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The Dementias

The Dementias. Dr Giles Richards Consultant Psychiatrist CFT. Some predictions: in 10 years time. Number of people over 65 yrs will increase by 15% Number of people over 85 yrs will increase by 27%

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The Dementias

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  1. The Dementias Dr Giles Richards Consultant Psychiatrist CFT

  2. Some predictions: in 10 years time • Number of people over 65 yrs will increase by 15% • Number of people over 85 yrs will increase by 27% • 60% older people have long standing illnesses ( mental illness more common and worse outcomes)

  3. Some figures • 700,000 people with Dementia • Will rise to 1.4 million • £17bn per annum on care (£12bn cancer) • Set to rise to £50bn • £27,000 per person • Cancer research £590 m (£50m)

  4. DEFINITION OF DEMENTIA (WHO 1993) • Syndrome due to disease of the brain, • Usually chronic / progressive in nature. • Impairment of multiple higher control functions e.g. memory, orientation, comprehension, calculation, learning, language and judgement. • Consciousness is not clouded. • Often accompanied by poor emotional control, social behaviour or motivation.

  5. New Definitions • Amyloid weighting • ApoE4 • CSF studies (phosphorolated Tau) • Hippocampus volume assessment • PET scanning

  6. Diagnostic Process • History • Mental State Exam • Examination • Investigations

  7. Investigations • Bloods • ECG • EEG • Scans: • CT, • MRI, • SPECT, • PIB

  8. RISK FACTORS • Family History x 3 • Family History of Parkinson’s Disease • Down’s Syndrome • Head Injury - Beta Amyloid • Neurotoxins - Aluminium / Zinc (inconclusive), Organophosphates • Educational Background

  9. CAUSES OF DEMENTIA • Alzheimer’s • Vascular Disease • Frontal Lobe Dementia • Huntingdon’s • Parkinson’s • Lewy Body Dementia • Brain Diseases • Normal Pressure Hydrocephalus

  10. Pathology • Atrophy (brain weight) • Widened sulci, narrowed gyri, enlarged ventricles • Amyloid Plaques (Beta secretase) • Neurofibrillary Tangles (phosphorolated Tau) • Hirano bodies

  11. Diagnosis • Probable LBD • Possible LBD • Differential diagnosis

  12. DIAGNOSIS (1) • Central Features: • Progressive cog decline, Memory (late), attention,exec function, visuospatial. • Core Features: • Fluctuating cog, Visual hallucinations, Spontaneous features of Parkinson's

  13. DIAGNOSIS (3) • Suggestive Features: • REM sleep behaviour, Neuroleptic sensitivity, changes on imaging • Supportive features: • Falls, transient LOC, autonomic dysfunction, delusions, other modes hallucinations, dep, EEG changes, occiput SPECT changes

  14. Diagnosis (4) • Less likely if: • Cerebrovascular disease present, other process to account in part for symptoms, Parkinson's appears late on. • Parkinson's Dementia • “ the 1 year rule”

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