You are on page 1of 27

By Usha Tejaswini.S.

Intern

Definition Features Etiology Diagnosis Differential

Diagnosis

Management

Its

a chronic organic disorder characterized

by: -impairment of intellectual functions -impairment of memory -deterioration of personality with lack of personal care.

Impairment

of judgment, impulse control & abstract thinking. Emotional labiality Catastrophic reaction Thought abnormalities- delusions & perseveration. Disorientation in time (place & person in late stage) Neurological signs depending on underlying cause.

Parechymatous

brain disease: Alzheimers, Picks, Parkinsons disease, Huntingtons chorea.


Vascular

dementia: Multi infarct dementia, sub-cortical vascular dementia.


Metabolic

dementia: Chronic hepatic/uremic encephalopathy, wilsons disease.

Toxic

dementia: Bromide intoxication, drugs, heavy metals, alcohol, carbon monoxide, benzodiazepines.
Deficiency

dementia: Pernicious anemia, pellagra, folic acid & thiamine deficiencies.


Endocrine

causes: Thyroid, parathyroid, pituitary & adrenal dysfunction.

Dementia

due to infections: Neurosyphilis, chronic meningitis, viral encephalitis, AIDS Dementia, SSPE.
Neoplastic

Dementia: Neoplasms, ICSOL.


Traumatic

Dementia: Head injury, chronic subdural hematoma.


Hydrocephalic

dementia: Normal pressure hydrocephalus.

FEATURES
SITE

CORTICAL TYPE
Cortex (frontal & temporo-parietooccipital areas, hippocampus) severe normal

SUBCORTICAL TYPE
Sub cortical grey matter (thalamus, basal ganglia, brain stem) Mild to moderate Dysarthria, tremor, chorea, ataxia, rigidity Complex delusions, rarely mania

SEVERITY MOTOR SYSTEM

OTHER FEATURES

Severe aphasia, apraxia, amnesia, slow cognitive speed, simple delusions

Commonest

cause 70% Common in women


Macroscopically-

enlarged ventricles, widened sulci, cortex shrinkage seen. senile plaques, cortical nerve cell loss seen. decreased AchE & CAT.

Microscopically-

Neurochemically-

Treatment:
Recently

developed drug TACRINE HYDROCHLORIDE (COGNEX) Ach concentration by slowing its degeneration.

Increases

2nd

commonest cause
Multiple cerebral infarction Progressive disruption of brain function Dementia

Abrupt Acute Step

onset

exacerbation due to repeat infarction

ladder pattern of deterioration course

Fluctuating Presence

of hypertension or other CVS

diseases.

Previous

H/O stroke or TIAs.

On

evaluation: -presence of focal neurological signs -insight in to the illness present -emotional lability present.

Treatment of underlying cause prevents further deterioration.

Most

important treatable & reversible cause of dementia. confirmed by lab tests.

Diagnosis Prompt

treatment can reverse dementia & can lead to complete recovery within 2 years of onset of dementia.

50-70%

of AIDS patients exhibit triad of COGNITIVE, BEHAVIOURAL & MOTORIC deficits of SUB CORTICAL DEMENTIA type known as ADC.
AIDS virus neurotropic features Crosses blood brain barrier early in disease Cognitive impairment

Confirmation of disease by: -ELISA -western blot technique


CT scan will show cortical atrophy MRI helpful in detecting white matter lesions.

According

required: Evidence of decline in both memory & thinking, sufficient to impair personal activities.
Memory

to ICD-10,following features are

impairment typically affects registration, storage & retrieval of new information(recent memory). Remote memory may be intact till late stages.

Thinking Flow

& reasoning capacity impaired

of ideas reduced of clear consciousness of atleast 6 months.

Presence Duration

NORMAL AGING

PROCESS:

-intellectual impairment is severe enough to interfere with social/occupational functioning SENESENT FORGETFULNESS.

FEATURES ONSET COURSE CONSIOUSNESS ORIENTATION

DELIRIUM Acute 1 week 1 month clouded Grossly disturbed

DEMENTIA Insidious protracted Usually normal Usually normal

COMPREHENSION SLEEP WAKE CYCLE


ATTENTION DIURINAL VARIATION

impaired Grossly disturbed


Grossly disturbed

Usually normal Usually normal


Usually normal

Marked sundowning Usually absent, present, visual hallucinations may illusions & occur hallucinations common

DEMENTIA Rarely C/O cognitive impairment Emphasizes achievement Patient unconcerned Makes mistakes on examination Recent memory impairment Confabulation present No H/O depression

PSEUDODEMENTIA Always C/O impairment Emphasizes disability Communicates distress Dont know answers frequent Preserved Rare Past H/O depression/Mania

INVESTIGATIONS:

CBC,

urine R/E, blood glucose, electrolytes, RFT, TFT, serum B12 & folate levels, serology for syphilis & HIV, CT & MRI scan of brain, psychological tests & drug screen.

Hypertension
Thyroid

in MID

hormone replacement in hydrocepalus dementia

Shunting L-DOPA

in parkinsonism of toxic agents in toxic causes.

Removal

Environmental Treatment Care

manipulation

of medical complications

of food & personal hygiene care of patient & the family for anxiety(lorazepam &

Supportive

Bezodiazepines

oxazepam)

Depression

can be treated with drugs having low cardiac & anticholinergic toxicity like trazodone. & disruptive behavior with low dose of antipsychotics like haloperidol & trifluperazine. term hospitalization

Psychotic

Short

Institutionalization Specific

in late stages.

drug treatment as TACRINE in alzheimers.