DEMENTIA-ETIOLOGY,CLINICAL FEATURES AND MANAGEMENT

                          DEMENTIA-ETIOLOGY,CLINICAL FEATURES AND MANAGEMENT

Dementia is acquired,global or multifocal involvement of cognitive functions causing decline in intellect,memory or personality in presence of normal conciousness.

    Causes of dementia

  1.Primary
  A. Alzimers disease-diffuse cortical atrophy
  B..Picks disease- frontal/temporal
  C.Frontal lobe degeneration

2.Secondary
Degenerative
                     Parkinsonism
                     Hereditary ataxia
                     Progressive supra nuclear palsy
                     Motor neuron disease
                     Huntingtons chorea
                     Multiple sclerosis

B.Conditions with raised ICT
                      Primary and secondary tumors
                      Hydrocephalus
                      chronic subdural hematoma
                      Carcinomatous meningitis

C.Vascular Dementia
                      Multi infarct dementia
                       Lacunar infarct
                       Thalamic infarct
                       diffuse atherosclerosis
                       Vasculitis-SLE, Polyarteritisnodosa ,Bechets

D.Chronic Infections
                       Syphilitic GPI
                       Tuberculosis
                        Fungal,protozoal
                        Slow virus disease(SSPE,CJ Disease,HIV

E.Dementia due to diffuse brain damage
                         Anoxia
                        Encephalitis
                        Acute head injury
                        Pugilistic dementia(in boxers)

F.Dementia due to endocrine disorders
                        Chronic hypoglycemia
                         Hypothyroidism
                         Hypo and Hyper parathyroidismAdrenal insuffiency
                         Cushings

G.Vitamin deficiency
                       B12,B1 deficiency and Niacin deficiency

H. Toxins
                       Alcohol
                       Drug and narcotic poisoning
                       Heavy metal intoxication
                       Dialysis dementia

I.Dementia in adolescents and young adults
                       Wilsons disese
                        progressive myoclonic epilepsy
                        Tuberous sclerosis
                        Leuko dystrophies
                        storage diseases
Common causes of dementia in the elderly 
                           Alzimers,vascular dementia,mixed dementia and Lewy body disease

Reversible causes of dementia in elderly
                         Metabolic,nutritional,Infections,psychiatric and drug inducedand autoimune .

TYPES OF DEMENTIA

I.Presenile sementia    Onset Before age of 65 Usually around age 40 or 50 .ExamplesPicks,Alzheimer

 II.Senile dementia      Onset after age65

III.cortical dementia    InPicks disease,Alzimers

IV.subcortica dementia -in Huntigtons disease,Multiple sclerosis

Differentiation between Alzimers and Picks disease

ALZIMERS	PICKS DISEASE
Diffuse involvement of the cortex	Focal involvement-frontal temporal
Pathologically neurofibrillary tangles,senile plaques	Picks bodies
Age of onset-presenile,senile	Presenile
Clinically features of diffuse cortical involvement	Fronto temporal features prominant

Clinical course:
rate of progression depends upon the under lying cause.
duration of symptoms helps to find the cause
alzimers disease is slowly progressive over the years
Encephalitis rapidly over weeks.
Cerebro vascular disease appear stroke by stroke

Factors accelerating dementia:
change of environment
inter current infection
Surgical procedures

Differential in initial phase;
Pseudo dementia of depressive illness.
History to be elicited
Rate of intellectual decline
Impairment of social function
general health and h/o stroke,head injury
drug history,family history
Nutritional status
Intellectual functions to be assessed
Memory
abstract thought
Judgement
Higher cortical functions
Neurological examination
Focal signs
primitive reflexes
pseudo bulbar signs
Involuntary movements
Neuro psychometric testing
Investigations:
CT brain
MRIscan
CSF pressure monitoring
Serumauto antibodies
tumor biopsy
CSF immunology
CSF viral antibodies
VDRL
TPHA
HIV status
serum B1
serum B12
serum folate
Metabolic and endocrine function test-
thyroid
para throid
renal
hepatic
adrenal
Treatable causes
nutritional,infective,metabolic and structural
Other cases
No effective treatment exists.
Many trials are in progress
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