Classification of Dementia

7/28/2019 Classification of Dementia

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C H A I R P E R S O N : D R . K R I S H N A M U R T H YP R E S E N T E R : D R . P R I M A D SOUZA

CLASSIFICATION OF

DEMENTIA

03.08.2011


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Dementia is defined as a progressive impairment of

cognitive functions occurring in clear consciousness

Derived from the Latin word dementatus, meaning outof one's mind

Prevalence: moderate to severe dementia

5% in the general population >65 yrs

20-40% in the general population >85 yrs

Male to female ratio is 0.6 to 0.8


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Alzheimer's disease: 50% - 60%

Vascular dementia: 15%

Mixed vascular and Alzheimer's dementia:15%

Fronto-temporal dementias: 5%

Other dementias: 10% (Lewy body dementia, Pick's

disease, NPH, alcoholic dementia, infectious dementia)

Reversible dementias: 5%


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Better understanding of the disorder, uniformity

Underlying pathology, severity

Investigation and management

Availability and timely application of effective treatment

Prognosis and planning..


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Decline in memory- registration, storage and retrieval of

new information

Impairment of thinking, reasoning capacity and

reduction in flow of ideas

Impair personal activities of daily living

Evident for at least 6 months


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F00 Dementia in Alzheimers disease

F00.0 with early onset

F00.1 with late onset

F00.2 atypical or mixed type

F00.9 unspecified


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F01 Vascular dementia

F01.0 Vascular dementia of acute onset

F01.1 Multi- infarct dementia

F01.2 Subcortical vascular dementia

F01.3 Mixed cortical and sub cortical

F01.8 Other vascular dementia

F01.9 Unspecified


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F02 Dementia in other diseases classified elsewhere

F02.0 Dementia in Picks disease

F02.1 Dementia in Creutzfeldt-Jacob disease

F02.2 Dementia in Huntingtons disease

F02.3 Dementia in Parkinsons disease

F02.4 Dementia in HIV disease

F02.8 Dementia in other diseases classified elsewhere

F03 Unspecified dementia


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Multiple cognitive deficits including memory impairement

Plus atleast one of: aphasia, apraxia, agnosia or disturbance

in executive functioning

Sufficiently severe to cause impairement in occupational or

social functioning

Decline from previously higher level of

functioning

Exclude delirium


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294.1x Dementia of Alzheimers type

294.10 without behavioral disturbance

294.11 with behavioral disturbance

Specify subtype:

With early onset: onset is at 65yrs or below

With late onset: onset after age 65 yrs


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290.4x Vascular dementia

290.41 with delirium

290.42 with delusions

290.43 with depressed mood

290.40 uncomplicated

Specify: with behavioral disturbances


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Dementia due to General medical conditions:

.10 without behavioral disturbance

.11 with behavioral disturbance

294.1x Dementia due to HIV Disease

294.1x Dementia due to Head trauma

294.1x Dementia due to Parkinsons disease

294.1x Dementia due to Huntingtons disease

294.1x Dementia due to Picks disease

294.1x Dementia due to CJD

294.1x Dementia due to other GMC


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Dementia due to substance use

Dementia due to multiple etiologies

294.8 Dementia NOS


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Cortical

Sub cortical

Mixed


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SUBCORTICAL

No aphasia

Impaired recall> recognition Calculation preserved late

Executive functiondisproportionately affected

Cognitive processing slowed

early Personality apathetic

Mood depressed

Speech dysarthric

Posture bowed Coordination impaired

Motor speed slowed

Chorea, tremor, tics,dystonia

CORTICAL

Aphasia early

Recall = recognition Involved early

Consistent with otherinvolvement

Normal till late in disease

Unconcerned

Euthymic

Articulate until late

Upright

Normal until late

Normal

absent


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Primary:

Diseases, injuries & insults that affect the brain directly or

with prediliction

Alzheimers, Picks, dementia with Lewy bodies, Parkinsons

Secondary:

Systemic diseases/ disorders that attack the brain as one of

multiple organs or systems of the body involved

HIV dementia, nutritional deficiency, metabolic


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Degenerative dementias:

Alzheimer's disease

Frontotemporal dementias (e.g., Pick's disease)

Parkinson's disease

Lewy body dementia

Miscellaneous:

Huntington's disease

Wilson's disease

Metachromatic leukodystrophy

Neuroacanthocytosis


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Cardiovascular:

Infarction (single, multiple or lacunar)

Binswanger's disease (subcortical arteriosclerotic encephalopathy)

Hemodynamic insufficiency

Physiologic:

Normal pressure hydrocephalus

Metabolic:

Vitamin deficiencies (e.g., vitamin B12, folate)

Endocrinopathies (e.g., hypothyroidism)

Chronic metabolic disturbances (e.g., uremia)


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Tumor:

Primary or metastatic: e.g., meningioma or metastatic breast or

lung cancer

Traumatic: Dementia pugilistica

posttraumatic dementia

Subdural hematoma

Infections:

Prion diseases: e.g., Creutzfeldt-Jakob disease

Acquired immune deficiency syndrome

Syphilis


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Demyelinating diseases:

Multiple sclerosis

Drugs and toxins:

Alcohol Heavy metals

Irradiation

Pseudodementia due to medication (e.g.anticholinergics)

Carbon monoxide

Psychiatric:

Pseudodementia of depression

Cognitive decline in late-life schizophrenia


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Mild dementia:

