Dementia Overview Lecture Notes

Study Notes

Dementia is a general term for a collection of brain diseases characterized by memory loss, impaired judgment, personality changes, and difficulties with daily tasks.
850,000 people in the UK (2019 study) are living with dementia, impacting 1 in 14 people aged 65+.
Dementia is not a part of normal aging and tends to affect older adults.
It has a clear neurological basis and involves specific brain areas showing accelerated neurodegeneration.
Today's lecture covers the overview of dementia, including Alzheimer's disease, vascular dementia, frontotemporal dementia, and Lewy body dementia.

Alzheimer's Disease (AD): The most common form, characterized by neurofibrillary tangles (tau protein) and amyloid plaque accumulation, leading to cell death and brain shrinkage.
Vascular Dementia (VD): Results from reduced blood flow to the brain, often stemming from cardiovascular disease, presenting as sudden or gradual changes in cognitive abilities. The decline can be linear or step-like in presentation.
Frontotemporal Dementia (FTD): Involves degeneration of the frontal and temporal lobes of the brain, leading to behavioral changes, language problems, and personality shifts. This type frequently includes overlapping symptoms, making differential diagnosis challenging. Three primary types are Behavioral Variant FTD (bvFTD), Primary Progressive Aphasia (PPA), and Movement Disorders FTD (MND).
Dementia with Lewy Bodies (DLB): Characterized by abnormal protein deposits (Lewy bodies) in brain cells, often appearing after Alzheimer's. Presents with fluctuations in cognitive function, motor symptoms (tremors, rigidity), visual hallucinations, and behavioral changes.

Alzheimer's Disease (AD): Genetic mutations (MAPT, GRN, C9ORF72) contributing to the accumulation of neurofibrillary tangles and amyloid plaques.
Vascular Dementia (VD): Caused by reduced blood flow to the brain, often due to cardiovascular diseases (like strokes).
Frontotemporal Dementia (FTD): Genetic mutations (C9ORF72, MAPT, GRN) are prominent in various FTD types, often leading to problems in behavior, language, and motor function.
Dementia with Lewy Bodies (DLB): Alpha-synuclein protein deposits (Lewy bodies) are linked to the development of this disorder.

Various symptoms will overlap, but distinguishing them is important for treatment

Alzheimer's Disease (AD): Memory loss, impaired language, visuospatial skills difficulty.
Vascular Dementia (VD): Memory loss, aphasia (speech difficulties), impaired motor skills, judgment impairments.
Frontotemporal Dementia (FTD): Personality changes, problems with language or behavior.
Dementia with Lewy Bodies (DLB): Cognitive fluctuations, visual hallucinations, Parkinsonism, sleep disturbances.

Economic impact (approximated £26 billion annually) of dementia is substantial and often managed informally and socially by caregivers.
Factors impacting dementia diagnosis include: common symptoms overlapping with other conditions (e.g., delirium, depression, thyroid issues, infections), difficulties diagnosing due to variations in symptoms and patterns of progression. There's a clear shortfall in funding for research, and given increased lifespans, societal risk of dementia is increasing. Current research also indicates that over half of people with dementia are not diagnosed.
There are tools and strategies for early diagnosis, as well as a paucity of specialist advice for GPs regarding protocol.
Some genetic risk factors exist (like APOE gene) with potential for future screening methodologies.

Specific criteria exist for various dementia types (including FTD, PPA, DLB), involving a combination of neurological examinations, cognitive tests, imaging studies (MRI or PET), and patient histories.

Overlapping symptoms with other conditions (e.g., delirium, depression) make diagnosis difficult. Delays in recognizing the illness are common.
Lack of readily available definitive tests complicate the identification and diagnosis procedures.
Lack of awareness among general practitioners regarding comprehensive procedures.