Dementia Presentation PDF

© Ma'en Aljezwi 1 Dementia © Ma'en Aljezwi 2  Introduction In the contemporary health care industry, non-communicable disease including dementia, poses a great health concerns starting from the year Dementia is the clinical presentation of a number of neurodegenerat...

© Ma'en Aljezwi 1 Dementia © Ma'en Aljezwi 2  Introduction In the contemporary health care industry, non-communicable disease including dementia, poses a great health concerns starting from the year Dementia is the clinical presentation of a number of neurodegenerative diseases, which includes: Alzheimer’s disease (AD), frontotemporal dementia, Lewy body dementia, vascular dementia © Ma'en Aljezwi 3  Alzheimer’s disease This pathology account for 60% to 80% of all cases of dementia. Post-mortem studies found that some cases of dementia for other causes had AD brain pathological changes. The coexistence of AD with other type of dementia is called mixed dementia. AD results from the deposition of beta- amyloid protein (plaques) outside neurons, and tau protein (tangles) inside neurons © Ma'en Aljezwi 4  Alzheimer’s disease (cont..) Early symptoms start by forgetfulness, not remembering recent events or conversations with depression and blunted affect. Poor communication, difficulty concentration, disorientation, confusion, and poor judgment are later symptoms, which finally progress to difficulty walking and eating in addition to impaired verbal communication © Ma'en Aljezwi 5  Vascular dementia This type of dementia results from infarctions that affect the brain (strokes) and accounts for 20% of the causes of dementia It can either result from blocked blood vessel or haemorrhage. Severity of the symptoms depend on the size and affected location of the brain infarction © Ma'en Aljezwi 6  Vascular dementia (cont…). In contrast to AD dementia, the symptoms start with poor judgment and inability to organize tasks, not forgetfulness. Having said that, only 10% of patients with dementia have vascular pathologies alone, most of them have other pathologies like AD, in this case the patient is diagnosed as mixed dementia © Ma'en Aljezwi 7  Dementia with Lewy bodies Aggregation of a protein called Alpha- synuclein in the neurons in the cortical area of the brain can cause symptoms of dementia known as dementia with Lewy bodies it is common for patients with Lewy bodies dementia also show AD pathology in their brains © Ma'en Aljezwi 8  Dementia with Lewy bodies (cont..) some patients may have vascular changes in the brain that can lead to dementia, in these instances when two or more causes of dementia coexist, the patient is said to have mixed dementia. © Ma'en Aljezwi 9  Dementia with Lewy bodies (cont..) The early symptoms usually starts with sleep disturbances, slowness, imbalanced gait, impaired excutive functioning, disinhibition, poor planning, and visual hallucinations. These symptoms may happen without memory loss as in AD © Ma'en Aljezwi 10  Fronto-temporal lobar degeneration The cause of dementia in this type is the atrophy of the brain cells in the frontal area and the temporal area, which can be accompanied by accumulation of a protein (usually tau protein) in the upper layer of the cortex © Ma'en Aljezwi 11  Fronto-temporal lobar degeneration (cont…) Unlike other types of dementia, this type have an earlier onset, 60% of the patients start symptoms between the age of 45 and 60 years. This type of dementia accounts for 10% of all cases of dementia © Ma'en Aljezwi 12  Dementia for other causes Parkinson disease is one of the causes that can result in dementia symptoms. As the alpha-synuclein protein starts to accumulate in the dopamine cells damaging it, this particular protein have also a role in the appearance of dementia symptoms © Ma'en Aljezwi 13 Dementia for other causes (cont..) The same principle can be found in the pathology of Creutzfeldt-Jakob disease. In this disease misfolding of a particular protein (prion) in the brain can cause behavioural changes and impairment in memory © Ma'en Aljezwi 14 Dementia for other causes (cont..) Hydrocephaly can increase the intracranial pressure, thus inducing impairment in memory and behaviour Also any medical condition that can induce symptoms of dementia e.g. Huntington disease, HIV, head trauma. Some drugs and toxins additionally can induce the symptoms of dementia © Ma'en Aljezwi 15  Progression of symptoms Typically, the aforementioned diseases will cause a progressive irreversible decline in cognitive abilities that affects functional capabilities in addition to memory Behaviour is another aspect that is also affected, patients usually are agitated from different life details because they cannot remember details © Ma'en Aljezwi 16  Progression of symptoms (cont,..) Patient eventually will start having neuropsychiatric symptoms like hallucinations and delirium. These symptoms will make the patients in need for constant supervision, thus increasing the burden on caregivers