Burcu Ormeci, MD Department of Neurology

 In the United States;  As many as 7 million people have dementia  Almost half of all people age 85 and older have some form of dementia  Although it is common in very elderly individuals, dementia is not a normal part of the aging process  Many people live into their 90s and even 100s without any symptoms of dementia

 Dementia is not a specific disease  It is a descriptive term for a collection of symptoms  There are many disorders that can cause lead to a progressive loss of cognitive functions  While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia

 Memory loss that affects job skills  Difficulty performing familiar tasks  Problems with language  Disorientation to time and place  Poor or decreased judgment  Problems with abstract thinking  Misplacing things  Changes in mood or behavior  Changes in personality  Loss of initiative

 Dementia has to diagnosed without loss of consciousness  There have to be at least 2 cognitive functions deficit and one of them has to be memory ▪ memory ▪ language ▪ perception ▪ Judgment ▪ Reasoning  These deficits have to do significant decline from a previous level of functioning  It has to be permanent or progressive

 Alzheimer’s Disease (AD)  Lewy Body Dementia (LBD)  Frontotemporal Dementia (FTD)

 Most common cause of dementia in people over age of 65  There are some early-onset forms of the disease, which may appear as early as age of 30  usually linked to a specific gene defect  Almost all brain functions are eventually affected  AD is characterized by two abnormalities in the brain  Amyloid plaques  Neurofibrillary tangles

 In the early stages  Patients may experience memory impairment, lapses of judgment and mild changes in personality  As the disorder progresses  Memory and language problems worsen  Patients begin to have difficulty performing activities of daily living  They may become disoriented about places and times  May suffer delusions ▪ The idea that someone is stealing from them ▪ Their spouse is being unfaithful ▪ May become nervous and hostile

 Late stages of the disease  Patients begin to lose the ability to control some motor functions ▪ Swallowing ▪ Bowel and bladder control  They eventually lose the ability to recognize family members and to speak  They develop symptoms such as aggression, agitation, depression, sleeplessness or delusions  Average life expectancy is 8 to 10 years after diagnosis ▪ some people live as long as 20 years

 Cells in the brain's cortex and in the substantia nigra die due to Lewy bodies  Symptoms overlap with Alzheimer's disease but also include hallucinations  Symptoms that may vary daily  LBD typically includes parkinsonian symptoms such as a shuffling gait (walk) and flexed posture  Patients with LBD live an average of 7 years after symptoms begin

 Sometimes called frontal lobe dementia  Dementia predominantly linked to degeneration of nerve cells in the frontal and temporal lobes  Some evidence for a genetic factor  Many have a family history of the disease  Usually ages 40 – 65  Symptoms ▪ Judgment and social behavior problems ▪ Stealing, neglecting responsibilities, increased appetite, compulsive behavior ▪ Motor skill problems ▪ Memory loss

 Vascular dementia  Reactions or side effects to medications  Metabolic problems and endocrine abnormalities  Nutritional deficiencies  Severe dehydration  Infections  Subdural hematomas  Poisoning  Brain tumors  Anoxia/hypoxia  Heart and chronic lung problems  Dementia Pugilistica

 Second most common cause of dementia (%20)  Caused by brain damage from cerebrovascular or cardiovascular problems  Symptoms similar to AD but personality and emotions effected only late in the disease  Course of disease has digits

 There are several types of vascular dementia;  Multi-infarct dementia (MID) ▪ caused by numerous small strokes in the brain  Single-infarct dementia ▪ There is a single stroke can damage the brain enough to cause dementia ▪ Talamus or hippocampus  Binswanger's disease ▪ There is a uncontrolled HT

Multi-infarct Dementia Binswanger Disease Single-infarct Dementia

 Reactions or side effects to medications  Medication’s side effects can mimic dementia. They may have a rapid onset or develop slowly over time  Metabolic problems and endocrine abnormalities  These problems can lead to apathy, depression, dementia, confusion or personality changes ▪ Thyroid disease, hypoglycemia, hyponatremia or hypernatremia, hypercalcemia

 Nutritional deficiencies  Thiamine (vitamin B1), B6, or B12  Severe dehydration  It can also cause mental impairment  Infections  Meningitis, encephalitis, untreated syphilis and lyme disease

 Subdural hematomas  Subdural hematoma can cause dementia-like symptoms and changes in mental function  It can occure in 3-6 weeks after head trauma in elderly people  Poisoning  Exposure to lead or other heavy metals, alcohol, recreational drugs or other poisonous substances can lead to symptoms of dementia  These symptoms may or may not resolve after treatment, depending on how badly the brain is damaged

 Brain tumors  In rare cases, people with brain tumor may develop dementia because of damage to their brain areas related the cognitive functions  Anoxia/hypoxia  Anoxia may be caused by many different problems, including heart attack, chronic lung disease or heart problems, severe asthma, heart surgery, smoke or carbon monoxide inhalation, overdose of anesthesia

 Dementia Pugilistica  Also named Boxer's syndrome  Due to traumatic injury (often repeatedly) to the brain  Symptoms commonly are dementia and parkinsonism  Other changes depending where brain injury has happened  It can appear many years after the trauma ends

 Although these conditions may resemble some aspects of dementia, they have different causes, usually are treatable and have better outcomes  Depression  Delirium  Mild cognitive impairment  Age-related cognitive decline  Organic brain syndrome

 Patient history (from patient and care-givers)  Physical examination  Neurological evaluations  Cognitive and neuropsychological tests  Brain scans  Laboratory tests  Psychiatric evaluation

 Patient History  How and when symptoms developed?  Patient's overall medical condition  Patient and his/her familiy do not want to accept the diagnosis ▪ in the beginning AD and other forms of dementia can resemble normal aging

 Physical examination  It can help rule out treatable causes of dementia  Cognitive and Neuropsychological Tests  These tests measure memory, language skills, math skills, and other abilities related to mental functioning  Brain Scans  These are CT, MRI, EEG, PET, SPECT, MRS  They have to use to identify brain changes ▪ strokes, tumors or other structural problems, cortical atrophy

 These drugs can improve symptoms and slow the progression of the disease  May improve the patient's quality of life, ease the burden on caregivers, and/or delay admission to a nursing home TREATMENT of DEMENTIA

 Ach is reduced in the brain of people with AD  Most of the drugs are cholinesterase inhibitors  Donapezil, Rivastigmine, Galantamine  Some drugs work by regulating the activity of a glutamate  Memantine

 Tight control to ischemic risk factors  Increasing intellectual activities  High education, continuous learning, social interactions, chess, crossword puzzles, playing a musical instrument  Daily phisycal activity