Consistent forgetfulness that is more marked for recent events

Inability to function effectively in interests and more complex

activities (work, community, home, social activities)

Maintained social judgment

May require prompting to perform activities of daily living he or

she is able to complete independently these tasks


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Moderate dementia:

Short-term memory is poor

Long-term memory may be only slightly affected

Impaired social judgment

Cannot perform independently outside of the home

Activities in the home are usually limited to simple chores Interests are severely curtailed


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Severe dementia:

Severe memory loss-Severe deficits in long-term short-term

memory

Disorientation usually to time and place

Inability to independently function inside or outside of the

home,

Requirement of help with activities of daily living (toileting,

bathing, and eating)

Possible incontinence


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Profound dementia:

Patient is unintelligible & unable to follow simple

commands

Incontinent

Unable to ambulate or to accomplish purposeful tasks

May be bedbound, unresponsive, have swallowing

difficulties and contractures.


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Reversible/ Treatable dementias:

5% of dementias

Causes:

Metabolic: hypothyroidism, hypoparathyroidism

Normal pressure hydrocephalus

Nutritional deficiencies: vitamin B12 or folate deficiencies

Tumor or other space-occupying lesion-chronic SDH Infection: syphilis, AIDS

Drugs: any drug with anticholinergic activity

Emotional: depression


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Progressive /irreversible dementia:

Alzheimer disease

Vascular dementia

Dementia with lewy bodies

Fronto-temporal dementia

Huntingtons disease


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Senile dementia:

onset after age 65 yrs

Eg: Alzheimers disease

Presenile dementia:

onset before age 65 yrs

Eg: Picks, Huntingtons, HIV dementia


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1. Diseases in which dementia is associated with clinical

and laboratory signs of othermedical disease

HIV infection

Endocrine: hypothyroidism, Cushings

nutritional deficiencies

CNS infections

Chronic drug/ heavy metal exposure


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2. Diseases in which dementia is associated with other

neurologic signs but not with other obvious medical disease

A. Invariably associated with other neurologic signs

Huntingtons disease

Multiple sclerosis

Parkinsons disease

CJD, myoclonic epilepsy

B. Often associated with other neurologic signs Cerebral infarct, tumors, trauma

Lewy body disease

NPH


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3. Diseases in which dementia is the only evidence of

neurologic disease or medical disease

A. Alzheimer's

B. Picks

C. Some cases of AIDS

D. Fronto-temporal and frontal lobe dementias

E. Degenerative disease of unspecified type


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National Institute of Neurological Communicative

Disease and Stroke and the Alzheimer's Disease and

Related Disorders Association

Definite: based on histological evidence

Probable: based on clinical criteria

Possible: atypical features or coexisting disorders such as

Parkinsons disease


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PSEUDODEMENTIA

Onset well demarcated

History short

Rapidly progressive

H/o previous psychiatricdifficulty or recent crisis

C/o cognitive function

Affective change present

Behavior unaffected

No nocturnal exacerbation

Examination: I dont know,little effort spent

Inconsistent memory loss

Specific memory gaps

DEMENTIA

Indistinct

Long history

Initially unnoticed

Uncommon

Little c/o cognitive loss Apathetic, shallow

emotions

Compatible with memoryloss

Nocturnal accentuation Tries items, struggles with

tasks

Recent>remote, consistent

No specific memory gaps


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Memory impairement accompanied by abnormal memory

test scores

Normal cognitive function

Preserved activities of daily living

No social or occupational impairement

1020% progress to dementia yearly

Risk factors- degree of cognitive impairement

Evaluation similar to dementia

Treatment controversial


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Neurocognitive Disorders

Minor Neurocognitive Disorder (MCI), with the necessary

neurocognitive impairment in only one domain

Major Neurocognitive Disorder or Dementia-involve at

least two domains.

Memory impairment would not be necessary fordiagnosing either of these conditions.


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Subclassified according to etiologye.g.,

Alzheimer disease,

vascular neurocognitive disorder,

Frontotemporal degeneration,

Lewy Body disease,

Mixed (specify which ones),

Not otherwise specified


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Specifiers to better define the clinical condition

Course (transient, remitting, persistent but stable, persistent

and worsening, persistent with fluctuations)

Age of onset (


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4th century AD- Oribasius- a disease of cerebral atrophy thatcaused loss of intellectual capacity and weakness ofmovement

Esquirol: acute, chronic, and senile

Senile dementia was defined as a cerebral affectioncharacterized by a weakening of the sensibility,understanding and will

1845- Wilhelm Griesinger - senile dementia as a disease of thecerebral arteries

1907-Alois Alzheimer was the first to identify specifichistopathological changes associated with progressivedegenerative dementia

Aphasia, apraxia, agnosia, and the histopathological findingof neurofibrillary tangles and milar foci


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CORTICAL SUBCORTICAL

Aphasia early

Recall = recognition Involved early

Consistent with otherinvolvement

Normal till late in disease

Unconcerned

Euthymic

Articulate until late

Upright Normal until late

Normal

absent

No aphasia

Impaired recall> recognition Calculation preserved late

Executive functiondisproportionately affected

Cognitive processing slowed

early Personality apathetic

Mood depressed

Speech dysarthric

Posture bowed

Coordination impaired

Motor speed slowed

Chorea, tremor, tics,dystonia

Classification of Dementia

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