The onset of symptoms is usually at late age (>65 years), however it can start at younger age, as the previously mentioned Fronto- temporal lobar degeneration dementia © Ma'en Aljezwi 17  Risk factors Dementia can result from an interaction of comorbidities, gens, and the environment In general there are modifiable and non- modifiable risk factors © Ma'en Aljezwi 18  Modifiable risk factors Comorbidities such as diabetes, hypertension, atherosclerosis, obesity, and hyperlipidaemia Illiteracy Lake of physical activity Tobacco use © Ma'en Aljezwi 19  Non-modifiable risk factors Ethnicity: it is highest in Latin America and lowest in South Africa Age: Studies found that dementia risk increase in the age group 80-84 years, then starts to fall around the age 95 yea © Ma'en Aljezwi 20  Diagnosis Medical history ADLs MMSE Medical imaging: CT, MRI Positron emission tomography (PET) © Ma'en Aljezwi 21 PET of the brain of a person with AD showing a loss of function in the temporal lobe © Ma'en Aljezwi 22  Microscopy image of a neurofibrillary tangle, conformed by hyperphosphorylated tau protein © Ma'en Aljezwi 23 Enzymes act on the APP (amyloid precursor protein) and cut it into fragments. The beta-amyloid fragment is crucial in the formation of senile plaques in AD. © Ma'en Aljezwi 24  Treatment  Aricept Used to delay or slow the symptoms of AD Donepezil Loses its effect over time Used for mild, moderate and severe AD Does not prevent or cure AD  Celexa Citalopram Used to reduce depression and anxiety May take 4 to 6 weeks to work Sometimes used to help people get to sleep  Depakote Used to treat severe aggression Sodium Valproate Also used to treat depression and anxiety  Exelon Used to delay or slow the symptoms of AD Rivastigmine © Ma'en Aljezwi 25  Advanced treatment Cholinesterase inhibitors increase the levels of acetylcholine in the brain, which plays a key role in memory and learning Examples: donezepil HCL), Exelon (rivastigmine), and Razadyne (galantamine) © Ma'en Aljezwi 26  Facts about dementia People with Alzheimer’s disease are particularly prone to depression It has been scientifically proven that mental exercise can prevent a person from getting Alzheimer’s disease. After symptoms of Alzheimer’s disease appear, the average life expectancy is 6 to 12 years. © Ma'en Aljezwi 27  Facts about dementia (cont…) When a person with Alzheimer’s disease becomes agitated, a medical examination might reveal other health problems that caused the agitation People with Alzheimer’s disease do best with simple, instructions giving one step at a time. If a person with Alzheimer’s disease becomes alert and agitated at night, a good strategy is to try to make sure that the person gets plenty of physical activity during the day. © Ma'en Aljezwi 28  Facts about dementia (cont…) People whose Alzheimer’s disease is not yet severe can benefit from psychotherapy for depression and anxiety.. Poor nutrition can make the symptoms of Alzheimer’s disease worse. A person with Alzheimer’s disease becomes increasingly likely to fall down as the disease gets worse. © Ma'en Aljezwi 29  Facts about dementia (cont…) Eventually, a person with Alzheimer’s disease will need 24hour supervision. Having high cholesterol may increase a person’s risk of developing Alzheimer’s disease. Symptoms of severe depression can be mistaken for symptoms of Alzheimer’s disease. © Ma'en Aljezwi 30  Facts about dementia (cont…) Trouble handling money or paying bills is a common early symptom of Alzheimer’s disease One symptom that can occur with Alzheimer’s disease is believing that other people are stealing one’s things. © Ma'en Aljezwi 31  Facts about dementia (cont…) Having high blood pressure may increase a person’s risk of developing Alzheimer’s disease. Genes can only partially account for the development of Alzheimer’s disease Alzheimer’s disease cannot be cured. © Ma'en Aljezwi 32  Misconceptions about dementia When people with Alzheimer’s disease begin to have difficulty taking care of themselves, caregivers should take over right away. f trouble with memory and confused thinking appears suddenly, it is likely due to Alzheimer’s disease. © Ma'en Aljezwi 33  Misconceptions about dementia (cont…) When people with Alzheimer’s disease repeat the same question or story several times, it is helpful to remind them that they are repeating themselves Once people have Alzheimer’s disease, they are no longer capable of making informed decisions about their own care. © Ma'en Aljezwi 34  Misconceptions about dementia (cont…) Tremor or shaking of the hands or arms is a common symptom in people with Alzheimer’s disease When a person has Alzheimer’s disease, using reminder notes is a crutch that can contribute to decline Prescription drugs that prevent Alzheimer’s disease are available. © Ma'en Aljezwi 35  Misconceptions about dementia (cont…) It is safe for people with Alzheimer’s disease to drive, as long as they have a companion in the car at all times. © Ma'en Aljezwi 36