Transcript Dementia: A Factor in Complex Health Matters

Dementia: A Factor in Complex
Health Matters
Partners in Care… Living in the
Moment
Alzheimer’s Society conference
March 6, 2007
Dr. Suzanne Thille
Objectives
Appreciate that other types of dementia
exist that have their own additional
disabilities
Learn about some of the features and
peculiar problem of people with Lewy
Body Dementia
Learn about some of the features and
variety of types of Vascular dementias
Definitions
Dementia- progressive decline in 2 or more
cognitive domains resulting in functional
impairment. At least of 6 months duration.
Alzheimer’s 50-60% of cases
Memory and language. Physically well.
Delirium- acute decline in cognition (hours to
days in onset) with fluctuating cognition and
fluctuating activity.
Executive function- higher cognitive processes
where several cognitive functions are used.
Plans of action, complex tasks, planning ahead.
Lewy Body Dementia
Neurodegenerative disorder affecting all
levels of the brain
20% of dementias?
Primary features
Fluctuating cognition, especially attention
Visual hallucinations
Extrapyramidal signs- bradykinesia, rigidity
Secondary features
Repeated falls
Syncope
Neuroleptic sensitivity
delusions
Clinical Course
MMSE seems to under represent the severity of the
condition.
5-8 year survival
Treatment
Nonpharmacologic approaches for management of
behavioral symptoms, psychosocial aspects, and
caregiver stress
Cholinesterase inhibitors
Parkinsonism treatment
Antipsychotic treatment
Vascular Dementia
Multiple diagnostic criteria and names
suggested. i.e. Vascular cognitive impairment
15% of all dementias? May be mixed.
Group of differing conditions
Multi-infarct (multiple large complete infarcts)
8-25% of stroke have dementia as a result eventually
Strategic single infarct
Lacunar infarcts, small vessel disease
Hypoperfusion, chronic ischemia?
Hemorrhagic- subdurals, subarachnoid,
intracerebral
Vasculitis
General features
Abrupt onset
Stepwise
Impaired executive function, slowing
Gait disorder
Emotional lability, behavioral
Temporal relationship
Course- classically stable for a time but overall
pattern depends on future injuries
Treatment- prevention
Hypertension
Cigarette smoking
Heart disease
Diabetes
Hyperlipidemia
Management of behavioural symptoms,
psychosocial aspects, and caregiver stress.
Others
Others with neurologic features
Cognitive impairment with medical
illness
Cognitive and neurological conditions
due to alcoholism
Conclusions
 Though 50-60% of all dementias are Alzheimer’s
disease with little additional physical issue until later in
the disease, most of the remainder have other related
disabilities or issues.
 Lewy Body dementia has psychotic issues and or
impairment in gait. Some aspects look like delirium.
 Vascular dementias are variable but do not follow the
pattern of decline nor deficits expected with Alzheimer’s
disease. Physical findings may be present that help to
determine that a vascular cause exists. Prevention is
the main goal of intervention.