Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine

1. Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine Palmerston North Hospital

2. Outline • the ageing brain • basic definitions • causes of dementia • symptoms of dementia • cognitive testing

3. Ageing

4. The ageing brain

5. Case history 1 A 65 year old writer presents with difficulty reading and writing. He has taken to dictating his stories to a PA. He is independent with ADLs. Cognitive testing reveals a normal MMSE, with intact STM. Detailed neuropsychological testing confirms dyslexia and dysgraphia.

6. Case history 2 An 85 year old man with previous TIAs, hypertension and myocardial infarction is brought to his GP by his wife because of STM loss. He is completely independent with ADLs, socially appropriate and manages household finances well. His MOCA is 20/30 with deficits in recall and executive function.

7. What is dementia?

9. Dementia • loss of brain function • affecting normal social and occupational activities

10. Mild cognitive impairment • loss of brain function • does not affect ability to live independently • Cognitive • Impairment • Not • Dementia

11. The significance of MCI • prevalence of 3 to 22% >65 years • 10 to 15% conversion rate to dementia per year • reversion rate 40% over a 5 year period • is it possible to prevent/delay progression to dementia?

12. Causes of dementia 1 • brain injury • brain tumours • chronic alcohol abuse • metabolic problems • vitamin B12 deficiency • normal pressure hydrocephalus

13. Causes of dementia 2 • Alzheimer’s disease • dementia with Lewy bodies • vascular dementia • Parkinson disease dementia • fronto-temporal dementia • Huntington’s disease • HIV and other infections

14. Brain function – an alternative view

15. Brain function – an alternative view

16. Brain function

17. Alzheimer’s disease

18. Alzheimer’s disease – symptoms 1 • forgetfulness • getting lost on familiar routes • misplacing items • language problems

19. Alzheimer’s disease – symptoms 2 • difficulty performing tasks that take some thought • loss of interest in things previously enjoyed • personality changes and loss of social skills • difficulty doing basic tasks • losing awareness of self • poor judgement and insight • Behavioural and Psychological Symptoms of Dementia

20. Vascular dementia

21. Vascular dementia – symptoms • abrupt onset • step-wise deterioration and fluctuation • memory impairment • executive dysfunction • personality change and emotional lability • incontinence • gait disorder

22. Dementia with Lewy bodies Lewybody

23. Dementia with Lewy bodies – symptoms • fluctuating cogntive function – 50 to 75% • recurrent visual hallucinations – 80% • REM sleep behaviour disorder • apathy • parkinsonism • autonomic dysfunction

24. Cognitive screening • role • which test? • MMSE • MoCA

26. Case history 1 A 65 year old writer presents with difficulty reading and writing. He has taken to dictating his stories to a PA. He is independent with ADLs. Cognitive testing reveals a normal MMSE, with intact STM. Detailed neuropsychological testing confirms dyslexia and dysgraphia.

27. Case history 2 An 85 year old man with previous TIAs, hypertension and myocardial infarction is brought to his GP by his wife because of STM loss. He is completely independent with ADLs, socially appropriate and manages household finances well. His MOCA is 20/30 with deficits in recall and executive function.

28. Summary • diagnosis of dementia is primarily based on the history • symptoms of dementia help define the subtype • comorbidities help define the subtype • MCI is common, its significance uncertain • early recognition is vital for appropriate management

29. Thank you for listening