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Dementia

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Updated 2011-06-22 09:18

Summary

Dementia and related terms and types.

DSM-IV Criteria

Question Answer
Memory impairmentmust have impaired ability to learn or recall
Aphasiamust have 1 of 4
Apraxiamust have 1 of 4
Agnosiamust have 1 of 4
Disturbance in executive functionmust have 1 of 4, eg planning, organizing, sequencing
Is not deliriumIs not acute, does not usually impair consciousness, is not usually reversible
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Anterior or Posterior

Question Answer
AnteriorBehavioural changes
AnteriorLoss of inhibition
AnteriorAnti Social
AnteriorIrresponsible
AnteriorExamples include Frontotemporal dementia, Normal Pressure Hydrocephalus, Huntington's.
PosteriorIncludes parietal and temporal lobes
PosteriorDisturbance in memory
PosteriorDisturbance in language
PosteriorExamples include Alzheimer's
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Cortical or Subcortical

Question Answer
CorticalDysphasia
CorticalAgnosia
CorticalApraxia
CorticalExamples include Alzheimer's
SubcorticalApathetic
SubcorticalForgetful
SubcorticalSlow
SubcorticalAssociated with other neurological signs
SubcorticalExamples include Parkinson's, AIDS
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DDx by surgical Sieve

Question Answer
VascularMultiple Infarct(20%), Chronic subdural Haematoma, CADASIL
InfectiveCJD, Syphilis, HIV
TraumaHead injuries
Autoimmunenil
Metabolichepatic. Wernicke Korsakoff (B1 deficiency usually in alcoholics, 5%), B12 deficiency
IdiopathicNormal Pressure Hydrocephalus, Alzheimer's,
NeoplasticFrontal Tumour
ConegenitalCADASIL
DegenerativeAlzheimer's (60%), Frontaltemporal/Pick's (5%), Dementia with Lewy bodies (10%)
DrugsSedatives, anticholinergic, drug interactions
EndocrineThyroid
FunctionalPseudodementia from depression, Malingering
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Investigations

Question Answer
Head CTExclude multiple infarcts, Mass lesions
EEGFocal pathologies
MRIVentricles, mass lesions
BiochemistryDehydration, hepatic or kidney failure, Delirium
CBPInfection, anaemia pointing to B12/folate deficiencies
TFTHypothyroidism
B12/FolateNutritional deficiency
LPCNS infection, CSF pressure, Demylenating disease
SPECTBlood flow imaging
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Alzheimer's Pathology

Question Answer
Neuritic PlaquesExtracellular lesions with filaments around a central amyloid core. Found in hippocampus and parietal lobes
Neurofibrillary TanglesIntracellular lesions of tau proteins close to the nucleus. Mostly found in pyramidal cells
Gross StructureSmall brain, atrophy of gyri especially superior and middle temporal gyri.
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Alzheimer's Tx

Question Answer
GoalReduce symptoms. Not curative or significant slowing of progression
Acetycholinesterase inhibitorsDonepoezil, Rivastigmine, Galantamine
NMDA antagonistMemantine
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