.  More than 50,000 pts in K.S.A. Discuss the prevalence of dementia

6. PatientFamily Impact on the individual and the family

7.  Initial Manifestations  Impaired recent memory (repeats self, forgets what was heard or read, misplaces things)  Poor decision making, judgment, or problem solving; decreased organizational skills  Difficulty learning new tasks or performing routine tasks Evaluate a patient with suspecting dementia

8.  Problems managing money (balancing checkbook, forgetting to pay bills)  Difficulties expressing self (word finding) or participating in conversation  Getting lost in familiar areas, forgetting known routes while driving  Change in personality (apathetic, disinhibited), mood (sad, irritable), or behavior (odd or bizarre)

9.  Temporal Factors  Mode of onset (acute, subacute, insidious)  Course (static progressive, improvement over time, fluctuating)

10.  Individual Factors  Cultural background  Educational level  Social/occupational demands (and changes incurred by symptoms)  Life circumstances (social, financial, occupational, living arrangements)

11.  Hereditary Factors  Familial risk factors (stroke, hypertension, diabetes mellitus)  Genetic: family history suggesting autosomal dominant inheritance or multiple cases in family suggesting non–mutation-associated familial disease (e.g., apolipoprotein E4–associated Alzheimer disease)

12.  Medical/Neurological Conditions  General medical conditions (hypothyroidism, hypertension, diabetes mellitus, heart disease)  Neurological conditions (transient ischemic attacks, strokes, seizures, syncope, head trauma)  Associated motor features (tremor, gait difficulties, speech/swallowing disturbance, ataxia)  Sleep disturbances (sleep apnea, insomnia, sleep- associated movement disorder)

13.  Examination:  Ex: mini-mental examination to test the cognitive functions.  Neurological examination  General medical examination

14.  DSM-IV Criteria for Dementia:  ▪ The development of multiple cognitive deficits that include memory impairment and at least one of the following:  ▪ Aphasia  ▪ Apraxia  ▪ Agnosia  ▪ Disturbance in executive functioning  ▪ The cognitive deficits must meet the following criteria:  ▪ Be sufficiently severe to cause impairment in occupational or social functioning  ▪ Represent a decline from a previous higher level of functioning Diagnostic criteria of dementia

15. Common types of dementia

16. Management goals in early dementia center on improving or stabilizing cognitive ability and mood, maintaining or reestablishing independence, promoting autonomy, and effective planning for the future. Management of dementia

17. Potential interventions in management of dementia. Presentation and Clinical Management of Dementia Bayer, Antony, BROCKLEHURST'S TEXTBOOK OF GERIATRIC MEDICINE AND GERONTOLOGY, CHAPTER 52, 392-401 Copyright © 2010 Copyright © 2010, 2003, 1998, 1992, 1985, 1978, 1973 by Saunders, an imprint of Elsevier Inc.

18.  Stimulation-oriented approaches (e.g., recreational activities or therapies, music therapy, dance therapy, art therapy, exercise, multisensory stimulation, simulated presence, aromatherapy)  Emotion-oriented approaches (e.g., supportive psychotherapy)  Cognition-oriented approaches (skills training) non-pharmacological management

19. Treatments for cognitive and functional losses  Cholinesterase inhibitors: donepezil (sever), rivastigmine, galantamine(mild-modrate)  Memantine (modrate – severe )  Vit. E ( no more)  NSAIDs, statin and estrogen ( not recommended)