Gc08-1 - Diagnosis and Treatment of Dementia Theresa A Zesiewicz MD Professor of Neurology Parkinson Research Foundation University of South

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Unformatted text preview: Diagnosis and Treatment of Dementia Theresa A. Zesiewicz, MD Professor of Neurology Parkinson Research Foundation University of South Florida Overview ¡ Epidemiology ¡ Age associated Cognitive Changes ¡ Diagnosis ¡ Differential Diagnosis ¡ Etiology ¡ Workup ¡ Non-pharmacologic Treatments ¡ Drug Treatments ¡ Terminal Care Epidemiology ¡ Prevalence: ¢ 1% at age 60 ¢ Doubles every five years ¢ 30-50% by age 85 ¢ Prevalence curve flattens out at about age 90 ¡ 4 th leading cause of death in the elderly ¡ Life expectancy after diagnosis 3-15 years, recent data suggests shorter life expectancy Wolfson, NEJM April, 2001 Epidemiology of Alzheimer’s ¡ Accounts for 60-70% of dementia in US ¡ Risk factors: ¢ Older age ¢ Family history £ ( ε 4 allele and other chromosomal defects) £ 3x risk with 1 st degree relative ¢ Lower education level Other Causes of Dementia ¡ Dementia with Lewy Bodies ¢ #2 in autopsy studies, males > females ¢ Parkinsonism, little benefit from sinemet, fluctuating impairment, visual hallucinations, neuroleptic sensitivity, rapid progression ¡ Frontotemporal Dementias: e.g. Pick’s disease ¢ Personality changes, euphoria, apathy, disinhibition, compulsive behaviors ¢ Relatively preserved visuospatial function Other Causes of “Cognitive Impairment ” ¡ PSP & related disorders ¡ Huntington’s ¡ Post-anoxic ¡ NPH ¡ B12 ¡ Hypothyroidism ¡ Hypercalcemia ¡ Alcohol/thiamine ¡ Infections ¢ HIV ¢ Syphilis ¢ Lyme’s ¢ CJD ¡ Encephelopathy ¢ Uremic ¢ Hepatic “Reversible Dementias” ¡ More properly called “potentially reversible cognitive impairments” ¡ Candidates: Drug induced, depression, thyroid, B12, NPH, subdural hematoma ¡ Truly reversible <1-3% ¡ Most patients go on to develop dementia Clarfield1994, Larson 1985, Patterson 1999, Freter 1998 Diagnosis of Dementia ¢ Multiple cognitive deficits manifested by impaired memory plus: ¡ Impaired language or ¡ Apraxia or ¡ Agnosia or ¡ Impaired executive function ¢ Deficits: ¡ Significant enough to impair function ¡ Interferes with work or social activities ¢ Not delirium Differential Diagnosis ¡ Delirium ¡ Depression ¡ Psychotic disorders ¡ Medication induced cognitive problems ¡ Sensory deficits ¡ Aphasia ¡ Developmental disability ¡ Low literacy or education Age Related Cognitive Changes – More trouble with difficult tasks when distracted – Slower information processing – Some decline in process oriented manipulative aspects of short term memory – Primary problem in long term memory is recall, not recognition – Most common complaint: word (name) finding The Workup ¡ History: onset, personality, meds, family, social supports, functioning ¡ PE: Focal neuro exam? Vision?...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Gc08-1 - Diagnosis and Treatment of Dementia Theresa A Zesiewicz MD Professor of Neurology Parkinson Research Foundation University of South

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