Dementia management

1. Dementia
http://crisbertcualteros.page.tl

2. Dementia
 Is a syndrome encompassing deficits in several
cognitive domains
 Initial presentation: memory loss over months or
years
 Days: stroke/ infection
 Weeks: depression
 Later stages: aggitation, aggresion or apathy

3. Prevalence
 Rare: <55yo
 5-10%: >65 yo
 20%: >80 yo
 70%: >100 yo

4. Diagnosis
 Good history
 Timeline of the progression of impaired
cognition/memory
 What was noticed first
 How it affects the ADL & their ability to
cope with task
 ASK: agitation, aggression, hallucination,
wandering, slow repetitious speech,
apathy, mood disturbance

5. Cognitive testing: abbreviated mental test score
 Abbreviated Mental Test Score: 6 or < suggests
delirium/dementia
A score of 6 or less suggests delirium or dementia

6. Physical Exam
Identify:
physical cause of the cognitive
impairment
risk factors
parkinsonism

7. Investigation
 FBC, ESR, U&E, Ca, LFT, TSH,
autoantibodies, B12/Folate,
 CT/MRI: for vascular damage,
hemorrhage, struc pathology
 Syphilis serology
 EEG
 CSF
 Metabolic, genetic or HIV test

8. Cause
1. AD: most common cause
2. Vascular dementia:
 25%, cumulative effects of small strokes
 Sudden onset
 High BP
 past strokes
 focal CNS signs

9. Cause
3. Lewy Body Dementia
 3rd cause
 Fluctuating cognitive impairment
 Detailed visual hallucinations
 Parkinsonism
 Histology: lewy body in brainstem &
neocortex

10. Rare causes
 Alcohol/drug abuse
 Repeated head trauma
 Pellagra
 Whipple’s disease
 Huntington’s disease

11. 1. Fronto-temporal dementia
 Executive impairment
 Behavioral/ personality change
 Early preservation of episodic memory &
spatial orientation
 Disinhibition
 Hyperorality
 Stereotyped behavior
 Emotional unconcern

12. management
 Care coordinator
 Capacity: can the patient make decisions
on medical/ financial affairs?
 Who will care for the care-giver? Care-
giver support group

13. Challenging behavior
 r/o pain/infection for worsening behavior
1. Trazodone 50-300mg ON or
 Lorazepam 0.5 mg OD – 2mg BD
2. Aggitation: quetiapine, respiridone, olanzapine,
haloperidol
3. Depression: SSRI: Citalopram 10-20mg OD,
 If severe dep: mirtazapine15-45mg at night

14.  http://crisbertcualteros.page.tl