Dementia clues

S.R.Chandra

FOR MODULE 2 CLUES BY src

SARVAM KRISHNARPANAM

FOR MODULE 2 CLUES BY src

Approach to memory complaint
• Is it dementia,depression,language ,Delirium ?
• If dementia is it SCD (subjective cognitive decline or objective )
• If objective is it benign forgetfulness of old age, MCI.
• What are problems in ABC (activities of daily
living,Behaviour,Cognition).
• What are the domains affected ?
• What other parts of nervous system affected?
• What are the systemic problems?
• What drugs he is on ?
FOR MODULE 2 CLUES BY src
FLOWCHART 1

PERSON WITH MEMORY COMPLAINT

SHORT DURATION

RAISED INTRACRANIAL PRESSURE NO INTRACRANIAL PRESSURE

INFECTIONS, DRUGS, TRAUMA,

WITH OR WITHOUT FOCAL FEATURES VASCULAR, ENDOCRINE, METABOLIC,
AUTO-IMMUNE

FOR MODULE 2 CLUES BY src

FLOWCHART 2

PATIENT WITH MEMORY COMPLAINT

LONG DURATION

MEMORY OR MIMIC
MCI AMNESIC

BENIGN FORGETFULNESS
MCI NON-AMNESIC

MILD COGNITIVE
IMPAIRMENT MCI SINGLE DOMAIN

MCI MULTI DOMAIN

FOR MODULE 2 CLUES BY src

 Types of MCI

Single domain Multi domain

Non amnesic Amnesic Non amnesic combined

FOR MODULE 2 CLUES BY src

FLOWCHART 3

PATIENT WITH DEMENTIA

WITH OTHER PARTS OF CNS NOT WITH OTHER PARTS OF CNS

INVOLVED INVOLVED

SUBCORTICAL DEMENTIA
CORTICAL DEMENTIAS
AND SVD

WHEN DID THE 24 HOURS ROUTINE

CHANGED?

WHAT WAS THE CHANGE

FOR MODULE 2 CLUES BY src

 Degenerative dementia

Cortical Sub-cortical

(i) Quick & wrong (i) Slow & right

(ii) Euphoric (ii) Apathy, depression
(iii) Agnosia, Aphasia (iii) nil
Apraxia, Seizures,
Myoclonus
(iv) Late (iv) Motor + EPS
(v) Ach (v) GABA, Dopamine

FOR MODULE 2 CLUES BY src

FLOWCHART 4

WHAT STARTED THE CHANGE?

DELIRIUM

BECLOUDING
CJD

AUTO-IMMUNE

DRUGS, TOXINS, METABOLIC,

ENDOCRINE, INFFECTIONS,
ELECTROLYTES, NUTRITION

FOR MODULE 2 CLUES BY src

FLOWCHART 5

WHAT STARTED THE CHANGE?

LANGUAGE

PROGRESSIVE STATIC

FTD STRATEGIC INFART

PPA SEMANTIC

FOR MODULE 2 CLUES BY src

 FLOWCHART 6

WHAT STARTED THE CHANGE?

FRONTAL LOBE PARIETAL LOBE TEMPORAL LOBE OCCIPITAL LOBE

DYSFUNCTION DYSFUNCTION DYSFUNCTION DYSFUNCTION

AD AND
FTD, SVD, PD, MND,
AD, DLBD, CBD TEMPORAL ONSET DLBD
FRONTAL CBD
FTD

FOR MODULE 2 CLUES BY src

FLOWCHART 7

WHAT STARTED THE CHANGE?

PROCEDURAL MEMORY AND OTHER

UNCHARACTERIZED OVERLAPS
PARTS OF NEURO AXIS

MIXED, UNCLASSIFIED
PSP, PDD, CBD, VASCULAR

HD,NPH,SCA,NBIA,DRPLA

FOR MODULE 2 CLUES BY src

Classification of Reversible dementia
• 1.Specific conditions presenting with cognitive decline
eg .NPH,Tumours,infections etc.

• 2.Medical conditions causing chronic delirium presenting with

disturbances of attention and thinking and memory.

• 3. Pseudodementias.

FOR MODULE 2 CLUES BY src

Questions to be asked
• Is it dementia or not ?

• Does it have an irreversible cause ?

• Is it in isolation or overlaps degeneration ?

• Is the reversible condition medical, surgical or psychiatric ?

FOR MODULE 2 CLUES BY src

 Pseudo Dementia True Dementia

(i) Patient complaints (i) Relatives

(ii) Definite onset (ii) Vague onset
(iii) I don’t know answers (iii) Wrong answers
(iv) Recent & remote lost (iv) Recent
(v) Ganser phenomena (v) -
(vi) Depressed (vi) May or may not be
(vii) Dopamine (vii) ACH
(viii) EEG - Expectancy wave (viii) Changes as per cause
(ix) P300 - Normal (ix) Abnormal
(x) PET - Normal (x) Abnormal

FOR MODULE 2 CLUES BY src

 Vascular

Classification of RPD Systemic

Infections
causes/Seizures

• Etiological
classification
–
Iatrogenic/Inborn
errors of
metabolism VITAMINS Tumors

• Prion v/s
non-prion
disease

• Treatable v/s Neurodegerative Autoimmune

non-
treatable Metabolic and
toxic

illnesses Mnemonic:
VITAMINS
FOR MODULE 2 CLUES BY src
 LIMBIC SYMPTOMS

infective Non infective

Non paraneoplastic
PARANEOPLASTIC (known antibody /
unknown antibody)

FOR MODULE 2 CLUES BY src

Some clinical clues
HYPOPHYSIS TRIAD OF PANIC DIARRHOEA
WITH AND SLEEPINESS
WITH CATATONIA -CEREBROTENDINOUS
DEMENTIA XANTHOMATOSIS
AND/OR
SEIZURES - MNGIE
SUSPECT - COELIAC DISEASE
-SARCOID - -WHIPPLES DISEASE
AUTOIMMUNE - -CHRONIC
-iGg4 RELATED CAUSE. NUTRITIONAL
DEMENTIAS
-HISTIOCYTOSIS - -PELLAGRA

FOR MODULE 2 CLUES BY src

 DIPS: a structured approach to
management of Dementia

• Dementia: treat the cause where possible

• Illness: treat concurrent illness
• Problem list: tackle each major problem
• Support the supporters: care for the carers

COGNITION DEMENTIA FEB 2016 SRC