Dementia

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Dementia
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Specialty scores for Dementia

Overview

Overview

Dementia is a major neurocognitive disorder characterized by a significant decline in multiple cognitive domains. The impairment in addition to memory and recall should occur in at least one of the following core mental functions:

  • Aphasia
  • Reasoning and judgment
  • Focus and concentration
  • Visual perception

The functional damage is of sufficient magnitude to compromise an individual's activities of daily living.

For the diagnosis of probable Alzheimer's, the criteria suggested by the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA) include:

  • Dementia established by examination and objective testing
  • Deficits in two or more cognitive areas
  • Progressive worsening of memory and other cognitive functions
  • No disturbance in consciousness
  • Onset between the ages 40 and 90

Epidemiology

Dementia affects about 50 million of the population. It is most common in elderly individuals; age being the most important predictor of dementia. However, some sporadic cases of early onset Alzheimer's disease can occur under the age of 65 years. The incidence of this neurodegenerative disorder doubles with every 5-year increase in age.

Etiology and Pathophysiology

Abnormalities in 3 genes are known to cause AD. Amyloid precursor protein (APP), presenilin-1 (PSEN1), and presenilin-2 (PSEN2). A majority of the neurodegenerative disorders possess both the sporadic and the autosomal-dominant traits for genetic abnormalities. The common sporadic form of AD tends to be less severe than the rare autosomal-dominant forms.

Vascular dementia is due to brain cell death caused by conditions such as cerebrovascular disease or stroke. This prevents normal blood flow, depriving brain cells of oxygen and life.

In AD, there is progressive atrophy and gliosis, predominantly in the the hippocampus and mesial temporal lobe (the memory and cognitive areas). The two histological hallmarks of AD are the deposition of extracellular amyloid plaques and intraneuronal aggregates of tau protein, called neurofibrillary tangles.

Types of Dementia

  • Alzheimer's disease (AD)- the most common type of dementia
  • Vascular dementia: Cigarette smoking, hypertension, obesity, diabetes, can trigger cerebrovascular lesions and stroke
  • Frontotemporal dementias (FTD- including Pick’s disease, progressive nonfluent aphasia, and semantic dementia)
  • Lewy body dementia: Parkinsonian features, daytime hallucinations, fluctuating cognition and behavior
  • Huntington's disease
  • Wilson's disease: It is a metabolic disorder in which there is an accumulation of copper Copper is toxic to the neurons of the cerebral cortex
  • Medication-induced dementia: It is the one of the most frequent causes of “reversible” dementia. The incidence of drug- induced dementia increases with age owing to the altered renal, hepatic, and cardiac functions associated with aging
  • Normal pressure hydrocephalus: It is a triad of dementia, ataxia, and urinary incontinence. Accounts for 5% of dementia cases
  • Vitamin B12 deficiency
  • Chronic subdural hematoma: Venous bleeding between the outer (dura) and middle (arachnoid) membranes
  • Acute intermittent porphyria
  • Autosomal dominant cerebellar ataxia, deafness, and narcolepsy (ADCA-DN): Neurologic disorder characterized by progressive cerebellar ataxia, narcolepsy/cataplexy, sensorineural deafness, and dementia in adults

Treatment

Patients with dementia are incapable of making decisions and adhering to treatment plans. A careful discussion with the patient's caregiver is, therefore, of utmost importance. Given the overlapping of symptoms, one type of dementia should be appropriately distinguished from the other and treated accordingly. Apart from a meticulous history, dementia diagnosis also warrants a thorough physical and MRI examination. It is also essential to address the behavioral problems in patients with dementia. Physical rehabilitation is as important as cognitive rehabilitation.

Medications approved for the treatment of AD primarily include cholinesterase inhibitors and memantine. These alleviate the symptoms but do not reverse the brain damage or stop it from progressing.

FDA Approved Medicines

  • FDA approved rivastigmine tartrate, sold as Exelon, manufactured by Novartis for the treatment of the treatment of mild to moderate dementia of the Alzheimer's type ( Alzheimer Disease | Dementia ) in year 2000.
  • FDA approved galantamine hydrobromide, sold as Reminyl, manufactured by Janssen Pharmaceuticals for the treatment of mild to moderate dementia of the Alzheimer's type ( Dementia ) in year 2001.
  • FDA approved memantine hydrochloride extended-release + donepezil hydrochloride, sold as Namzaric, manufactured by Forest Laboratories for the treatment of moderate to severe dementia of the Alzheimer's type ( Alzheimer Disease | Dementia ) in year 2014.
  • FDA approved memantine HCl, sold as Namenda, manufactured by Forest Laboratories for the treatment of moderate to severe dementia of the Alzheimer�s type. ( Alzheimer Disease | Dementia ) in year 2003.