Dementia

Definition:
Progressive deterioration of the intellectual and cognitive functions typically with preservation of the level of consciousness.
 

Epidemiology:

  • Over age 65 there is 6% prevalence.  

  • Over age 85 the prevalence increases to 20%.

  • 25% of stroke patients will develop dementia. 

  • Hospital based-study in Saudi Arabia showed a frequency of dementia in general was 19.3/100,000 patients.

 

Risk factors:
Increasing age: the most important risk factor. 

  • Family history. 

  • Gender (female: male ratio is 2:1).

 

Etiologies:

Study guide:

*NPH: normal pressure hydrocephalus, PML: progressive multifocal leukoencephalopathy, CJD: creutzfeldt jakob disease.

Types:

  1. Primary neurological disease:

    1. Alzheimer’s disease

    2. Vascular dementia

    3. Space occupying lesions

    4. NPH

    5. Dementia with Lewy bodies

    6. Pick’s disease

    7. Parkinson’s, Huntington’s disease.

  2. Infections:

    1. HIV

    2. Neurosyphilis

    3. CJD

    4. Cryptococcal CNS infection

    5. PML

  3. Metabolic diseases:

    1. Thyroid disorder

    2. B12, niacin, thiamine deficiency

  4. Drugs and Toxins:

    1. Alcohol

    2. Aniline dyes

    3. Lead  

  5. Psuedodementia (severe depression)

Diagnosis:

  • Laboratory tests:

    • CBC with differential

    • Chemistry panel

    • Thyroid function tests o VLDRL (syphilis)

    • VLDRL (syphilis)

    • B12 and folate

    • HIV screening

    • CT or MRI of the head

Management:

  • Treat the reversible causes.

  • B12 and folate

  • HIV screening

  • CT or MRI of the head

  • Monitor the patient’s medications: opioids, lithium, hypnotics, anxiolytics, anticholinergic, and glucocorticoids).

  • Treat and control the comorbidities: HTN, DM, visual and hearing impairments. o Vitamin E supplements.

  • Biopsychosocial approach through multidisciplinary team method.

  

 

 

References:

  1.  Le, Tao, Vikas Bhushan, and Herman Singh Bagga. First Aid For The USMLE Step 2 CK. New York: McGraw-Hill Medical, 2010. Print.

  2.  Yogarajah, Mahinda. Neurology. Edinburgh: Mosby/Elsevier, 2014. Print.

  3.  Agabegi, Steven S, Elizabeth D Agabegi, and Adam C Ring. Step-Up To Medicine. Philadelphia: Wolters

    Kluwer/Lippincott Williams & Wilkins, 2013. Print.

  4. Kumar, Parveen J, and Michael L Clark. Kumar & Clark's Clinical Medicine. Print.

  5. Hauser, Stephen, and Scott Josephson. Harrison's Neurology In Clinical Medicine. 3rd ed. McGraw Hill. Print.

  6. Le, Tao, Vikas Bhushan, and Herman Singh Bagga. First Aid For The USMLE Step 2 CK. New York: McGraw-Hill

    Medical, 2010. Print.

  7. N.p., 2015. Print.  

First author:        Roaa amer

                           Abdullah AlAsaad
Second author :  Lama Al Luhidan

Web Publisher :  Adel Yasky

Audio recording:
​Read by: Amal Alfarhan
​Directed by: Rana Alzahrani
Audio production: Bayan Alzomaili