Dementia

Problem: Economical Social Medical Late diagnosis Insufficient prevention of VaD

Perspectives of age distribution in population

Source: United Nations Department of Economic and Social Affairs, Population Division.

World Population Prospects. The 2004 Revision. New York : United Nations, 2005.

Prevalence of dementia

Canadian Study of Health and Aging: study methods and prevalence of dementia. CMAJ 1994;150:899–913 .

The most frequent dementias

5%5%15%

20%

55%

ADVDLBDFTDothers

Diagnosis

Dementia - Gradual and progressive change in memory function at disease onset reported by patients or relatives for a period greater than 6 months

+ 1 next sign - - aphasia - apraxia - agnosia

Diagnosis

History (from patient + from relatives)

MiniMental State Examination - MMSE

Clock test Activities of daily living- phoning,

transportation, using of drugs, shopping, etc.)

MMSE

Orientation

1. Year

2. Season

3. Month

4. Date

5. Day

Orientation

6. Country7. County8. City9. Name of the institution10. Floor

1 point for each answer 1 point for each answer

MMSE

• Memory

11. Reproduction of 3 terms (0-3)

(apple, table, tree)

• Attention and counting

12. Counting 100 –7,.... or (terms) (0-5)

13. Reproduction of 3 terms from 11. (0-3)

MMSE• Higher cognitive functions

14. Clock (0-1)

15. Pencil (0-1)

16. Repeating (0-1)

17. Understanding (3-steps) (0-3)

18. Understanding (1-step) – CLOSE THE EYES (0-1)

19. Writing the sentence(0-1)

20. Picture (0-1)

MMSE

MMSE

Summary

• 25 - 30 normal (24-25 mild cognitive impairment)

• 20 - 24 mild dementia

• 10 - 19 moderate dementia

• 0 - 9 severe dementia

Clock test

Clock test

1 point - the clock circle 1 point - for all the numbers being in the correct order 1 point - for the numbers being in the proper special

order 1 point - for the two hands of the clock 1 point - for the correct time.

A normal score is 4 or 5 points.

Clock test

Clock test

Others – 5% - most of them we can treat

Hypothyreosis Anemia Neuroinfections (neuroboreliosis,

neurpsyphylis, HIV, CJD,...) Metabolic, toxic etiology Brain tumors Autoimunne limbic encephalitis Normotension hydrocephalus Hypovitaminosis B12 Chronic alcoholism Head injury