clinmed2test3: DEMENTIA ppt

Dementia

• Dementia can be classified into several types, including Mild Cognitive Impairment, Alzheimer's Dementia, Frontotemporal Dementia, Lewy Body Dementia, Rapidly Progressive Dementia, and Normal Pressure Hydrocephalus.

Mild Cognitive Impairment (MCI)

• MCI can be on the Alzheimer's spectrum, but not all MCI is early Alzheimer's disease.
• Symptoms of MCI include cognitive impairment, but individuals are able to complete daily tasks.
• Evaluation of MCI involves history, physical, and MoCA to assess domains affected.
• Treatment of MCI involves treating reversible causes, and Aducanumab, a monoclonal antibody against amyloid beta, is currently in post-approval trials.

Alzheimer's Dementia

• In the US, nearly 7 million individuals over the age of 65 are living with clinical Alzheimer's disease.
• Incidence of dementia doubles every 10 years after age 60.
• 2/3 of Alzheimer's sufferers are women, and older Black Americans are twice as likely to have Alzheimer's as whites.
• Alzheimer's pathology includes early-onset and late-onset forms, with different genetic patterns.
• Risk factors for Alzheimer's include family history, brain trauma, lifestyle, T2DM, HTN, and cerebrovascular disease.
• Clinical features of Alzheimer's include memory impairment, executive dysfunction, and imaging findings of generalized and focal atrophy.
• Alzheimer's progression is measured with MMSE, MoCA, and Clinical Dementia Rating Scale, with patients declining 3-3.5 points on average on the MMSE each year.
• Treatment of Alzheimer's involves no cure, but Aducanumab decreases the amount of beta-amyloid in the brain.

Frontotemporal Dementia (FTD)

• Behavioral variant (BVFTD) is the most common subtype of FTD.
• Primary progressive aphasias are a type of FTD, characterized by gradual language deficits.
• Subtypes of primary progressive aphasias include nonfluent, logopenic, and semantic variants.

Lewy Body Dementia

• Lewy Body Dementia is the second most common cause of dementia.
• Cells die in the brain's cortex and substantia nigra, with remaining nerve cells containing abnormal Lewy bodies.
• Clinical presentation of Lewy Body Dementia includes dementia "plus" symptoms such as fluctuating cognition, visual hallucinations, and parkinsonism.
• Prognosis of Lewy Body Dementia is similar to Alzheimer's, but with a slightly faster rate of cognitive decline and shorter survival time.

Rapidly Progressive Dementia

• Rapidly Progressive Dementia can be caused by Creutzfeldt-Jakob disease (CJD) or vascular dementia.
• CJD is the most common human form of prion disease, characterized by spongiform encephalopathy and rapidly progressive cognitive decline.
• Vascular dementia, also called multi-infarct dementia, is caused by multiple brain insults accumulated over time.

Normal Pressure Hydrocephalus (NPH)

• NPH is characterized by large ventricular size with normal opening pressures (LP).
• Epidemiology of NPH shows it is most common in adults over the age of 60, with equal prevalence in both genders.
• Pathophysiology of NPH involves impaired CSF absorption.
• Temporal course of NPH involves gait difficulty, urinary urgency/incontinence, and cognitive changes.
• Treatment of NPH involves lumbar puncture to aid in diagnosis and ventriculoperitoneal shunt, with a good prognosis for improvement in symptoms after shunt placement.