Dementia

Dementia is a global disorder of intellect, memory and personality that significantly disrupts normal daily activities that occur [1] after the development of cognitive functions (after the second year of life). The percentage of patients increases with age, 5% of the population suffers from dementia at the age of 65. Loss of cognitive functions interferes with all activities of the affected person.

  • Chronological course of performance decline in an individual:
  1. cognitive function affected;
  2. behavioral and emotional impairment;
  3. activities of daily living affected.

The clinical picture

  • forgetfulness;
  • spatial imagination and orientation disorder;
  • wandering;
  • disorders of executive functions (eg cookbooks forget how to cook, etc.);
  • reduced intellectual performance;
  • amnestic disorientation - a short-term memory disorder in which the sufferer does not remember where he or she is;

We also find dementia:

  • emotional disorders ( anxiety , depression );
  • behavioral disorders (aggression, restlessness);
  • perceptual disorders ( hallucinations );
  • sleep disorders ;
  • disorders of cortical functions ;
  • accessory symptoms - agraph , alexia , anuria , apraxia , agnosis .

Diagnosis

Orientation diagnostics:

  • Mini-Mental State Examination (MMSE):
30–27 points – standard;
26–25 points – mild cognitive impairment;
24–10 points – mild to moderate dementia;
9–6 points – moderate to severe dementia;
5–0 points – severe dementia.

Dementia of atrophic-degenerative origin

Alzheimer's disease

Alzheimer's disease

{More detailed information can be found on the pag|M. Alzheimer, clinical picture, treatment}}

Cortical dementia with Lewy bodies

PSymptoms similar to Alzheimer's disease and Parkinson's disease . However, there are also Lewy bodies in the microscopic image.

Symptoms:

  • a combination of dementia , parkinsonism and complex visual hallucinations is typical ;
  • paranoid-persecution delusions ;
  • hypersensitivity to antipsychotics - extrapyramidal manifestations worsen after them !;
  • often delirium ;
  • fluctuations during the day;
  • deficit of attention (!), verbal function and orientation in space.

Dementia in Parkinson's disease

In 10-20% of Parkinson's patients, it has a subcortical character.

Symptoms:

  • overall deceleration;
  • slow thinking ( bradypsychism );
  • difficult to remember new information.

Frontotemporal dementia

Pick disease
Frontotemporal dementia without Pick bodies
Progressive non-fluent aphasia

Left frontal cortex degeneration. Slow development of the disease.

Symptoms:

  • have difficulty reading and writing text;
  • inability to remember the right word;
  • inability to form a grammatically correct sentence;
  • truncates words into shapes that sound similar;
  • behavioral disorders.
Fluent progressive aphasia
  • semantic dementia.
Dementia with amyotrophy

Huntington's disease

AD inheritance, on chromosome 4 - CGA triplet. It starts in 3-5. decade.

Huntington disease (MRI)

Symptoms:

  • initially neurological symptomatology - choreatic limb movements , rigidity;
  • less pronounced subcortical dementia .

Progressive supranuclear palsy

= Steele-Richardson-Olszewski syndrome It belongs to Parkinson's type diseases.

Symptoms:

  • the disabled can only move their eyes horizontally
  • ends in death

Secondary (symptomatic) dementia

Ischemic vascular dementia

Other secondary dementia

Dementia infectious etiology

Metabolic dementia

  • dementia in hepatic encephalopathy;
  • dementia in uremic encephalopathy;
  • pellagra;
  • Wilson's disease (hepatolenticular degeneration);
  • acute intermittent porphyria .

Dementia intoxication

  • Alcohol's most common, simple alcoholic dementia resembles Alzheimer' disease
  • Pharmacogenicin which the cause of improper therapy, most are reversible, mainly anticholinergics, some benzodiazepines.
  • carbon monoxide .
  • drugs.

Traumatic dementia

  • posttraumatic
    • extensive contusions;
    • apallic syndrome;
      • traumatic brain stem damage;;
      • failure of basic memory contents (alexia, agrafie)

Other

  • dementia based on normotensive hydrocephalus ;
  • tumors ( glioblastoma multiforme );
  • collagenosis ( SLE ) and others.


Reference

  1. ↑ AMBLER, Zdeněk. Základy neurologie :  [učebnice pro lékařské fakulty]. 7. edition. Praha : Galén, c2011. ISBN 9788072627073.

Sources

Literature used

  •  AMBLER, Zdeněk. Základy neurologie :  [učebnice pro lékařské fakulty]. 7. edition. Praha : Galén, c2011. ISBN 9788072627073.