DEMENTIA IN NEUROSCIENCEDEPARTEMENT OF NEUROLOGYCHRISTIAN
UNIVERSITY OF INDONESIAMEDICAL FACULTYDEFINITION OF
DEMENTIADEMENTIA-the disease with acquired deterioration in
cognitive/ intellectual abilities without impairment of
consciousnessognitive de!cit represent a decline from previous
level of functioningDSM IV DIAGNOSTIC CRITERIA"# Memor$
impairment%# At least one of the
following&AphasiaApra'iaAgnosiaDisturbance in e'ecutive
functioning(# Disturbance in " and % interferes with dail$
function)# Does not occur e'clusivel$ during deliriumTEN WARNING
SIGNS OF DEMENTIA"# Memor$ loss that a*ects +ob s,ills%# Di-cult$
performing familiar tas,s(# .roblems with language)# Disorientation
to time and place/# .oor or decreased +udgment0# .roblems with
abstract thin,ing1# Misplacing things2# hanges in mood or
behavior3# hanges in personalit$"4# 5oss of initiativeEPIDEMIOLOGY6
/ to 2 7 at age 0/ to 146 "/ to %4 7 at age 1/ to 24up to )4 to /4
7 over age 2/6 / to 2 7 at age 0/ to 146 "/ to %4 7 at age 1/ to
24up to )4 to /4 7 over age 2/ Al8heimer9s disease is most common
dementia /4-1/7 Dementia with 5ew$ bodies "/ to (/ 7 :ascular
dementia / ; %4 7 Al8heimer9s disease is most common dementia
/4-1/7 Dementia with 5ew$ bodies "/ to (/ 7 :ascular dementia / ;
%4 7ETIOLOGYNEURO-DEGENERATIVEAlzheimer' D! Deme"#i$ %i#h Le%&
'()ie! Fr("#(-#em*(r$l )eme"#i$! P$r+i"(", D:A Infarction?
@emod$namic insu-cienc$NE=>A5ABIA5 Multiple INE
@$poth$roidismN=T>ITIANA5 Def# of :it# C"%D ThiamineD
NiacinINEETIA=enal Insu-cienc$? FilsonGs DsT>A=MATI ule out
correctable or contributor$ causes of dementiaImaging& omputed
tomograph$ without contrast or magnetic resonance imaging>ule
out infarctsD mass lesionsD tumorsD and h$drocephalusNeurological
e'amination orrelate imaging !ndings with clinical
e'aminationNeurops$chological testing Mini-Mental ecurrent stro,es
- I- multiple areas of infarctionCinswangerGs disease - Di*use
white matter disease- 5acunar infarctionlinical
Manifestation&SonfusionD personalit$ changesD
ps$chosisS.$ramidal signs I cerebellar signs TSBait disorderD
urinar$ incontinenceD d$sarthriaSEmotional labilit$
Fr("#(#em*(r$l Deme"#i$Fr("#(#em*(r$l Deme"#i$3ften begins "ith
$ar,ed -eha.i/ra( dist*r-ances, unlike A*&lassic form 8 'ic,+s
disease$atients fre4uently hot'tempered and socially disinhibited
memory+ #isuo spatial skills spared-mpaired planning,judgement and
languageEcholalia 93#erlap "ith $S$,&0*, motor neuron
disease-llness 0r/gresses 1/r 2ears, like A*-ne#itable dec(ineM3I4
(/-ar atr/0h2 /1 1r/nta( and5/r te$0/ra(About :;< of patients
ha#e 1a$i(2 hist/r2 LEWY 'ODY DEMENTIA5ew$ bod$ dementia ma$
present as&late onset .ar,insonGs disease followed months or
$ears later b$ visual hallucinationsD episodes of confusionD memor$
loss and then global dementiaD or cognitive or ps$chiatric s$mptoms
followed b$ milder .ar,insonian features later in the course of the
disease#To diagnose 5ew$ Cod$ disease&Ouctuating cognitive
performance with episodes of confusion hallucinations and/or
paranoid delusions earl$ gait disturbance an$ combination of
rigidit$D brad$,inesiaD tremor and Oe'ed posture temporoparietal
dementia with inattention in a patient with .ar,insonGs disease
TREATMENT FOR DEMENTIAholinesterasi InhibitorDonepe8il
JAriceptK>ivastigmine JE'elonKBalantamine
J>emin$lKMemantineEbi'aA'uraMEDICATION TO AVOID IN ALL PATIENTS
WITH DEMENTIAQJDementiaandognitiveImpairmentDiagnosisandTreatment
Buideline#Availableathttps&//www#ghc#org/all-sites/guidelines/dementia#pdfKRMEDICATION
RATIONALETri.&.li. $"#i)e*re$"# 5TCA6Amitript$lineD amo'apineD
clomipramineD desipramineD do'epinD imipramineD nortript$lineD
protript$lineD trimipramine
