UOB/Al kindy college medicine 5th grade

1. Dementia
Hussein Ali
Ameer Hayder
Tamara Sadik
Haneen Salam
Tabarak Ali
Aya Mofeed
Anwer Abdulkareem
Azhar Sarmad

2. • Dementia isn't a specific disease.
• It is a syndrome caused by a disease in the brain, usually of a chronic or progressive nature,
in which there is disturbance of multiple higher cortical functions, including memory,
thinking, orientation, calculation, learning capacity, language, and judgment.
• Though dementia generally involves memory loss, but it has different causes. So memory loss
alone doesn't mean you have dementia.
What is Dementia ?

3. Symptoms of dementia
1. The most common signs of dementia seen in patients at the early stages of the disease. They start
experiencing memory loss, particularly remembering recent events.
2. Confusion may arise as they can no longer remember faces, find the right words, or interact with
people normally.
For example, they may misplace their car keys, forget what comes next in the day, or have
difficulty remembering someone they’ve met before.
3. Lose the ability to do everyday tasks.

4. Symptoms of dementia
4. Repetition is common in dementia because of memory loss. The person may repeat daily
tasks, such as shaving, or they may collect items obsessively and also may repeat the same
questions in a conversation after they’ve been answered.
5. Personality or behavior changes such as immediate occurrences of maniac (laugh) and
depression (sadness) episodes.
6. Apathy and withdrawal or depression.

5. DSM – IV Criteria for Dementia
1. Memory Impairment plus at least one of the following:
• APHASIA (Deterioration of Language function)
• APRAXIA (inability to Execute Motor function)
• AGNOSIA (inability to Recognize or Naming of Object)
• Disturbance in executive functioning
2. Causing significant impairment in social or occupational functioning and represent a
significant decline from a previous level of functioning.
3. The cognitive deficits do not occur exclusively during the course of delirium

6. DSM-5 criteria for major neurocognitive disorder
(previously dementia)
A. Evidence of significant cognitive decline from a previous level of performance in one or
more cognitive functions.
B. The cognitive deficits interfere with independence in everyday activities. At a minimum,
assistance should be required with complex instrumental activities of daily living, such as
paying bills or managing medications.
C. The cognitive deficits do not occur exclusively in the context of a delirium
D. The cognitive deficits are not better explained by another mental disorder (eg, major
depressive disorder, schizophrenia)

7. Pseudodementia
A group of disease which have symptoms of cognitive impairment due to functional disease
rather than organic dementia such as:
• Depression
• Hysterical Dementia
• Psychogenic amnesia
Depression Dementia
Little effort on tasks Struggles to complete tasks
Don’t know answers Attempts answers, but incorrect
Absence of Dyspraxia Have Dyspraxias, Agnosias
No language problem Have Language problem

8. Possible etiologies
• Degenerative dementias
• Alzheimer's disease
 Frontotemporal dementias (e.g., Pick's disease)
 Parkinson's disease
 Lewy body dementia
 Idiopathic cerebral ferrocalcinosis (Fahr's disease)
 Progressive supranuclear palsy
• Psychiatric
 Pseudodementia of depression
 Cognitive decline in late-life schizophrenia

9. • Tumor
 Primary or metastatic (e.g., meningioma or metastatic breast or lung
cancer)
• Traumatic
 Dementia pugilistica, posttraumatic dementia
 Subdural hematoma
• Infection
 Prion diseases (e.g., Creutzfeldt-Jakob disease, bovine spongiform
encephalitis, Gerstmann-Strauussler syndrome)
 Acquired immune deficiency syndrome (AIDS)
 Syphilis

10. • Cardiac, vascular, and anoxia
 Infarction (single or multiple or strategic lacunar)
• Demyelinating diseases
 Multiple sclerosis
• Drugs and toxins
 Alcohol
 Heavy metals Carbon monoxide

11. • Metabolic
 Vitamin deficiencies (e.g., vitamin B12, folate)
 Endocrinopathies (e.g., hypothyroidism)
 Chronic metabolic disturbances (e.g., uremia)
• Miscellaneous
 Huntington's disease
 Wilson's disease

12. Differential Diagnosis
Delirium
Differentiating between delirium and dementia can be more difficult
than the DSM-IV-TR classification indicates. In general, delirium is
distinguished by
• rapid onset,
• brief duration,
• cognitive impairment fluctuation during the course of the day,
• nocturnal exacerbation of symptoms,
• marked disturbance of the sleep - wake cycle,
• prominent disturbances in attention and perception

