75 %
25 %
Information about Dementia
Health & Medicine

Published on November 20, 2013

Author: ngk2k



Dementia in Geriatrics



WHAT IS IT : Dementia Latin word De "without" + ment, means “mind” Definition: It is a loss of brain function that effects memory, thinking, language, judgement, and behaviour.  It is a degenerative (non-reversible) condition. This means that the damage done to the brain cannot be treated or stopped.


GOALS IN DEMENTIA  Evaluation and Diagnosis  Current Therapy for Dementia  Complications  Resources for the Caregivers

Early Symptoms and Warning Signs As we get older, many of us become more forgetful – for example we might misplace our keys occasionally or find it difficult to find the right word to describe something. This is normal and isn’t a cause for concern. It is important to be able to differentiate between these changes and the early warning signs of a more serious condition. These early signs can start to develop as much as twenty years before a diagnosis is made. Research carried out at Stanford University in the USA suggests that a newly developed blood test can identify people most at risk from developing DEMENTIA disease up to six years before the symptoms become apparent. The test measures the levels of a number of proteins in the blood associated with Alzheimer’s.


Diagnosis  Based on memory loss (both short and long-term), plus one or more of the following:  Aphasia – language problems  Apraxia – organisational problems  Agnosia – unable to recognise objects or tell their purpose  Disturbed executive function – personality and inhibition

Is it JUST “Old Age?” Signs of Dementia Typical Age Related Changes  Poor judgment and decision making  Inability to manage a budget  Making a bad decision once in a while  Losing track of the date or the season  Missing a monthly payment  Forgetting which day it is and remembering later  Sometimes forgetting which word to use  Losing things from time to time.  Difficulty having a conversation  Misplacing things and being unable to retrace steps to find them

Types of Dementia  Alzheimer’s – Most common , Memory, Language, Visuospatial, Indifferent to Loss  Lewy Body – second most common (vivid hallucinations), Visual hallucinations, delusions, flucutating mental status  Fronto-temporal – shrinking frontal and temporal lobes, Memory, Marked Personality changes, Preserved visuospatial

TYPES OF DEMENTIA cont…  Vascular Dementia– aka multi-infarct dementia,1530% develop dementia  Progressive Supranuclear Palsy  The Rare Birds : Late onset Metabolic Disease  Other causes: Alcoholism, AIDS, Pick’s disease, etc… Disease

EVALUATION  HISTORY HPI, Medical, Medications, Psychiatric, Functional, Caregiver  EXAM Physical, Neurologic, Psychiatric, Cognitive Testing

EVALUATION  LABORATORY  Blood Work    CBC, TSH, Chem 7, Ca 2+, B12, Folate RPR Imaging   CT or MRI Other Studies  LP, neuropsychiatric testing, EEG,  SPECT, PET

DIFFERENTIAL DIAGNOSIS  DEPRESSION Pseudodementia  CNS: Neoplasm, NPH, stroke  Vascular: subdural, vasculitis,  Endocrine: Thyroid, Calcium,  Nutritional: B12, Thiamine,ETOH  Infections: HIV, Cryptococcus

CURRENT THERAPY CHOLINESTERASE INHIBITORS   For mild to moderate disease, slow progression, stabilize ADL and MMSE 1st Generation   Tacrine hepatotoxic, last choice 2nd Generation   Donepezil 5-10 mg qd $113/mp  Rivastigmine 3-6 mg bid $153/mo  Galantamine 16-32 $298/mo

CURRENT THERAPY cont…  VITAMIN E   GINKGO BILOBA   Antioxident, anti-inflammatory ESTROGENS   Antioxident, inexpensive neuroprotective? NSAIDS  Epidemiologic suggestions

COMPLICATIONS     Depression Suspicion Disinhibition Agitation  Verbal, Vocal, Anxiety  Aggression  Withdrawal  Vegetative    Psychosis  Hallucinations  Delusions sleep  Motor appetite Wandering  Apathy 

APPROACHES TO BEHAVIOUR PROBLEMS 1.  2.  3.  4.   5. 6.  7.  8.  9.  Define target symptoms Revisit medical diagnoses Establish neuropsychiatric diagnoses Assess and remove provoking factors: environmental, psychosocial, other Adapt environment and treatments to specific cognitive deficits Educate caregivers Employ behavior management principles Treat specific psychiatric disease specifically For remaining behavior problems consider symptomatic pharmacotherapy

PHARMACOTHERAPY  DEPRESSION   TCADS Nortriptyline   SSRI’S Paroxetine, Sertraline, Others ECT if life threatening ANXIETY   Buspirone,Lorazepam, Propanolol PSYCHOSIS  Rispiridone, Olanzepine, Haloperidol

