The Dementias Dr Giles Richards Consultant Psychiatrist CFT.

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Presentation transcript:

The Dementias Dr Giles Richards Consultant Psychiatrist CFT

Some predictions: in 10 years time Number of people over 65 yrs will increase by 15% Number of people over 85 yrs will increase by 27% 60% older people have long standing illnesses ( mental illness more common and worse outcomes)

Some figures 700,000 people with Dementia Will rise to 1.4 million £17bn per annum on care (£12bn cancer) Set to rise to £50bn £27,000 per person Cancer research £590 m (£50m)

DEFINITION OF DEMENTIA (WHO 1993) Syndrome due to disease of the brain, Usually chronic / progressive in nature. Impairment of multiple higher control functions e.g. memory, orientation, comprehension, calculation, learning, language and judgement. Consciousness is not clouded. Often accompanied by poor emotional control, social behaviour or motivation.

New Definitions Amyloid weighting ApoE4 CSF studies (phosphorolated Tau) Hippocampus volume assessment PET scanning

Diagnostic Process History Mental State Exam Examination Investigations

Bloods ECG EEG Scans:  CT,  MRI,  SPECT,  PIB

RISK FACTORS Family History x 3 Family History of Parkinson’s Disease Down’s Syndrome Head Injury - Beta Amyloid Neurotoxins - Aluminium / Zinc (inconclusive), Organophosphates Educational Background

CAUSES OF DEMENTIA Alzheimer’s Vascular Disease Frontal Lobe Dementia Huntingdon’s Parkinson’s Lewy Body Dementia Brain Diseases Normal Pressure Hydrocephalus

Pathology Atrophy (brain weight) Widened sulci, narrowed gyri, enlarged ventricles Amyloid Plaques (Beta secretase) Neurofibrillary Tangles (phosphorolated Tau) Hirano bodies

Diagnosis Probable LBD Possible LBD Differential diagnosis

DIAGNOSIS (1) Central Features: Progressive cog decline, Memory (late), attention,exec function, visuospatial. Core Features: Fluctuating cog, Visual hallucinations, Spontaneous features of Parkinson's

DIAGNOSIS (3) Suggestive Features: REM sleep behaviour, Neuroleptic sensitivity, changes on imaging Supportive features: Falls, transient LOC, autonomic dysfunction, delusions, other modes hallucinations, dep, EEG changes, occiput SPECT changes

Diagnosis (4) Less likely if: Cerebrovascular disease present, other process to account in part for symptoms, Parkinson's appears late on. Parkinson's Dementia “ the 1 year rule”