Basic of Geriatrics and Internal Medicine for Physiotherapist by Rasheedy D - HTML preview

Dementia

Dementia is a syndrome of acquired (not learning difficulties), chronic (lasts months to years), global (not just memory or just language problems), progressive impairment of higher brain function, in an alert patient (not drowsy), which interferes with social and functional abilities.

What are the higher brain functions?

• Learning and Memory (e.g. free recall, cued recall)
• Aphasia (e.g. word-finding difficulty)
• Apraxia (inability to perform motor tasks, such as cutting a loaf of bread, despite intact motor function)
• Agnosia (inability to recognize objects despite intact sensory function)
• Impaired executive function (poor abstraction, mental flexibility, planning, and judgment).

Different causes of dementia

Pathology of Alzheimer disease

Differential Diagnosis

Delirium

Depression

Age related memory loss:

• Much milder symptoms
• Not substantially progressive
• Does not impair function

Mild cognitive impairment

• May represent a transitional state between normalcy and dementia but some cases may not progress to Dementia
• Either amnestic or non-amnestic MCI
• No functional impairment

Alarming signs:

1. People with dementia often forget things and never remember them.
2. Asking the same question over and over
3. Difficulty in performing familiar tasks.
4. Problems with language.
5. Time and place disorientation.
6. Misplacing things.
7. Poor judgment

Consequences of dementia

Malnutrition, safety issues, fall risk, functional decline, incontinence, Delirium, depression, sleep disorders, aspiration, immobility, Caregiver stress.

Means of Confirmation or Diagnosis

Definitive diagnosis is made upon autopsy.

 Exclude reversible causes

Laboratory Tests

Cerebrospinal fluid (CSF) for protein analysis

Neuropsychological testing

Mini mental state examination

 Imaging

Computed tomography (CT) of the brain

Magnetic resonance imaging (MRI) of the brain

Single-photon emission computed tomography (SPECT) for hypoperfusion in the parietal and temporal regions

Positron emission tomography (PET) scan for abnormal brain proteins

Treatment

Memory issues: not curative may delay progression

Cholinesterase inhibitors: donepezil

Memantine: Namenda

Behavioural and psychological symptoms BPSD:

• Behavioural symptoms that may occur in dementia include wandering, aggression and agitation. Psychological symptoms include anxiety, depression and hallucinations. The mainstay of treatment for BPSD is non-pharmacological and approaches include orientation, reassurance, and complementary therapies.
• Antipsychotic drugs may have a role but should only be prescribed by specialists.
• Acetylcholinesterase inhibitors are increasingly used for their effect on BPSD.