Dementia: Difference between revisions

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== Description/Definition ==
== Description/Definition ==
Dementia refers to a group of symptoms associated with a decline in mental ability. It is caused by disorders affecting the brain, and are described by a collection of symptoms affecting the brain. Dementia has an effect on thinking, behaviour and social interaction, as well as functional abilities.<ref name=":0">Dementia Australia. What is dementia? https://www.dementia.org.au/about-dementia/what-is-dementia (accessed 26/09/2018).</ref><ref name=":1">Alzheimer's association. What is dementia? https://www.alz.org/alzheimers-dementia/what-is-dementia (accessed 26/09/2018).</ref>
Dementia refers to a group of symptoms associated with a decline in mental ability. It is caused by disorders affecting the brain, and are described by a collection of symptoms affecting the brain. Dementia has an effect on thinking, behaviour and social interaction, as well as functional abilities<ref name=":0">Dementia Australia. What is dementia? https://www.dementia.org.au/about-dementia/what-is-dementia (accessed 26/09/2018).</ref><ref name=":1">Alzheimer's association. What is dementia? https://www.alz.org/alzheimers-dementia/what-is-dementia (accessed 26/09/2018).</ref>.


{{#ev:youtube|HobxLbPhrMc}}
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== Clinically relevant anatomy ==
== Clinically Relevant anatomy ==
'''Hippocampus:'''<ref name=":1" />
'''Hippocampus'''<ref name=":1" />
* Center of memory and learning
* Centre of memory and learning
* Cells in this region are normally first to be damaged, resulting in the most common symptom of memory loss  
* Cells in this region are normally first to be damaged, resulting in the most common symptom of memory loss  
== Epidemiology & Etiology ==
== Epidemiology & Etiology ==


=== Epidemiology ===
=== Epidemiology ===
Dementia is more common in the population above 65.<ref name=":0" />
Dementia is more common in the population above 65<ref name=":0" />.


=== Etiology ===
=== Etiology ===
Damage to brain cells causes changes to cognitive, behavioural and emotional functions, causing dementia
Damage to brain cells causes changes to cognitive, behavioural and emotional functions, causing dementia.
*


Different types of dementia has different causes. Common types of dementia are:<ref name=":0" />
Different types of dementia has different causes. Common types of dementia are<ref name=":0" />:
* [[Alzheimer's Disease|Alzheimer's disease]] (most common type):
* [[Alzheimer's Disease|Alzheimer's disease]] (most common type):
** 60-80% of cases
** 60-80% of cases
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== Clinical Presentation ==
== Clinical Presentation ==
Early signs of dementia are normally subtle, and not always obvious. It can include:<ref name=":0" /><ref name=":1" />
Early signs of dementia are normally subtle, and not always obvious. It can include<ref name=":0" /><ref name=":1" />:
* Progressive and frequent memory loss (mostly short-term)
* Progressive and frequent memory loss (mostly short-term)
* Confusion
* Confusion
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* Loss of functional abilities to perform activities of daily living
* Loss of functional abilities to perform activities of daily living


Although some cases of dementia are reversible (e.g. hormonal or vitamin deficiencies), most are progressive, with a slow, gradual onset. Certain symptoms, mostly behavioural and psychological, can result from drug interactions, environmental factors, unreported pain and other illnesses.<ref name=":0" />
Although some cases of dementia are reversible (e.g. hormonal or vitamin deficiencies), most are progressive, with a slow, gradual onset. Certain symptoms, mostly behavioural and psychological, can result from drug interactions, environmental factors, unreported pain and other illnesses<ref name=":0" />.


