Dementia

Dementia
Dementia is characterized by multiple cognitive deficits that include impairment in memory

without impairment in consciousness.The cognitive functions that can be affected in
dementia include general intelligence, learning and memory, language, problem solving,
orientation, perception, attention and concentration, judgement and social abilities.
Epidemiology
Dementia is essentially a condition of older people. In the US about 5% of the people older
than 65 yrs of age have dementia and 15% have mild dementia. Those older than 80 years
of age -20% have severe dementia.
Type and prevalence

The most common type of dementia is the dementia of Alzheimer’s type, the second most
common type is Vascular dementia which is causally related to cerebrovascular diseases,
Hypertension predisposes a person to the disease.
Vascular dementia accounts for 15-30 % of all dementia cases, occurs in ages between
60-70 years , more common in men than women.
Causes
Common causes of dementia include head trauma, alcohol related
dementia, various movement disorder related dementia such as Huntington’s
disease and Parkinson’s disease.
1. Neurochemicals: The neurotransmitters that are most often implicated in

Pathophysiological conditions of Alzheimer’s disease are acetylcholine and
norepinephrine, both of which are hypothesized to be hypoactive. Other data in
support of a cholinergic deficit in Alzheimer’s disease are those that demonstrate
decrease in acetylcholine concentrations in the brain. Choline acetyltransferase is the
key enzyme for the synthesis of acetylcholine. Further the cholinergic antagonists like
the scopolamine and atropine impair cognitive abilities. On the other hand,cholinergic
agonists such as physostigmine and arecoline enhance cognitive abilities.Aluminium
toxicity has been proven to be a causative factor , but is not considered a significant
etiological factor.
2. Vascular Dementia, formerly referred to as multi- infarct dementia, is presumed to be

multiple cerebral vascular disease, resulting in a symptom pattern of dementia. This
disorder affects primarily small and medium sized cerebral vessels which undergo
infarction and produce multiple parenchymal lesions spread over wide areas of the
brain. The causes of the infarctions may include occlusion of the vessels by
arteriosclerotic plague or Thromboembolic from distant organs (such as heart
valves).
3. Pick’s Disease : is characterised by a preponderance of atrophy in the fronto.

Temporal regions. Pick's disease is difficult to distinguish from dementia of the
Alzheimer’s type although the early stages of Pick disease are often characterised by
personality and behavioural changes with a relative preservation of other Cognitive
functions. Features of Kluwer pricy syndrome like hypersewality, Placidity,
hyperorality also could be seen in pick’s disease.
4. Lewy Body Disease: is a dementia similar to Alzheimer’s disease, often

characterized by hallucination & EPS. Huntington’s Disease: the dementia in this
disease in the subcortical type characterized by more motor abnormalities and fewer
language abnormalities than in cortical type of dementia. Huntington disease exhibits
psychomotor slowing and difficulty with complex tasks, but memory language and
Insight remain relatively intact in the early and middle stages of them.
Treatment
The general treatment approach to patients with dementia is to provide supportive medical
care, emotional support for the patients and their family members and the pharmacological
treatment.Symptomatic treatment also includes the maintenance of a nutritious diet, proper
exercise, recreational and activity therapies, attention to visual and auditory cues, treatment
of any co-morbidities like urinary tract infections, ulcers, cardiopulmonary dysfunctions.
Particular attention must be provided to the caretakers and family members who deal with
frustrations, grief, and psychological burnout as they care for a patient over a long
period.Therapeutic sessions must be planned in such a way, that you see a patient on
regular basis-once a week initially and gradually once in fortnight, gradually space out.
Evaluate for suicide potential or self harm, Restrict Driving. Educate the family about the
disease, financial decisions, living wills, support groups, community organizations.
Psycho-Social treatment includes Stimulation oriented treatment,Recreational Activity, Art
Therapy,Dance/ Movement Therapy,Pet Therapy,Reminiscence Therapy,Cognitive or Reality
Therapy.
Drug Therapy:- To follow the medical prescription as per the medical consultant religiously
and regularly. Any changes in behaviour , to report to the Physician immediately for further
advice.

Dementia

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Dementia

Dementia is characterized by multiple cognitive deficits that include impairment in memory

Type and prevalence

1. Neurochemicals: The neurotransmitters that are most often implicated in

2. Vascular Dementia, formerly referred to as multi- infarct dementia, is presumed to be

3. Pick’s Disease : is characterised by a preponderance of atrophy in the fronto.

4. Lewy Body Disease: is a dementia similar to Alzheimer’s disease, often

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