1 / 19

The Dementias

The Dementias. Dr Giles Richards Consultant Psychiatrist CFT. Some predictions: in 10 years time. Number of people over 65 yrs will increase by 15% Number of people over 85 yrs will increase by 27%

lei
Download Presentation

The Dementias

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Dementias Dr Giles Richards Consultant Psychiatrist CFT

  2. Some predictions: in 10 years time • Number of people over 65 yrs will increase by 15% • Number of people over 85 yrs will increase by 27% • 60% older people have long standing illnesses ( mental illness more common and worse outcomes)

  3. Some figures • 700,000 people with Dementia • Will rise to 1.4 million • £17bn per annum on care (£12bn cancer) • Set to rise to £50bn • £27,000 per person • Cancer research £590 m (£50m)

  4. DEFINITION OF DEMENTIA (WHO 1993) • Syndrome due to disease of the brain, • Usually chronic / progressive in nature. • Impairment of multiple higher control functions e.g. memory, orientation, comprehension, calculation, learning, language and judgement. • Consciousness is not clouded. • Often accompanied by poor emotional control, social behaviour or motivation.

  5. New Definitions • Amyloid weighting • ApoE4 • CSF studies (phosphorolated Tau) • Hippocampus volume assessment • PET scanning

  6. Diagnostic Process • History • Mental State Exam • Examination • Investigations

  7. Investigations • Bloods • ECG • EEG • Scans: • CT, • MRI, • SPECT, • PIB

  8. RISK FACTORS • Family History x 3 • Family History of Parkinson’s Disease • Down’s Syndrome • Head Injury - Beta Amyloid • Neurotoxins - Aluminium / Zinc (inconclusive), Organophosphates • Educational Background

  9. CAUSES OF DEMENTIA • Alzheimer’s • Vascular Disease • Frontal Lobe Dementia • Huntingdon’s • Parkinson’s • Lewy Body Dementia • Brain Diseases • Normal Pressure Hydrocephalus

  10. Pathology • Atrophy (brain weight) • Widened sulci, narrowed gyri, enlarged ventricles • Amyloid Plaques (Beta secretase) • Neurofibrillary Tangles (phosphorolated Tau) • Hirano bodies

  11. Diagnosis • Probable LBD • Possible LBD • Differential diagnosis

  12. DIAGNOSIS (1) • Central Features: • Progressive cog decline, Memory (late), attention,exec function, visuospatial. • Core Features: • Fluctuating cog, Visual hallucinations, Spontaneous features of Parkinson's

  13. DIAGNOSIS (3) • Suggestive Features: • REM sleep behaviour, Neuroleptic sensitivity, changes on imaging • Supportive features: • Falls, transient LOC, autonomic dysfunction, delusions, other modes hallucinations, dep, EEG changes, occiput SPECT changes

  14. Diagnosis (4) • Less likely if: • Cerebrovascular disease present, other process to account in part for symptoms, Parkinson's appears late on. • Parkinson's Dementia • “ the 1 year rule”

More Related