== Diagnostic Procedures ==
== Diagnostic Procedures ==
There are no clear test to diagnose dementia. To make the diagnosis of dementia, at least two of the core mental functions need to be significantly impaired:<ref name=":1" />
There are no clear test to diagnose dementia. To make the diagnosis of dementia, at least two of the core mental functions need to be significantly impaired<ref name=":1" />:
* Memory
* Memory
* Communication and language skills
* Communication and language skills
Line 59: Line 58:
* Visual perception
* Visual perception


Certain types of dementia is diagnosed by medical history, physical examination, blood tests, and characteristic changes in thinking, behaviour and the effect on performance of activities of daily living. The diagnosis of dementia itself is relatively straight-forward to make, but a lot of times it is difficult to diagnose the exact type, as a lot of the symptoms and brain changes overlap. Neurologists or gero-psychologist normally assist in the diagnosis of the specific types of dementia.<ref name=":1" />
Certain types of dementia is diagnosed by medical history, physical examination, blood tests, and characteristic changes in thinking, behaviour and the effect on performance of activities of daily living. The diagnosis of dementia itself is relatively straight-forward to make, but a lot of times it is difficult to diagnose the exact type, as a lot of the symptoms and brain changes overlap. Neurologists or gero-psychologist normally assist in the diagnosis of the specific types of dementia<ref name=":1" />.


== Differential Diagnosis ==
== Differential Diagnosis ==
Dementia can have different causes, and the following causing conditions can improve with treatment:<ref name=":0" /><ref name=":1" />
Dementia can have different causes, and the following causing conditions can improve with treatment<ref name=":0" /><ref name=":1" />:
* Vitamin deficiencies
* Vitamin deficiencies
* Hormone deficiencies (e.g. thyroid problems)
* Hormone deficiencies (e.g. thyroid problems)
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== Outcome Measures ==
== Outcome Measures ==
* Mood:
* Mood
** [http://www.primaris.org/sites/default/files/resources/Depression/depression_cornell%20scale%20for%20depression%20final.pdf Cornell Scale for Depression in Dementia]
** [http://www.primaris.org/sites/default/files/resources/Depression/depression_cornell%20scale%20for%20depression%20final.pdf Cornell Scale for Depression in Dementia]
** [http://dementiapathways.ie/_filecache/0c8/57e/37-gds.pdf Geriatric Depression Screening Scale]
** [http://dementiapathways.ie/_filecache/0c8/57e/37-gds.pdf Geriatric Depression Screening Scale]
** Rating Anxiety in Dementia
** Rating Anxiety in Dementia
* Quality of life:
* Quality of life
** Quality of Life in Alzheimer’s Disease
** Quality of Life in Alzheimer’s Disease
** The Dementia Quality of Life Instrument
** The Dementia Quality of Life Instrument
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** [https://apsoc.org.au/PDF/Publications/Abbey_Pain_Scale.pdf Abbey Pain Scale]
** [https://apsoc.org.au/PDF/Publications/Abbey_Pain_Scale.pdf Abbey Pain Scale]
** [[Visual Analogue Scale|VAS]]
** [[Visual Analogue Scale|VAS]]
* Behaviour:
* Behaviour
