Dementia Alzheimer, 50-70% dementia. 10-15% vascular , lewy bodies or frontotemporal dementia.
Dx. cognitive deficits.
1.memory impairment.
2. 1 of the following.
aphasia
apraxia
agnosia
Both cause impairment in social or occupational functioning.
Do not occur exclusively during the course of delirium.
Alzheimer.

Dementia
deficit in 2 or more areas of cognition
no disturbance of consciouness
onset 40-90 years

Pathologic dx.

Neurifibrillary tangles.
Neuritic plaques(seniles).

cholinergic markers are depleted.

risk factors,
advanced age, cardiovasc. factors, genetic predisposition and postmenopausal factors.
trisomy 21 assoc. with very high rate of alzheimer.
Systolic hypertension is a modifiable risk factor for dementia.


tx. Cholinergic augmentation improves cognition. Tacrine, donezepil, galantamine. inh. cholinesterase.
also improves the psych. sx.
Memantine, antiglutaminergic.also improve cognition.
vit. E and selegiline may slow progression.

Vascular dementia. Cerebrovascular disease must be documented by imaging and neurologic signs.
dementia must have started within 3 months of a stroke or stroke-like course of illness.

frontotemporal dementia. personality changes and asymmetric frontal atrophy

screening for dementia.
b12 vit. def. hypothyroidism, depression.
b12, t3,t4,tsh, ct scan or mri to evaluate pathology and assess vascular disease.



This is the second version

Dementia
1-normal level of consciousness
2-bad memory,bad judgment and bad abstract thinking

Initial workup
1- First thing is to rule out drugs
2- Second is to rule out treatable dementias like:
-low B12
-Wilson Disease
-low t3,t4= hypothyroidism
-Syphilis
-Lead
NPH= Normal Pressure Hydrocephalea

Alzheirmer
-Most common dementia after 60
Initial signs and symptoms are
- poor recent memory
-poor naming
-Imprecise speech

Several years later
Apathy------------------------------------ Frontal lobe problem
sloppiness------------------------------ Frontal lobe problem
low spontaneity --------------------- Frontal lobe problem



After the frontal lobe problems then the patients develope GAIT problems.
They have normal LP
Tx
Aricept-- Donepezil
Cognex-- Tacrine

Depression
looks like Dementia but they will not have the grasp/suck reflexes(what ever that means)
Immediate recall is POOR