Dementia in Neuroscience

DEMENTIA IN NEUROSCIENCEDEPARTEMENT OF NEUROLOGYCHRISTIAN UNIVERSITY OF INDONESIAMEDICAL FACULTYDEFINITION OF DEMENTIADEMENTIA-the disease with acquired deterioration in cognitive/ intellectual abilities without impairment of consciousnessognitive de!cit represent a decline from previous level of functioningDSM IV DIAGNOSTIC CRITERIA"# Memor$ impairment%# At least one of the following&AphasiaApra'iaAgnosiaDisturbance in e'ecutive functioning(# Disturbance in " and % interferes with dail$ function)# Does not occur e'clusivel$ during deliriumTEN WARNING SIGNS OF DEMENTIA"# Memor$ loss that a*ects +ob s,ills%# Di-cult$ performing familiar tas,s(# .roblems with language)# Disorientation to time and place/# .oor or decreased +udgment0# .roblems with abstract thin,ing1# Misplacing things2# hanges in mood or behavior3# hanges in personalit$"4# 5oss of initiativeEPIDEMIOLOGY6 / to 2 7 at age 0/ to 146 "/ to %4 7 at age 1/ to 24up to )4 to /4 7 over age 2/6 / to 2 7 at age 0/ to 146 "/ to %4 7 at age 1/ to 24up to )4 to /4 7 over age 2/ Al8heimer9s disease is most common dementia /4-1/7 Dementia with 5ew$ bodies "/ to (/ 7 :ascular dementia / ; %4 7 Al8heimer9s disease is most common dementia /4-1/7 Dementia with 5ew$ bodies "/ to (/ 7 :ascular dementia / ; %4 7ETIOLOGYNEURO-DEGENERATIVEAlzheimer' D! Deme"#i$ %i#h Le%& '()ie! Fr("#(-#em*(r$l )eme"#i$! P$r+i"(", D:A Infarction? @emod$namic insu-cienc$NE=>A5ABIA5 Multiple INE @$poth$roidismN=T>ITIANA5 Def# of :it# C"%D ThiamineD NiacinINEETIA=enal Insu-cienc$? FilsonGs DsT>A=MATI ule out correctable or contributor$ causes of dementiaImaging& omputed tomograph$ without contrast or magnetic resonance imaging>ule out infarctsD mass lesionsD tumorsD and h$drocephalusNeurological e'amination orrelate imaging !ndings with clinical e'aminationNeurops$chological testing Mini-Mental ecurrent stro,es - I- multiple areas of infarctionCinswangerGs disease - Di*use white matter disease- 5acunar infarctionlinical Manifestation&SonfusionD personalit$ changesD ps$chosisS.$ramidal signs I cerebellar signs TSBait disorderD urinar$ incontinenceD d$sarthriaSEmotional labilit$

Fr("#(#em*(r$l Deme"#i$Fr("#(#em*(r$l Deme"#i$3ften begins "ith $ar,ed -eha.i/ra( dist*r-ances, unlike A*&lassic form 8 'ic,+s disease$atients fre4uently hot'tempered and socially disinhibited memory+ #isuo spatial skills spared-mpaired planning,judgement and languageEcholalia 93#erlap "ith $S$,&0*, motor neuron disease-llness 0r/gresses 1/r 2ears, like A*-ne#itable dec(ineM3I4 (/-ar atr/0h2 /1 1r/nta( and5/r te$0/ra(About :;< of patients ha#e 1a$i(2 hist/r2 LEWY 'ODY DEMENTIA5ew$ bod$ dementia ma$ present as&late onset .ar,insonGs disease followed months or $ears later b$ visual hallucinationsD episodes of confusionD memor$ loss and then global dementiaD or cognitive or ps$chiatric s$mptoms followed b$ milder .ar,insonian features later in the course of the disease#To diagnose 5ew$ Cod$ disease&Ouctuating cognitive performance with episodes of confusion hallucinations and/or paranoid delusions earl$ gait disturbance an$ combination of rigidit$D brad$,inesiaD tremor and Oe'ed posture temporoparietal dementia with inattention in a patient with .ar,insonGs disease TREATMENT FOR DEMENTIAholinesterasi InhibitorDonepe8il JAriceptK>ivastigmine JE'elonKBalantamine J>emin$lKMemantineEbi'aA'uraMEDICATION TO AVOID IN ALL PATIENTS WITH DEMENTIAQJDementiaandognitiveImpairmentDiagnosisandTreatment Buideline#Availableathttps&//www#ghc#org/all-sites/guidelines/dementia#pdfKRMEDICATION RATIONALETri.&.li. $"#i)e*re$"# 5TCA6Amitript$lineD amo'apineD clomipramineD desipramineD do'epinD imipramineD nortript$lineD protript$lineD trimipramine