** [https://www.alz.org/national/documents/C_ASSESS-RevisedMemoryandBehCheck.pdf Revised Memory and behaviour problems checklist]
** [https://www.alz.org/national/documents/C_ASSESS-RevisedMemoryandBehCheck.pdf Revised Memory and behaviour problems checklist]
** [https://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/CONT/A/CONT_21_3_2015_02_26_KAUFER_2015-10_SDC2.pdf Neuropsychiatric Inventory]
** [https://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/CONT/A/CONT_21_3_2015_02_26_KAUFER_2015-10_SDC2.pdf Neuropsychiatric Inventory]
** [http://www.dementiamanagementstrategy.com/file.axd?id=c9f7405f-3596-4f5f-9f8d-f322e5188678 Neuropsychiatric Inventory (Nursing Home)]
** [http://www.dementiamanagementstrategy.com/file.axd?id=c9f7405f-3596-4f5f-9f8d-f322e5188678 Neuropsychiatric Inventory (Nursing Home)]
** CAMI
** CAMI
* Reaction to behaviour:
* Reaction to behaviour
** [https://www.alz.org/national/documents/C_ASSESS-RevisedMemoryandBehCheck.pdf Revised Memory and behaviour problems checklist]
** [https://www.alz.org/national/documents/C_ASSESS-RevisedMemoryandBehCheck.pdf Revised Memory and behaviour problems checklist]
** [https://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/CONT/A/CONT_21_3_2015_02_26_KAUFER_2015-10_SDC2.pdf Neuropsychiatric Inventory with Caregiver Distress Scale]
** [https://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/CONT/A/CONT_21_3_2015_02_26_KAUFER_2015-10_SDC2.pdf Neuropsychiatric Inventory with Caregiver Distress Scale]
** [http://www.dementiamanagementstrategy.com/file.axd?id=c9f7405f-3596-4f5f-9f8d-f322e5188678 Neuropsychiatric Inventory in Nursing Homes]
** [http://www.dementiamanagementstrategy.com/file.axd?id=c9f7405f-3596-4f5f-9f8d-f322e5188678 Neuropsychiatric Inventory in Nursing Homes]
* Carer mood:
* Carer mood
** [http://www.assessmentpsychology.com/HAM-D.pdf Hamilton Depression Rating Scale]
** [http://www.assessmentpsychology.com/HAM-D.pdf Hamilton Depression Rating Scale]
** General Health Questionnaire
** General Health Questionnaire
** [http://www.chcr.brown.edu/pcoc/cesdscale.pdf Centre for Epidemiological Studies – Depression Scale]
** [http://www.chcr.brown.edu/pcoc/cesdscale.pdf Centre for Epidemiological Studies – Depression Scale]
* Carer burden:
* Carer burden
** [http://dementiapathways.ie/_filecache/edd/c3c/89-zarit_burden_interview.pdf Zarit Burden Interview]
** [http://dementiapathways.ie/_filecache/edd/c3c/89-zarit_burden_interview.pdf Zarit Burden Interview]
** Sense of competence scale
** Sense of competence scale
** Relative Stress Scale
** Relative Stress Scale
* Carer health-related quality of life:
* Carer health-related quality of life
** [[SF-36]]
** [[SF-36]]
** [http://www.who.int/substance_abuse/research_tools/en/english_whoqol.pdf WHOQoL-Bref]
** [http://www.who.int/substance_abuse/research_tools/en/english_whoqol.pdf WHOQoL-Bref]
** EQ-5D
** EQ-5D
* Resource utilisation:
* Resource utilisation
** [https://www.pssru.ac.uk/csri/files/2017/10/TYOCPA-CSRI-v2.pdf Client Service Receipt Inventory]
** [https://www.pssru.ac.uk/csri/files/2017/10/TYOCPA-CSRI-v2.pdf Client Service Receipt Inventory]
** [https://rudinstrument.files.wordpress.com/2016/08/rud-3-2-sample.pdf The Resource Utilization in Dementia (RUD) Instrument]
** [https://rudinstrument.files.wordpress.com/2016/08/rud-3-2-sample.pdf The Resource Utilization in Dementia (RUD) Instrument]
* Staff carer morale:
* Staff carer morale
** Maslach Burnout Inventory
** Maslach Burnout Inventory
<ref>Neurodegeneration Research. Dementia outcme measures: Charting new territory. Report of a JPND Working Group on Longitudinal Cohorts. 2015.http://www.neurodegenerationresearch.eu/wp-content/uploads/2015/10/JPND-Report-Fountain.pdf (accessed 30/09/2018).</ref>
<ref>Neurodegeneration Research. Dementia outcme measures: Charting new territory. Report of a JPND Working Group on Longitudinal Cohorts. 2015.http://www.neurodegenerationresearch.eu/wp-content/uploads/2015/10/JPND-Report-Fountain.pdf (accessed 30/09/2018).</ref>


