Approach To Dementia

Approach to Dementia/Major Neurocognitive Disorder (NCD)
Authors: Iqra Rahamatullah Mahrukh Kaimkhani
Reviewers: Yvette Ysabel Yao Mao Ding Gary Michael Klein* *MD at time of publication
1) Changes noticed?
Modest ↓cognitive performance from previous, DOES NOT interfere with daily independence
MILD COGNITIVE IMPAIRMENT
More pronounced ↓cognitive performance from previous, DOES interfere with daily independence
MILD TO MODERATE DEMENTIA
↓Cognitive performance, difficulty with ≥1 basic activities of daily living (ADL) or ≥2 instrumental ADLs
MODERATE TO SEVERE DEMENTIA
DEMENTIA
Fluctuating course, acute onset, inattention WITH either disorganized thinking or altered level of consciousness
DELIRIUM
2) Is it dementia?
Normal, age-related: ↓focus, ↓cognitive speed, ↓reaction time, ↓memory
NORMAL COGNITIVE DECLINE
3) What is the cause of the dementia? (main causes discussed here)
Loss of cognitive functioning, including memory, language, problem solving, and other thinking abilities, that interferes with independence in everyday activities
Beta-secretase cleaves beta amyloid protein
Atherosclerosis or thrombosis
Misfolded alpha- synuclein
Toxic beta amyloid plaque and tau tangle (sticky) formation
Ischemia to areas of brain (strokes)
Build ups and deposition within neurons (Lewy bodies)
Disrupted signaling, inflammation, hippocampal and cerebral impairment
Necrosis of brain tissue in areas impacted by strokes
Neuronal impairment and atrophy (especially in substantia nigra)
Neuronal atrophyàfrontal + temporal lobe atrophy
Progressive atrophy of basal ganglia and dorsal striatum + lateral ventricles expanding
Death of dopaminergic neurons in substantia nigra
Alzheimer’s Dementia
Vascular Dementia
Lewy Body Dementia
Frontotemporal Dementia
Huntington’s Disease
Parkinson’s Disease
↓Memory, ↓learning, ↓language skills, disorientation, inattention
Total debilitation, fatal infections
Findings vary depending on area
Step-wise worsening impairment
Parkinsonism, hallucinations, REM- sleep behavior disorder
Total debilitation, dependence
Personality and behavioral changes
Mental status changes
Chorea, ↓cognition, mood changes
Aspiration, dementia, suicide
Resting tremor, rigidity, anosmia
Depression, dementia, falls
Abnormal protein inclusions and tangles (usually tau) form in neurons
Autosomal dominant disease (with anticipation) with ↑CAG repeats in Huntingtin gene
Genetic mutations, environmental exposures, or idiopathic cause
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published September 17, 2023 on www.thecalgaryguide.com

Approach to Dementia/Major Neurocognitive Disorder (NCD)
Authors: Iqra Rahamatullah Mahrukh Kaimkhani Reviewers: Yvette Ysabel Yao
Fluctuating course, acute onset, inattention WITH either disorganized thinking or altered level of consciousness (LOC)?
DELIRIUM
1) Changes noticed?
2) Is it dementia?
Normal, age-related: ↓focus, ↓cognitive speed, ↓reaction time, ↓memory
NORMAL COGNITIVE DECLINE
Modest ↓cognitive performance from previous, DOES NOT interfere with daily independence
MILD COGNITIVE IMPAIRMENT
More pronounced ↓cognitive performance from previous, DOES interfere with daily independence
MILD TO MODERATE DEMENTIA
↓Cognitive performance, difficulty with ≥1 basic activities of daily living (ADL) or ≥2 instrumental ADLs
MODERATE TO SEVERE DEMENTIA
3) What is the cause of the dementia? (main causes discussed here)
Beta-secretase cleaves beta amyloid protein
Atherosclerosis or thrombosis
Misfolded alpha-synuclein
Toxic beta amyloid plaque and tau tangle (sticky) formation
Ischemia to areas of brain (strokes)
Build ups and deposition within neurons (Lewy bodies)
Disrupted signaling, inflammation, hippocampal and cerebral impairment
Necrosis of brain tissue in areas impacted by strokes
Neuronal impairment and atrophy (especially in substantia nigra)
Neuronal atrophyàfrontal + temporal lobe atrophy
Progressive atrophy of basal ganglia and dorsal striatum + lateral ventricles expanding
Death of dopaminergic neurons in substantia nigra
Alzheimer’s Dementia
Vascular Dementia
Lewy Body Dementia
Frontotemporal Dementia
Huntington’s Disease
Parkinson’s Disease
↓Memory, ↓learning, ↓language skills, disorientation, inattention
Total debilitation, fatal infections
Findings vary depending on area
Step-wise worsening impairment
Parkinsonism, hallucinations, REM- sleep behavior disorder
Total debilitation, dependence
Personality and behavioral changes
Mental status changes
Chorea, ↓cognition, mood changes
Aspiration, dementia, suicide
Resting tremor, rigidity, anosmia
Depression, dementia, falls
DEMENTIA
Loss of cognitive functioning, including memory, language, problem solving, and other thinking abilities, that interferes with independence in everyday activities
Abnormal protein inclusions and tangles (usually tau) form in neurons
Autosomal dominant disease (with anticipation) with ↑CAG repeats in Huntingtin gene
Genetic mutations, environmental exposures, or idiopathic cause
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published September 17, 2023 on www.thecalgaryguide.com