1. Dementia Care overview
Sture Eriksson
V¨sterbotten L¨ns Landsting
a a
29 maj 2012

2. Cognitive disorders
Group of symptoms
I Cognitive symptoms
I Functionell decline (ADL)
I BPSD (Behavoiural and Psychic Symptoms in Dementia)

3. Cognitive disorders
Classification
I Mild cognitiv impairment (MCI)
I Dementia disorders
I Confusional syndrome
I Mnestiska syndrome

4. Mild cognitiv impairment
Definition
1. Subjectiv memory decline
2. Pathology in delay recall (16 word test)
80% develops manifest dementia disorder within 5 year
No established pharmacological treatment.

5. Dementia disorders
Classification
I Alzheimer’s disease
I Dementia of Lewy body typ
I Vaskular dementia
I Dementia in Parkinson’s disease
I Other forms of dementia disorders

6. What is dementia?
Definition
1. Development of memory decline
2. Afasi, agnosi, apraxi or exekutiva disturbances
3. Severe enough to interfere with occupational and/or
social abilities
4. Not only confusional state

7. Alzheimer’s disease
Definition
1. Dementia syndrome
2. Incidious onset and progressive course
3. Other disorders excluded
Patogenes: Pathological metabolism av -amyloid giving for
example disturbances of signal substances
Low levels of acetylcholine, serotonin, dopamin and other
Increase of glutamat.

9. Diagnostic methods in cognitive decline
I Auto- and heteroanamnesis
I Clincal assessement
I Testing including neuropsylogical assessment
I Laboratory investigment
I Occupational and social assessments
I Imageing such as
I CT-scan, MRI, SPECT, PET-scan

10. Treatment in deficits of acetylcholine
Cholinergic deficients in for example
I Alzheimer’s disease
I Dementia av Lewy body type
I Dementia vid Parkinsons disease

11. Cholinerga drugs
Acetylkolinesteras inhibitors
I donezepil 5-10 mg/dygn
I rivastigmin 3 - 12 mg/dygn
I galantamin 8 - 16 mg/dygn

12. E↵ect of cholinergic drugs
Symptomatic e↵ect
I Attention
I Stability
I Cognitiv improvement
E↵ects during long term treatment!

13. E↵ects of cholinergic drugs
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