بسم الله الرحمن الرحیم

1. بسم الله الرحمن الرحیم

2. Dementia • Dementia is a condition characterised by a progressive decline of mental abilities accompanied by changes in personality and behaviour. • There is a loss of memory and skills that are needed to carry out everyday activities.

3. Dementia is a complex syndrome Cognitive • Amnesia Apraxia Aphasia Agnosia Behavioral Behavioral disturbances • Psychological / psychiatric symptoms Functional Personal ADL Instrumental ADL

4. whyDifferential Diagnosis?

5. Differential diagnosis : • 1- functional Disorders: • 2-Other Dementias • 3-Medical (NPH)…….. • 4-Delirium • 5-MCI • Medical (NPH)……..

6. Differential diagnosis • Functional : • Mania ,hypomania (in the most patients • The symptoms and signs of functional illness are clear) • Cognitive impairment ccurs in 40-60 percent of symptomatic bipolar elderly • Attention ,executive function and memory • Poor prognosis, prodrome of dementia

7. Differential diagnosis • Functional: • Schizophrenia( early onset and late onset) • Rarly very late onst sch. • cognitive symptoms increase than normal aging

8. Differential diagnosis • Functional : • depression • DePression with reversible dementia • Isolation ,memory loss, …… • prodrome of dementia(20 percent per yer) • 9

9. Differential diagnosis :depression • Onset • Response • Risk factors • Fh • Other symptoms

10. Differential diagnosis • Depression –executive dysfunction syndrome (damage to frontostriatal circuits) • executive dysfunction,psychomotor retardation reduced interest in activities and response to antidepresants

11. Differential diagnosis • 2-Other Dementias: • Vascular dementia (10-20 percent of the • Old age dementia) • Frontotemporal dementia • Lewy body dementia

12. Vascular Dementia Lewy Body Dementia Acute onset Stepwise Risk factors Gait Neurological Hallucinations Fluctuations Visuospatial Parkinsonism Alzheimer’s Disease Frontotemporalal Dementia Gradual onset Memory loss Normal examination Behavioural Language Family hx Young onset

13. Medical NPH Endocrine: hypothroidism,cushing Tumour, Toxin, Trauma Infection, Immunologic, Drugs;anticholinergic agents Metabolic Nutritional

14. Mild Cognitive Impairment • functioning well and do not meet clinical criteria for dementia atients who are memory impaired but are otherwise are classified as having MCI • Symptoms include • Memory complaint • Objective memory impairment • Normal general cognitive function • Intact activities of daily living • Not demented • Patients with MCI should be recognized and monitored for cognitive and functional decline due to their increased risk for subsequent dementia

15. delirium • Syndrome of : • Disturbed consciousness ,cognition and with perception and behavioral symptoms • Acute onset • Flactuative course • History for dementia • Subtypes:hyperactive and hypoactive

16. Delirium ? Depression ? Reversible causes ? Dementia ? MCI ?? Acute onset Stepwise Risk factors Gait Neurological Gradual onset Memory loss Normal examination Hallucinations Fluctuations Visuospatial Parkinsonism Behavioural Language Family hx Young onset Vascular Dementia Lewy Body Dementia Frontotemporal Dementia Alzheimer’s Disease

17. وبه طور خلاصه: • شرح حال در زمینه موارد زیر: • نحوه شروع علایم،حاد یا تدریجی • تغییرات در طول زمان • سابقه خانوادگی • ریسک فاکتورها • بیماریهای زمینه ای • علایم همراه • سایکوموتور

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