13. Depression
Some patients with depression have symptoms of cognitive impairment difficult
to distinguish from symptoms of dementia. The clinical picture is sometimes
referred to as pseudodementia, patients with depression-related cognitive
dysfunction generally have
• prominent depressive symptoms,
• more insight into their symptoms than do demented patients,
• often a history of depressive episodes

14. Factitious Disorder
Factitious disorders are conditions in which a person acts as if he
has a physical or mental illness while he is not really sick.
Schizophrenia

15. Normal Aging
• Aging is not necessarily associated with any significant cognitive decline, but
minor memory problems can occur as a normal part of aging.
• These normal occurrences are sometimes referred to as benign senescent
forgetfulness or age-associated memory impairment.
•They are distinguished from dementia by their minor severity and because
they do not interfere significantly with a person's social or occupational
behavior.

16. Other Disorders
• Mental retardation
• Amnestic disorder
• Malingering

17. Alzheimer disease (AD)
 Is a chronic neurodegenerative disease which means loss of neurons in the brain particularly at the
cortex
 It is the most common type of dementia
 The most common early symptom is difficulty in remembering recent events (short-term memory
loss).As the disease advances, symptoms can include problems with language, disorientation
(including easily getting lost), mood swings, not managing self care, and behavioural issues. As a
person's condition declines, they often withdraw from family and society

18. Although Alzheimer disease (AD) is not completely understood but there are two major
pathognomic findings
1. The amyloid plaques
2. Neurofibrillary tangles
Other pathognomonic microscopic findings are
 Neuronal loss (particularly in the cortex and the hippocampus),
 Synaptic loss (perhaps as much as 50 percent in the cortex),
 Granulovascular degeneration of the neurons

25. Beta-amyloid is chemically "sticky" and gradually builds up into plaques.
1. these plaques can potentiality go between the neurons and preventing neuron to neuron signalling and
if the brain cells can not signal and relay information then the brain function like memory can be
seriously impaired
2. They may also activate immune system cells that trigger inflammation and cause damage to the
surrounding neurons
3. amyloid plaque can also deposit around the blood vessels called amyloid angiopathy which weakens the
blood vessel walls in the brain and increase the risk of haemorrhage or rupture

26. stabilizing microtubules

32. Etiology of
Dementia of the Alzheimer's Type

33. • as many as 40 percent of patients have a family history of dementia of the Alzheimer's
type.
• the concordance rate for monozygotic twins, which is higher than the rate for dizygotic
twins (43 percent vs. 8 percent, respectively).
• the disorder has been transmitted in families through an autosomal dominant gene,
although such transmission is rare.
* Alzheimer's type dementia has shown linkage to chromosomes 1, 14, and 21
1- Genetic Factors

34. Amyloid precursor protein (APP)
* is an integral membrane protein expressed in
many tissues and concentrated in
the synapses of neurons.
APP is a precursor molecule
whose proteolysis generates
beta amyloid (Aβ) ;
is a 42-amino acid peptide
And it is the major constituent of senile plaques.
2- Amyloid precursor protein

35. * The gene for amyloid precursor protein is on the
long arm of chromosome 21.
So….
In Down syndrome (trisomy 21) a pathological
process results in the excessive deposition of β/A4
protein.

36. * One study implicated gene E4 in the origin of Alzheimer's disease.
* People with one copy of the gene have Alzheimer's disease three times more frequently than
do those with no E4 gene, and people with two E4 genes have the disease eight times more
frequently than do those with no E4 gene
genes 3-multiple E4

37. In Alzheimer disease :
_ Acetylcholine and norepinephrine are hypoactive .
_ There is decrease in concetrations of somatostatin and corticotropin .
* cholinergic antagonists, such as scopolamine and atropine, impair cognitive abilities
* cholinergic agonists, such as physostigmine and arecoline, enhance cognitive abilities
4- Neurotransmiters

38. 5- neuropathy
6- other causes
• abnormality in the regulation of membrane phospholipid
metabolism results in membranes that are less fluid-that is, more
rigid-than normal.
• Aluminum toxicity high levels of aluminum have been found in the
brains of some patients with Alzheimer's disease
• * Excessive stimulation by the transmitter glutamate that may
damage neurons.

39. treatment
• Psychosocial therapies :
1. Behavioral intervention .
2. Emotion-oriented interventions .
3. cognition-oriented treatments .