== Medical Management ==
== Medical Management ==
Medical management should be obtained as soon as symptoms start appearing, as some of the causes are treatale, and early diagnosis and management can slow down or treat the disease process to allow most benefit from available treatments.<ref name=":1" />
Medical management should be obtained as soon as symptoms start appearing, as some of the causes are treatable, and early diagnosis and management can slow down or treat the disease process to allow most benefit from available treatments<ref name=":1" />.


=== Medication <ref name=":0" /> ===
=== Medication <ref name=":0" /> ===
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** Zuclopenthixol (Clopixol)
** Zuclopenthixol (Clopixol)


* Treats agitation, aggression and psychotic symptoms
* Treat agitation, aggression and psychotic symptoms
* Side-effects:
* Side-effects:
** Sedation
** Sedation
** Dizziness
** Dizziness
** Unsteadiness
** Unsteadiness
** Shakiness, slowless, stiffness of limbs (resembles Parkinson's disease)
** Shakiness, slowlessness, stiffness of limbs (resembles Parkinson's disease)


==== Hypnotics ====
==== Hypnotics ====
Line 240: Line 239:


== Physiotherapy Management ==
== Physiotherapy Management ==
Physiotherapy is not a modality used to treat dementia, but a well rounded knowledge about the condition is very important in the management of patients presenting to physiotherapy for other conditions, with the co-morbidity of dementia. Therapeutic management can include cognitive stimulation therapy, that can be administrated by any one working with dementia patients - carers, nurses or occupational therapists.<ref>Cognitive Stimulation Therapy. An Introduction to Cognitive Stimulation Therapy.http://www.cstdementia.com/ (accessed 30/09/2018).</ref>
Physiotherapy is not a modality used to treat dementia, but a well rounded knowledge about the condition is very important in the management of patients presenting to physiotherapy for other conditions, with the co-morbidity of dementia. Therapeutic management can include cognitive stimulation therapy, that can be administrated by any one working with dementia patients - carers, nurses or occupational therapists<ref>Cognitive Stimulation Therapy. An Introduction to Cognitive Stimulation Therapy.http://www.cstdementia.com/ (accessed 30/09/2018).</ref>.


=== Exercise Therapy ===
=== Exercise Therapy ===
Physiotherapists can play a role in customizing exercise programmes. Research have shown positive effects that exercise can prevent or delay the onset of dementia, by slowing down the cognitive decline.<ref>Ko MH. [https://synapse.koreamed.org/search.php?where=aview&id=10.12786/bn.2015.8.1.24&code=0176BN&vmode=FULL Exercise for Dementia.] Brain & Neurorehabilitation 2015;8(1):24-8.</ref><ref name=":2">Rolland Y. [https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119952930.ch77 Exercise and Dementia]. Pathy's Principles and Practice of Geriatric Medicine 2012;1:911-21.</ref> This can lead to improved quality of life and slowing down of functional decline expected with the disease process.<ref name=":2" />
Physiotherapists can play a role in customising exercise programmes. Research have shown positive effects that exercise can prevent or delay the onset of dementia, by slowing down the cognitive decline<ref>Ko MH. [https://synapse.koreamed.org/search.php?where=aview&id=10.12786/bn.2015.8.1.24&code=0176BN&vmode=FULL Exercise for Dementia.] Brain & Neurorehabilitation 2015;8(1):24-8.</ref><ref name=":2">Rolland Y. [https://onlinelibrary.wiley.com/doi/abs/10.1002/9781119952930.ch77 Exercise and Dementia]. Pathy's Principles and Practice of Geriatric Medicine 2012;1:911-21.</ref>. This can lead to improved quality of life and slowing down of functional decline expected with the disease process<ref name=":2" />.


== Resources ==
== Resources ==

Revision as of 01:01, 26 November 2018

Original Editors - Leana Louw

Top Contributors - Vidya Acharya, Kim Jackson, Lucinda hampton, Leana Louw, Lauren Lopez, Simisola Ajeyalemi, Aminat Abolade, Tony Lowe, Shaimaa Eldib, Naomi O'Reilly, Kalyani Yajnanarayan, Safiya Naz, Ewa Jaraczewska, Carina Therese Magtibay and Aya Alhindi  

Description/Definition[edit | edit source]

Dementia refers to a group of symptoms associated with a decline in mental ability. It is caused by disorders affecting the brain, and are described by a collection of symptoms affecting the brain. Dementia has an effect on thinking, behaviour and social interaction, as well as functional abilities[1][2].

Clinically Relevant anatomy[edit | edit source]

Hippocampus[2]

  • Centre of memory and learning
  • Cells in this region are normally first to be damaged, resulting in the most common symptom of memory loss

Epidemiology & Etiology[edit | edit source]

Epidemiology[edit | edit source]

Dementia is more common in the population above 65[1].

Etiology[edit | edit source]

Damage to brain cells causes changes to cognitive, behavioural and emotional functions, causing dementia.