PHARMACOTHERAPY  Aggression  Trazedone,  Buspirone, Olanzepine, Others Agitation  Haloperidol,  Insomnia  Melatonin,  Lorazepam, Trazedone, Carbamazepine Benzodiazepines, Trazedone Sundowning  Trazedone, Haloperidol, Risperidone, Olanzepine

   PROGRESSION Forgetfulness  complains of memory deficits, misplace objects, trouble word finding, functional Confusional  getting lost, job trouble, language problems, lost objects denial, anxiety, lost current events, can’t handle finance other executive functions, withdrawal Early Dementia  Need assistance, can’t use phone reliably, disorientation to time, place, know family, can feed and toilet with reminders

PROGRESSION  Middle Dementia   Late Dementia   Unaware of surroundings, forget spouse’s name, loss of recent events of life, personality and behavior changes, needs help with most ADL Loss of all verbal abilities, complete incontinence, no thirst or hunger responses TIME COURSE

DAY TO DAY CARE  Be Firm, Don’t Rush or Argue  Now  it time to….., don’t rush or argue Minimize Distractions  Decrease  Keep It Simple, Keep It Safe  Cannot  follow multi-step commands Lower Your Standards  Expect  noise, remove visual clutter less from the patient Establish Routines  Reassuring, reduce agitation

CARE FOR CAREGIVERS  Information about progression  Facilitate Day-to-Day Care  Stress Reduction Skills    Support Risk for depression, illness, fatigue, elder abuse How to know when you can no longer provide care at home

Economics of Dementia  2-5 million affected With  current demographics 10 million by 2030 Expenses TOTAL $100 Billion Ranks  Per third (Heart disease and Cancer) Capita Direct $10-25K home, $40-50k NH Indirect Unpaid Paid $60k Care $10-50k Out of Pocket 65%

Consider Hospice/Palliative Care  Dementia is a terminal disease. Consider palliative care referrals and/or referrals to support agencies early on.  Once patient has progressed and is in the late stages of the disease, consider a hospice referral to help keep the patient comfortable and provide ongoing support for the family.

Research In 2013, multiple AD biomarkers are receiving research attention, including structural and metabolic brain alterations as well as amyloid and tau protein levels in both the brain and cerebrospinal fluid (CSF). Lilly’s experimental Alzheimer’s drug (Solanezumab): Created to attach to protein fragments in the brain before those fragments clump together to become plaques. DIAN studies – Alzheimer’s Association has funded 4.2 million for this study. DIAN is a network of investigators recruiting families with dominantly inherited AD. These families have rare, inherited gene mutations that cause young onset, familiar AD.

Thank you

Add a comment

Related presentations

Related pages

Dementia - Wikipedia, the free encyclopedia

Dementia, also known as senility, is a broad category of brain diseases that cause a long term and often gradual decrease in the ability to think and ...
Read more

Dementia – Signs, Symptoms, Causes, Tests, Treatment ...

Dementia symptoms, signs, causes, tests, diagnosis, stages, treatment and care - learn about dementia and how it relates to Alzheimer's and memory loss.
Read more

Dementia Types, Stages, Causes, Symptoms, Treatments

WebMD explains the different types of dementia, a brain condition that causes problems with thinking and memory.
Read more

Dementia: MedlinePlus - National Library of Medicine ...

Dementia is the name for a group of symptoms caused by disorders that affect the brain. It is not a specific disease. People with dementia may not be able ...
Read more

Dementia: Symptoms, Causes, Types & Treatments -

Dementia A Mental Health Condition. Dementia is an umbrella term for conditions involving cognitive impairment, with symptoms that include memory loss ...
Read more

Dementia: Learn About Stages and Symptoms

Learn about the stages and symptoms of dementia. Get the facts on the different types of dementia including Alzheimer's disease, vascular dementia, Lewy ...
Read more

Dementia: MedlinePlus Medical Encyclopedia

Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.
Read more

Dementia: Causes, Symptoms and Treatments - Medical News Today

Dementia is a term used to describe various symptoms of cognitive decline such as forgetfulness, but is not a clinical diagnosis itself until an underlying ...
Read more

Dementia - Cognitive Impairment Disorder Symptoms & Signs ...

Learn all about dementia, a term to describe a decline in cognitive function. Read about the causes, symptoms, treatments and risk factors of dementia.
Read more

Dementia - Mayo Clinic

Dementia — Comprehensive overview covers symptoms, causes and treatments of this mental deterioration.
Read more