Burcu Ormeci, MDDepartment of Neurology

In the United States; As many as 7 million people have dementia Almost half of all people age 85 and older have some form

of dementia Although it is common in very elderly individuals, dementia

is not a normal part of the aging process Many people live into their 90s and even 100s

without any symptoms of dementia

Dementia is not a specific disease

It is a descriptive term for a collection of symptoms

There are many disorders that can cause lead to a progressive loss of cognitive functions

While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia

Memory loss that affects job skills Difficulty performing familiar tasks Problems with language Disorientation to time and place Poor or decreased judgment Problems with abstract thinking Misplacing things Changes in mood or behavior Changes in personality Loss of initiative

Dementia has to diagnosed without loss of consciousness There have to be at least 2 cognitive functions deficit and

one of them has to be memory▪ memory▪ language▪ perception▪ Judgment▪ Reasoning

These deficits have to do significant decline from a previous level of functioning

It has to be permanent or progressive

Alzheimer’s Disease (AD) Lewy Body Dementia (LBD) Frontotemporal Dementia (FTD)

Most common cause of dementia in people over age of 65

There are some early-onset forms of the disease, which may appear as early as age of 30 usually linked to a specific gene defect

Almost all brain functions are eventually affected AD is characterized by two abnormalities in the brain

Amyloid plaques Neurofibrillary tangles

In the early stages Patients may experience memory impairment, lapses of

judgment and mild changes in personality As the disorder progresses

Memory and language problems worsen Patients begin to have difficulty performing activities of daily

living They may become disoriented about places and times May suffer delusions ▪ The idea that someone is stealing from them▪ Their spouse is being unfaithful▪ May become nervous and hostile

Late stages of the disease Patients begin to lose the ability to control some motor

functions ▪ Swallowing▪ Bowel and bladder control

They eventually lose the ability to recognize family members and to speak

They develop symptoms such as aggression, agitation, depression, sleeplessness or delusions

Average life expectancy is 8 to 10 years after diagnosis▪ some people live as long as 20 years

Cells in the brain's cortex and in the substantia nigra die due to Lewy bodies

Symptoms overlap with Alzheimer's disease but also include hallucinations

Symptoms that may vary daily

LBD typically includes parkinsonian symptoms such as a shuffling gait (walk) and flexed posture

Patients with LBD live an average of 7 years after symptoms begin

Sometimes called frontal lobe dementia Dementia predominantly linked to degeneration of nerve

cells in the frontal and temporal lobes Some evidence for a genetic factor

Many have a family history of the disease Usually ages 40 – 65 Symptoms ▪ Judgment and social behavior problems▪ Stealing, neglecting responsibilities, increased appetite, compulsive

behavior

▪ Motor skill problems▪ Memory loss

Vascular dementia Reactions or side effects to medications Metabolic problems and endocrine abnormalities Nutritional deficiencies Severe dehydration Infections Subdural hematomas Poisoning Brain tumors Anoxia/hypoxia Heart and chronic lung problems Dementia Pugilistica

Second most common cause of dementia (%20)

Caused by brain damage from cerebrovascular or cardiovascular problems

Symptoms similar to AD but personality and emotions effected only late in the disease

Course of disease has digits

There are several types of vascular dementia; Multi-infarct dementia (MID)▪ caused by numerous small strokes in the brain

Single-infarct dementia▪ There is a single stroke can damage the brain

enough to cause dementia▪ Talamus or hippocampus

Binswanger's disease▪ There is a uncontrolled HT

Multi-infarct Dementia

Binswanger Disease

Single-infarct Dementia

Reactions or side effects to medications Medication’s side effects can mimic dementia. They may

have a rapid onset or develop slowly over time

Metabolic problems and endocrine abnormalities These problems can lead to apathy, depression, dementia,

confusion or personality changes▪ Thyroid disease, hypoglycemia, hyponatremia or hypernatremia,

hypercalcemia

Nutritional deficiencies Thiamine (vitamin B1), B6, or B12

Severe dehydration It can also cause mental impairment

Infections Meningitis, encephalitis, untreated syphilis and lyme

disease

Subdural hematomas Subdural hematoma can cause dementia-like symptoms and

changes in mental function It can occure in 3-6 weeks after head trauma in elderly people

Poisoning Exposure to lead or other heavy metals, alcohol, recreational

drugs or other poisonous substances can lead to symptoms of dementia

These symptoms may or may not resolve after treatment, depending on how badly the brain is damaged

Brain tumors In rare cases, people with brain tumor may develop

dementia because of damage to their brain areas related the cognitive functions

Anoxia/hypoxia Anoxia may be caused by many different problems,

including heart attack, chronic lung disease or heart problems, severe asthma, heart surgery, smoke or carbon monoxide inhalation, overdose of anesthesia

Dementia Pugilistica Also named Boxer's syndrome Due to traumatic injury (often repeatedly) to the brain Symptoms commonly are dementia and parkinsonism Other changes depending where brain injury has

happened It can appear many years after the trauma ends

Although these conditions may resemble some aspects of dementia, they have different causes, usually are treatable and have better outcomes Depression Delirium Mild cognitive impairment Age-related cognitive decline Organic brain syndrome

Patient history (from patient and care-givers) Physical examination Neurological evaluations Cognitive and neuropsychological tests Brain scans Laboratory tests Psychiatric evaluation

Patient History How and when symptoms developed? Patient's overall medical condition Patient and his/her familiy do not want to accept the

diagnosis▪ in the beginning AD and other forms of dementia can resemble

normal aging

Physical examination It can help rule out treatable causes of dementia

Cognitive and Neuropsychological Tests These tests measure memory, language skills, math skills,

and other abilities related to mental functioning

Brain Scans These are CT, MRI, EEG, PET, SPECT, MRS They have to use to identify brain changes▪ strokes, tumors or other structural problems, cortical atrophy

These drugs can improve symptoms and slow the progression of the disease

May improve the patient's quality of life, ease the burden on caregivers, and/or delay admission to a nursing home

TREATMENT of DEMENTIA

Ach is reduced in the brain of people with AD

Most of the drugs are cholinesterase inhibitors Donapezil, Rivastigmine, Galantamine

Some drugs work by regulating the activity of a glutamate Memantine

Tight control to ischemic risk factors

Increasing intellectual activities High education, continuous learning, social interactions,

chess, crossword puzzles, playing a musical instrument

Daily phisycal activity