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Dementia: A Factor in Complex Health Matters

Dementia: A Factor in Complex Health Matters. Partners in Care… Living in the Moment Alzheimer’s Society conference March 6, 2007 Dr. Suzanne Thille. Objectives. Appreciate that other types of dementia exist that have their own additional disabilities

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Dementia: A Factor in Complex Health Matters

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  1. Dementia: A Factor in Complex Health Matters Partners in Care… Living in the Moment Alzheimer’s Society conference March 6, 2007 Dr. Suzanne Thille

  2. Objectives • Appreciate that other types of dementia exist that have their own additional disabilities • Learn about some of the features and peculiar problem of people with Lewy Body Dementia • Learn about some of the features and variety of types of Vascular dementias

  3. Definitions • Dementia- progressive decline in 2 or more cognitive domains resulting in functional impairment. At least of 6 months duration. • Alzheimer’s 50-60% of cases • Memory and language. Physically well. • Delirium- acute decline in cognition (hours to days in onset) with fluctuating cognition and fluctuating activity. • Executive function- higher cognitive processes where several cognitive functions are used. Plans of action, complex tasks, planning ahead.

  4. Lewy Body Dementia • Neurodegenerative disorder affecting all levels of the brain • 20% of dementias? • Primary features • Fluctuating cognition, especially attention • Visual hallucinations • Extrapyramidal signs- bradykinesia, rigidity

  5. Secondary features • Repeated falls • Syncope • Neuroleptic sensitivity • delusions

  6. Clinical Course • MMSE seems to under represent the severity of the condition. • 5-8 year survival • Treatment • Nonpharmacologic approaches for management of behavioral symptoms, psychosocial aspects, and caregiver stress • Cholinesterase inhibitors • Parkinsonism treatment • Antipsychotic treatment

  7. Vascular Dementia • Multiple diagnostic criteria and names suggested. i.e. Vascular cognitive impairment • 15% of all dementias? May be mixed. • Group of differing conditions • Multi-infarct (multiple large complete infarcts) • 8-25% of stroke have dementia as a result eventually • Strategic single infarct • Lacunar infarcts, small vessel disease • Hypoperfusion, chronic ischemia? • Hemorrhagic- subdurals, subarachnoid, intracerebral • Vasculitis

  8. General features • Abrupt onset • Stepwise • Impaired executive function, slowing • Gait disorder • Emotional lability, behavioral • Temporal relationship • Course- classically stable for a time but overall pattern depends on future injuries

  9. Treatment- prevention • Hypertension • Cigarette smoking • Heart disease • Diabetes • Hyperlipidemia • Management of behavioural symptoms, psychosocial aspects, and caregiver stress.

  10. Others • Others with neurologic features • Cognitive impairment with medical illness • Cognitive and neurological conditions due to alcoholism

  11. Conclusions • Though 50-60% of all dementias are Alzheimer’s disease with little additional physical issue until later in the disease, most of the remainder have other related disabilities or issues. • Lewy Body dementia has psychotic issues and or impairment in gait. Some aspects look like delirium. • Vascular dementias are variable but do not follow the pattern of decline nor deficits expected with Alzheimer’s disease. Physical findings may be present that help to determine that a vascular cause exists. Prevention is the main goal of intervention.

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