Dementia: A Factor in Complex Health Matters

1. Dementia: A Factor in Complex Health Matters Partners in Care… Living in the Moment Alzheimer’s Society conference March 6, 2007 Dr. Suzanne Thille

2. 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

3. 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.

4. 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

5. Secondary features • Repeated falls • Syncope • Neuroleptic sensitivity • delusions

6. 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

7. 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

8. 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

9. Treatment- prevention • Hypertension • Cigarette smoking • Heart disease • Diabetes • Hyperlipidemia • Management of behavioural symptoms, psychosocial aspects, and caregiver stress.

10. Others • Others with neurologic features • Cognitive impairment with medical illness • Cognitive and neurological conditions due to alcoholism

11. 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.