Different types of dementia has different causes. Common types of dementia are[1]:

  • Fronto-temporal lobar degeneration dementia
  • Alcohol related dementia (Korsakoff's syndrome)
  • Creutzfeldt-Jacob disease

Clinical Presentation[edit | edit source]

Early signs of dementia are normally subtle, and not always obvious. It can include[1][2]:

  • Progressive and frequent memory loss (mostly short-term)
  • Confusion
  • Personality change
  • Apathy and withdrawal
  • Loss of functional abilities to perform activities of daily living

Although some cases of dementia are reversible (e.g. hormonal or vitamin deficiencies), most are progressive, with a slow, gradual onset. Certain symptoms, mostly behavioural and psychological, can result from drug interactions, environmental factors, unreported pain and other illnesses[1].

Diagnostic Procedures[edit | edit source]

There are no clear test to diagnose dementia. To make the diagnosis of dementia, at least two of the core mental functions need to be significantly impaired[2]:

  • Memory
  • Communication and language skills
  • Concentration and focus
  • Reasoning and judgment
  • Visual perception

Certain types of dementia is diagnosed by medical history, physical examination, blood tests, and characteristic changes in thinking, behaviour and the effect on performance of activities of daily living. The diagnosis of dementia itself is relatively straight-forward to make, but a lot of times it is difficult to diagnose the exact type, as a lot of the symptoms and brain changes overlap. Neurologists or gero-psychologist normally assist in the diagnosis of the specific types of dementia[2].

Differential Diagnosis[edit | edit source]

Dementia can have different causes, and the following causing conditions can improve with treatment[1][2]:

  • Vitamin deficiencies
  • Hormone deficiencies (e.g. thyroid problems)
  • Depression
  • Medication side-effects
  • Alcohol abuse
  • Overmedication
  • Infections
  • Brain tumours

Outcome Measures[edit | edit source]

[3]

Medical Management[edit | edit source]

Medical management should be obtained as soon as symptoms start appearing, as some of the causes are treatable, and early diagnosis and management can slow down or treat the disease process to allow most benefit from available treatments[2].

Medication [1][edit | edit source]

Antidepressants[edit | edit source]

Effectiveness is normally only seen after 2-3 weeks.

  • Types:
    • Tricyclic (amitriptyline, imipramine or dothiepin)
      • Side-effects:
        • Worsening confusion
        • Dry mouth
        • Blurry vision
        • Constipation
        • Dizziness in upright position (thus not recommended in Alzheimer's disease, as it can cause falls and injuries)
        • Difficulty with urination
    • Newer types of antidepressants have less side-effects
      • First line treatment: Fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram and escitalopram
      • Side-effect
        • Headaches
        • Nausea
  • Commonly prescribed:
    • Antidepressants:
      • Amitriptyline (Endep) 
      • Citalopram (Cipramil, also Celapram, Ciazil, Talam, Talohexal) 
      • Dothiepin (Prothiaden, also Dothep) 
      • Doxepin (Sinequan, also Deptran)
      • Escitalopram (Lexapro) 
      • Fluoxetine (Prozac, also Lovan, Auscap, Fluohexal, Fluoxebell, Zactin) 
      • Fluvoxamine (Faverin, also Movax, Luvox, Voxam) 
      • Imipramine (Tofranil, also Tolerade) 
      • Mirtazipine (Avanza, Axit, Mirtazon, Remeron) 
      • Nortriptyline (Allegron) 
      • Paroxetine (Aropax, Paxtine, Oxetine) 
      • Reboxetine (Edronax) 
      • Sertraline (Zoloft, Xydep, Eleva, Concorz) 
      • Venlafaxine (Efexor)
      • Lithium carbonate (Lithicarb, Quilonum) - mood stabilizer

Antipsychotics[edit | edit source]

  • Neuroleptics/major tranquillisers such as:
    • Amisulpride (Solian) 
    • Chlorpromazine (Largactil)  
    • Fluphenazine (Modecate) 
    • Haloperidol (Haldol, Serenace) 
    • Moclobemide (Auroix) 
    • Olanzapine (Zyprexa) 
    • Promazine (Promazine) 
    • Quetiapine (Seroquel) 
    • Risperidone (Risperdal) 
    • Sulpiride (Dolmatil, Sulparex, Sulpitil) 
    • Trifluoperazine (Stelazine) 
    • Zuclopenthixol (Clopixol)
  • Treat agitation, aggression and psychotic symptoms
  • Side-effects:
    • Sedation
    • Dizziness
    • Unsteadiness
    • Shakiness, slowlessness, stiffness of limbs (resembles Parkinson's disease)

