1. Dementia F.Etessam. MD

2. Dementia A progressive impairment of cognitive functions occurring in clear consciousness.

3. Dementia Global impairment of intellect Mood Thinking Perception Problem solving Personality Social behavior Memory Attention Comprehension Language orientation learning

4. Epidemiology 5 % in general population older than 65 years of age 20 – 40 % in general population older than 85 years of age 15 – 20 % in outpatients general medical practices 50 % in chronic care facilities

5. Etiology Degenerative dementias NPH Deficiency Metabolic Tumor Traumatic Infection vascular Anoxia Demyelinating dis. Drugs and toxins Endocrine

6. Head trauma Delirium Amnesia Personality change Emotional symptoms Headache Insomnia Decreased concentration

7. NPH Impaired memory Ataxia Retardation Incontinency

8. Ischemic Brain Disease Cognitive Impairment Personality change Depressed mood Mood instability

9. Dementia Common Etiologies Alzheimer s Disease Vascular Dementia Head Trauma Alcohol – related Dementias Huntington's Disease Parkinson's Disease Pick's Disease Lewy Body disease

10. Clinical features Cognitive impairment Language Praxis Gnosis Executive functioning

11. Psychiatric Changes Personality changes Behavioral disturbance Psychotic symptoms Sleep disturbances Affective and anxiety disturbances

12. Neurological signs Seizures Primitive reflexes Myoclonic jerks Focal neurological signs Pseudobulbar palsy Dysarthria dysphagia

13. AD Prognosis Alzheimer’s has a slowly progressive decline. These meds can slow the progression, NOT halt it. Time Function

14. Diagnosis History/MSE Neurological Examination Labs :CBC,Serum Electrolytes,Renal Function,LFT,TFT,Glucose,Albumin,Vit B12 Imaging Neuropsychological Testing Psychiatric Evaluation

15. diagnosis History/MSE Pathology Laboratory evaluation

16. Compare central sulcus of Alzheimer’s patient with normal 81 year old woman From Whole Brain Atlas at http://www.med.harvard.edu/AANLIB/home.html

17. Normal vs AD Brain Normal brain Alzheimer’s brain

18. Interventions Pharmacologic Nonpharmacologic

19. Thank you