Dementia description

1. Dementia
Randi Jones, Ph.D.
4/11/2008
Positive Impact

2. Delirium v. Dementia
 Delirium- transient global cognitive
impairment. Consciousness fluctuates.
Reversible. Acute onset
 Dementia- global impairment of cognitive
function, usually progressive, interferes
with normal social and occupation
function
 -Ayd, Frank. Lexicon of Psychiatry, Neurology and the Neurosciences, 2000.
Randi Jones, Ph.D. copyright 4/11/2008

3. Mild Cognitive Impairment
 Age related
 May go on to become dementia
 Amnestic or nonamnestic
 No FDA approved tx, but Aricept is often
prescribed
Randi Jones, Ph.D. copyright 4/11/2008

4. Broad Classification by Brain
Area Affected
 Cortical
 Subcortical
 A way to categorize and
understand.Could be viewed as
continuum.
 Some disorders affect a variety of areas
in the brain, so don’t categorize neatly
Randi Jones, Ph.D. copyright 4/11/2008

5. Cortical Characteristics
 Short-term memory problems. Encoding
and storage
 Information is lost
 Verbal ability declines-anomia
 Aphasia, apraxia, agnosia
Randi Jones, Ph.D. copyright 4/11/2008

6. Subcortical Characteristics
 Verbal comprehension is retained
 Memory problems due to retrieval
 Slowed mentation, but much remains
intact, including general IQ
 Typically frontal sx: attention,
organization, judgment, disinhibited
behavior, apathy
 Depression is very common
Randi Jones, Ph.D. copyright 4/11/2008

7. Classification by Possibility of
Recovery
 “Pseudodementia”-cognitive impairment
caused by a psychiatric disorder. Most
often depression, but also NPH,
meningiomas, etc.
 Toxic conditions
 Alcohol or drug induced
Randi Jones, Ph.D. copyright 4/11/2008

8. Alzheimer’s spectrum
 Early v. late onset. Early has greater
possibility of genetic etiology.
 Hippocampus, amygdala
 Treatments: Aricept,Reminyl, Exelon [Cognex
rarely used now]. acetylcholinesterase inhibition.
NMDA action: Namenda
 Environmental stimulation and enrichment
 Education of family caregivers
Randi Jones, Ph.D. copyright 4/11/2008

9. HIV (Aids Related Dementia
Complex)
 Subcortical, frontal areas affected.
 Motor sx possible.
 Depression is common. Watch for suicidal behavior.
 Rate initially declined as result of antiretroviral tx, but is
on the rise again.
 ADC increases chances for more rapid progression,
early death
 May distinguish “haves” from “have nots.”
 HIV Dementia Scale (4 subtests) and Memorial Sloan
Kettering Rating Scale (research)
 HAART can improve dementia sx.
Randi Jones, Ph.D. copyright 4/11/2008

10. Vascular
 2nd most common cause of dementia
 Mostly subcortical, but varies with brain
area affected.
 Treatment designed to minimize causes
such as hypertension or treat depression
 Possibility of physical limitations as well
such as hemiparesis and neglect.
Randi Jones, Ph.D. copyright 4/11/2008

11. Alcohol or other Substance
Induced
 Korsakoff’s syndrome. Hippocampus.
Thiamine deficiency.
 Alcohol dementia. Separate disorder?
Frontal, cerebellum
 Some recovery is possible with
abstinence.
Randi Jones, Ph.D. copyright 4/11/2008

12. Parkinson’s & other typically
subcortical dementias
 Parkinson’s disease: some genetic component for
specific phenotypes, but largely causes remain
idiopathic. Includes parkinson pugilistica.
 Huntington’s disease: genetic. Midlife onset. Fully
penetrant, autosomal dominant. Course 15-20 years.
No treatment.
 Spinal cerebellar ataxias: many are genetic, some are
dominant, some recessive.
 Multiple sclerosis. Dementia more common in primary
progressive, but cognitive impairment is expected in
~50% of patients.
Randi Jones, Ph.D. copyright 4/11/2008

13. Nonmedical Treatment Issues
 Optimizing function
 Assessing disability, if still employed
 Driving
 Competency
 End of life decisions
 Location of care
 Family dysfunction/reorganization
 Family education and caregiving
Randi Jones, Ph.D. copyright 4/11/2008