Hypnotics[edit | edit source]

  • Treatment of sleep disturbances
  • Side-effects:
    • Excessive sedation
    • Increased confusion
    • Unsteadiness
    • Long-term use: Tardive dyskinesia
  • Commonly prescribed:
    • Chloral hydrate (Welldorm) 
    • Clomethiazole (Heminevrin) 
    • Flurazepam (Dalmane) 
    • Nitrazepam (Mogadon also Alodorm) 
    • Temazepam (Femaze, Temtabs, Normison) 
    • Zopiclone (Imrest, Imovane) 
    • Zolpidem (Stilnoct)

Anxiety-relieving drugs[edit | edit source]

  • Benzodiazepine - short periods of anxiety
    • Short duration: Lorazepam, oxazepam
    • Long duration: Chlordiazepoxide, diazepam
  • Long term use not recommended
  • Side-effects:
    • Excessive sedation
    • Unsteadiness
    • Accentuation of confusion and memory deficits
  • Commonly prescribed:
    • Alprazolam (Xanax, also Alprax, Kalma, Zamahexal) 
    • Buspirone (Buspar) 
    • Diazepam (Valium also Antenex, Valpam, Ducene) 
    • Lorazepam (Ativan) 
    • Oxazepam (Alepam, Serepax, Minelax)

Anticonvulsants[edit | edit source]

  • Commonly prescribed:
    • Sodium valproate (Epilim also Valpro) 
    • Carbamazepine (Tegretol)
  • Reduce aggression and agitation

Cholinesterase inhibitors[edit | edit source]

  • Donepezil, galantamine, rivastigmine
  • Effects:
    • Improve memory and ability to perform activities of daily living (especially in Alzheimer's disease)
    • Slight effect on behavioural symptoms, mood, confidence, delusions, hallucinations
  • Side-effects (high dosages):
    • Increased agitation
    • Insomnia with nightmares

Lifestyle Modifications[edit | edit source]

  • Regular exercise/active lifestyle:
    • Very effective in the management of the depression component of dementia
  • Stimulating daily activities

[1]

Physiotherapy Management[edit | edit source]

Physiotherapy is not a modality used to treat dementia, but a well rounded knowledge about the condition is very important in the management of patients presenting to physiotherapy for other conditions, with the co-morbidity of dementia. Therapeutic management can include cognitive stimulation therapy, that can be administrated by any one working with dementia patients - carers, nurses or occupational therapists[4].

Exercise Therapy[edit | edit source]

Physiotherapists can play a role in customising exercise programmes. Research have shown positive effects that exercise can prevent or delay the onset of dementia, by slowing down the cognitive decline[5][6]. This can lead to improved quality of life and slowing down of functional decline expected with the disease process[6].

Resources [edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Dementia Australia. What is dementia? https://www.dementia.org.au/about-dementia/what-is-dementia (accessed 26/09/2018).
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Alzheimer's association. What is dementia? https://www.alz.org/alzheimers-dementia/what-is-dementia (accessed 26/09/2018).
  3. ↑ Neurodegeneration Research. Dementia outcme measures: Charting new territory. Report of a JPND Working Group on Longitudinal Cohorts. 2015.http://www.neurodegenerationresearch.eu/wp-content/uploads/2015/10/JPND-Report-Fountain.pdf (accessed 30/09/2018).
  4. ↑ Cognitive Stimulation Therapy. An Introduction to Cognitive Stimulation Therapy.http://www.cstdementia.com/ (accessed 30/09/2018).
  5. ↑ Ko MH. Exercise for Dementia. Brain & Neurorehabilitation 2015;8(1):24-8.
  6. ↑ 6.0 6.1 Rolland Y. Exercise and Dementia. Pathy's Principles and Practice of Geriatric Medicine 2012;1:911-21.
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