Post on 11-Feb-2016
description
Dementias: Common causes and Their Treatments
Presented by:Mehran HomamDepartment of Neurology
Azad university
Dementia
Progressive deterioration of intellect, behavior and personality as a consequence of diffuse disease of the brain hemispheres, maximally affecting the cerebral cortex and hippocampus.
Dementia is a symptom of disease rather than a single disease entity!!!
Dementias – causes
1-Alzheimer‘s disease (~60% of all dementias) 2-Cerebrovascular (multiinfarct state, subcortical small vessel,
amyloid angiopathy,…) (~20%) 3-Neurodegenerative (DLB, Pick‘s disease, Huntington‘s chorea,
Parkinson‘s disease)4-Infectious (Creutzfeld-Jakob disease, HIV infection, progressive
multifocal leucoencephalopathy)5-Normal pressure hydrocephalus TREATABLE!6-Nutritional (thiamine deficiency in alcoholics!, B12 deficiency, folate
deficiency)7-Metabolic (hepatic disease, thyroid d., parathyroid d., Cushing‘s
syndrome)8-Chronic inflammatory (MS, …)9-Trauma (head injury, ’Punch drunk‘ syndrome)10-Tumor (e.g. subfrontal meningioma)
1-Alzheimer’s Disease
-60-80% of cases of dementia in older patients-Memory loss, personality changes, global cognitive
dysfunction and functional impairments-Apraxia-Language disturbances -Personality changes-Visual spatial disturbances (early finding)Delusions/hallucinations (usually later in course)
1-Alzhimers Disease:treatment
1-Ach E Inhibitors:Exelon/Aricept/galantamine2-Memantine: NMDA antagonist3-Vit E4-Ginko5-nsaids6-Ssris7-antipsychotics:Quetiapen/olanzaine/rispiridone8-gene therapy & monoclonal antibodies
the most important:support of patient & family
2-vascular Dementia
-its present in many cases of Alzhimers disease
-25 to 30% of patients admitted for acute strokes were found to demented 3 months after event
-it should be differentiated from abulia or aphasic syndromes
2-vascular Dementia;treatment
-Prevention of subsequent vascular events -Depression is common serteraline is choice-Tricyclic antidepressents should be avoided-New researches shows benefical effects of
cholinestrae inhibitors-it seems risk factors of cva are same as alzheimer!
Normal pressure hydrocephalus
term applied to the triad of:DementiaGait disturbanceUrinary incontinenceoccuring in conjunction with hydrocephalus and normal
CSF pressure.
Two types: NPH with a preceding cause (SAH, meningitis, trauma,
radiation-induced).NPH with no known preceding cause – idiopathic (50%).
Normal pressure hydrocephalus-treatment
1-ethiologic cause if present2-drugs which reduce csf production3-surgery:shunt4-symptomatic treatment.
AIDS Dementia complex
-the most common in young adults in western countries-Approximately two-thirds of persons with AIDS develop
dementia, mostly due to AIDS dementia complex.-In some patients HIV is found in the CNS at postmortem.
In others an immune mechanism or an unidentified pathogen is blamed.
-Dementia is initially of a "subcortical " type.-CT - atrophy; MRI - increased T2 signal from white matter.-Treatment with Zidovudine (AZT) halts and partially revers
neuropsychological deficit.
Adults and children living with HIV/AIDS as of end 2009
Western Europe520 000520 000
North Africa & Middle East
220 000220 000Sub-Saharan
Africa23.3 23.3
millionmillion
Eastern Europe & Central Asia360 000360 000
South & South-East Asia
6 million6 millionAustralia & New Zealand
12 00012 000
North America920 000920 000
Caribbean360 000360 000
Latin America1.3 1.3
millionmillion
Total: 73.6 million 99000-E-1 – 1 December 1999
East Asia & Pacific530 000530 000
Trauma
reduction of intellectual function is common after severe head injury.
Chronic subdural haematoma can also present as progressive dementia, especially in the elderly.
Punch-drunk encephalopathy (dementia pugilistica) is the cumulative result of repeated cerebral trauma. It occurs in both amateur and professional boxers and it manifests by dysarthria, ataxia and expy signs associated with ’subcortical‘ dementia. There is no treatment for this progressive syndrome.
Subdural hematoma
Tumor
-Dementia rarely may be due to intracranial tumour, especially when tumours occur in certain anatomical sites.
-Mental or behavioral changes occur in 50-70% of all brain tumours as distinct from dementia which is associated with frontal lobe tumours, III ventricle tumours and corpus callosum tumours.
-Cognitive impairment also occurs as a non metastatic complication of systemic malignancy.
Treatable causes 0f Dementia
D;Depression E:Endocrine M:Metabollic(B12) E:Encephalitis N:Neoplasm T:Trauma I:Infection A:Alchol
Conclusion
1-common causes could managed better than previous2-causes are different and their prevalence may change in
future3-mixed types may present4-physician should not forget treatable causes