Progressive global decline in intellectual & memory function interfering with social/professional activity
10% of 65+. Rises sharply with age
Low level of education, age, Family history, head injury
from 3rd party.
Psychiatric (pseudodementia = depression)
Cardiac risk factors (it is thought that vascular
deterioration plays a part in Alzheimers). IQ (can mask sx).
Loss of recent memory (long-term goes last). Impairmeent of judgement.
Changes in personality. Disorientation in time & space.
Expressive and then receptive aphasia. Hygiene & behaviour
including wandering, aggression, disinhibition. Reduced level of
activities of daily-living (ADLs). Incontinence. Loss of insight,
visuospatial deficiency, apraxia.
Minimental test: (out of 30) is a good screening test for dementia
Neurological (parkinsons, stroke, normal pressure hydrocephalus - gait
glued to floor, change in cognitive function, incontinence)
tests: Sodium, calcium, γGT (alcoholism), TFTs (Hypotyroidism),
B12/folate deficiency (Wernickes), anaemia, syphilis serology
(VDRL, TPHL), inflammatory markers (UTI etc.)
CXR: prone to aspiration pneumonia in later stages
CT, MRI head: has there been a stroke?
SPECT scan: an expensive radiological investigation
DAT scan: exclude parkinsonism
Alzheimers, vascular dementia
Lewy-body, fronto-temporal, Downs, tumour, extrapyrimadal, Huntingtons
Normal Pressure hydrocephalus, alcohol abuse, neurosyphilis, hypothyroidism, Vit B12 deficiency, pseudo-dementia, neoplasms
Alzheimers (70%) Dementia
in the young ♂=♀. In the old ♂<♀. Unremitting.
2 copies of ApoE E4 allele on ch19
Sev atrophy with increased siize of ventricles & widened sulci.
Microscopically neurofibrillary tangles & senile plaques seen.
history and CT showing atrophy
Explanation, advice, support of relatives
Multidisciplinary: societies, social services, psychiatrists
Medical: cholinesterase inhibitors (galantine, dorepezil, rivastigmine), memantine
2-10 years after diagnosis. Patients
often die of aspiration pneumonia as they lose coordination of the
swallow reflex in the latter stages. Also UTIs and pressure sores.
Lewy Body (10%)
Widespread Lewy bodies in cerebral cortex
Parkinsonism features (but unlike parkinsons these patients
with dementia), progressive dementia, fluctuation in mental state, early visual hallucinations & behaviour disturbance.
onset, step-wise deterioration. Cognitive impairments (selective &
uneven), minor neuro signs (dysphasia or hemiparesis), confusion,
episodes, headache & dizziness, underlying vascular disease (e.g.
DM). Personality is preserved until late.
CT (infarction, small vessel disease)
Underlying cause (cardiovascular risk factors such as cholesterol), low dose aspirin
age range of 45-65 years.
change in personality, ↓judgement/responsibility/planning, inappropriate sexual/theft, mood swings, preference for sweet foods.
fluent aphasia + fluent speech with no content & lots of “things”,
impaired everyday memory. Delusions + hallucinations seen early.
Prognosis 5-10 years.
Global acute disruption of cognitive function. Usually changes in conscious level. Responds well to treatment.
Half of those with delirium have dementia
of consciousness, impairment of orientation, failure of recent memory,
poor concentration, visual hallucinations, fluctuations with lucid
intervals. Abrupt onset.
Many causes including:
Acute infection: any, but very often UTI
Cardiac/Respiratory: ↓BP and hypoxia leads to ↓cerebral perfusion
Electrolyte imbalance: especially hyponatraemia, hypo/hyperglycaemia, hypercalcaemia
Avoid sedation: causes falling & ↓respiration
Small dose antipsychotic may be useful but unlicensed for this purpose:
consider if it is in the best interest of the patient
Structured routine: same nurses, visits by family, ↓noise, dim lights at night, help feeding
Stimulation: including music and books