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Burcu Ormeci, MD Department of Neurology
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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
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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
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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
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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
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Alzheimer’s Disease (AD) Lewy Body Dementia (LBD) Frontotemporal Dementia (FTD)
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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
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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
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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
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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
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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
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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
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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
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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
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Multi-infarct Dementia Binswanger Disease Single-infarct Dementia
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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
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Nutritional deficiencies Thiamine (vitamin B1), B6, or B12 Severe dehydration It can also cause mental impairment Infections Meningitis, encephalitis, untreated syphilis and lyme disease
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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
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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
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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
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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
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Patient history (from patient and care-givers) Physical examination Neurological evaluations Cognitive and neuropsychological tests Brain scans Laboratory tests Psychiatric evaluation
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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
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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
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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
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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
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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
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