40. medication
1. Cholinesterase inhibitors : tacrine ,rivastigmine, galatamine, donepezil.
2. Memantine (NMDA receptor antagonist)

41. Prognosis of Alzheimer
• Alzheimer's disease is the sixth leading cause of death in the United States.
It's also a fatal condition, which means that a person will eventually die of
Alzheimer's disease if he or she does not die of something else beforehand.

42. • Alzheimer's disease typically progresses slowly in three general stages — mild
(early-stage), moderate (middle-stage), and severe (late-stage). Since
Alzheimer's affects people in different ways, each person will experience
symptoms - or progress through Alzheimer's stages – differently

43. Mild alzheimer’s disease (early stage)
• In the early stage of Alzheimer's, a person may function independently. He
or she may still drive, work and be part of social activities. Despite this, the
person may feel as if he or she is having memory lapses, such as forgetting
familiar words or the location of everyday objects.

44. • Common difficulties include:
• Problems coming up with the right word or name
• Trouble remembering names when introduced to new people
• Challenges performing tasks in social or work settings.
• Forgetting material that one has just read
• Increasing trouble with planning or organizing

45. Moderate Alzheimer's disease (middle-stage)
• Moderate Alzheimer's is typically the longest stage and can last for
many years. As the disease progresses, the person with
Alzheimer's will require a greater level of care. You may notice the
person with Alzheimer's confusing words, getting frustrated or
angry, or acting in unexpected ways, such as refusing to bathe.
Damage to nerve cells in the brain can make it difficult to express
thoughts and perform routine tasks

46. • Symptoms will be noticeable to others and may include:
• Forgetfulness of events or about one's own personal history
• Feeling moody or withdrawn, especially in socially or mentally challenging situations
• Being unable to recall their own address or telephone number or the high school or college
from which they graduated
• Confusion about where they are or what day it is
• The need for help choosing proper clothing for the season or the occasion
• Trouble controlling bladder and bowels in some individuals
• Changes in sleep patterns, such as sleeping during the day and becoming restless at night
• An increased risk of wandering and becoming
• Lost

47. Severe Alzheimer's disease (late-stage)
• In the final stage of this disease, individuals lose the ability to respond to their environment,
to carry on a conversation and, eventually, to control movement
• At this stage, individuals may:
• Need round-the-clock assistance with daily activities and personal care
• Lose awareness of recent experiences as well as of their surroundings
• Experience changes in physical abilities, including the ability to walk, sit and, eventually,
swallow
• Have increasing difficulty communicating
• Become vulnerable to infections, especially pneumonia

48. Is There a Cure for Alzheimer's Disease?
• There is currently no cure for Alzheimer's disease. However, there are a
handful of FDA-approved medications to manage the symptoms of
Alzheimer' disease. While these medications do not cure Alzheimer's, they
may delay the progression of symptoms in some people for a limited amount
of time. There is also no medication or other therapy that can prevent the
onset of Alzheimer's disease at this time, but researchers continue to work
toward this goal

49. Ways to Improve Quality of Life for People with Dementia
• . Facilitate Relationships
• Having someone to talk to and maintaining relationships is rated
as the most important factor in the research project entitled, "My
Name Is Not Dementia" that was conducted by the Alzheimer's
Society in the United Kingdom. This project interviewed people
with dementia and sought to identify which factors were
important to them in the fascilitating quality of life.

50. • Provide Meaningful Activities
• Physical Exercise
• Ensure a Comfortable Environment
• Keep a Sense of Humor
• Pet Therapy

51. • Positive Responses to Challenging Behaviors
• Adequate Monitoring for Pain
• Assess for Depression
• Touch
• Spiritual Care
• Relaxing Diet Restrictions

53. • Vascular dementia is a general term describing problems with reasoning ,
planning , judgment , memory and other thought processes .
• Caused by brain damage from impaired blood flow to brain .
• Vascular dementia is the second most common type of dementia .

54. Risk Factors :

55. Symptoms :
• Confusion , restlessness and agitation .
• Reduced ability to organize thoughts or actions .
• Trouble paying attention and concentrating.
• Unsteady gait .
• Problems with speech .
• Personality and mood changes , including depression.
• Wandering at night .

56. Types of vascular dementia :
• Lacunar disease: Affects small blood vessels .
• Multi-infract dementia: Affects medium sized blood vessels .
• Strategic single infract dementia: Affects crucial area of brain (e.g., thalamus )
.
• Binswanger’s dementia: ( subcortical vascular encephalopathy) Multiple lacunar
infracts associated with sever , poorly controlled hypertension and systemic
vascular disease .