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DEMENTIA NOOR HAFIZAH BT HASSAN  2007287236
REFERENCES: ,[object Object],[object Object],[object Object],[object Object],[object Object]
INTRODUCTION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DSM IV DIAGNOSIS
EPIDEMIOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
AETIOLOGY
 
DEMENTIA OF ALZHEIMER’S TYPE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SENILE  PLAQUES NUEROFIBRILLARY  TANGLES
[object Object]
DIFFERENTIATING FEATURES ALZHEIMER’S  DISEASE VASCULAR  DEMENTIA ETIOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object],AGE OF ONSET  Usually > 65 y/o  Less common in those > 75 y/o  ONSET OF SYMPTOMS Insidious Abrupt  COURSE OF ILLNESS Steady progression in function decline Worsening dementia PATTERN OF  COGNITIVE DEFICIT Global  Patchy: depending on the area of the brain affected RADIOLOGICAL  FINDINGS Diffuse cerebral  atrophy with  ventricle enlargement Multifocal  infarcts
ASSESSMENT OF DEMENTIA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PHYSICAL  EXAMINATION: - To exclude  treatable and  reversible  causes of  dementia ,[object Object],[object Object],[object Object]
 
CLOCK DRAWING TEST ,[object Object],[object Object]
SUMMARY OF MANAGEMENT Non pharmacological intervention Pharmacological treatment General principles ,[object Object],[object Object],[object Object],[object Object],[object Object]
SUMMARY OF MANAGEMENT Non pharmacological intervention Pharmacological treatment General principles ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SUMMARY OF MANAGEMENT Non pharmacological intervention Pharmacological treatment General principles ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CHOLINESTERASE INHIBITOR Donepezil (Aricept)  5-10 mg OD - For all stages of Alzheimer’s disease Rivastigmine (Exelon)  6-12 mg BD - For mild to moderate Alzheimer’s disease Galantamine (Reminyl)  16-24 mg BD - For mild to moderate Alzheimer’s disease
NMDA INHIBITOR ,[object Object],[object Object],[object Object]
THANK YOU

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Dementia Management Guidelines

Editor's Notes

  1. Course of the dss can be: Static Permanent Reversible: 15% chance. Potential of reversibility related to u/lying pathology and availability of rx. Better b4 irreversible brain damage occur.
  2. NEUROFIBRILLARY TANGLES: - not pathognomonic of AD. Can also be found in normal ppl, Down’s syndrome. - location: cortex/hippocampus/substantia nigra/locus ceruleus -components: phosphorylated tau protein 2. SENILE PLAQUES: - more suggestive of AD - aka amyloid plaques - no. of senile plaques correlate with disease severity
  3. 1.Treatment goals: treat u/lying cause, if exist provide rehab to mx deficit consider modified living situations or housing options to ensure pt safety provide reassurance, support, and familiarity to the pt 2. Treat the main distressing prob first: evaluate suicidal risk evaluate potential violence recommend adequate supervision prevention of falls minimize hazards of wandering restriction of driving/use of dangerous equipment
  4. 1.Treatment goals: treat u/lying cause, if exist provide rehab to mx deficit consider modified living situations or housing options to ensure pt safety provide reassurance, support, and familiarity to the pt 2. Treat the main distressing prob first: evaluate suicidal risk evaluate potential violence recommend adequate supervision prevention of falls minimize hazards of wandering restriction of driving/use of dangerous equipment
  5. 1.Treatment goals: treat u/lying cause, if exist provide rehab to mx deficit consider modified living situations or housing options to ensure pt safety provide reassurance, support, and familiarity to the pt 2. Treat the main distressing prob first: evaluate suicidal risk evaluate potential violence recommend adequate supervision prevention of falls minimize hazards of wandering restriction of driving/use of dangerous equipment
  6. MOA: inhibit cholinesterase enzyme  inhibit breakdown of acetylcholine  by maintaining Ach level, the drug helps to compensate for the loss of functioning brain cells Adverse effect: nausea, vomiting, muscle cramps, insomnia, brady, dizziness. marked on D2-D4 of initiating rx.