Dementia (Alzheimer's Disease)
Epidemiology
Risk Factors
Aetiology
Clinical Features
Symptoms
Investigations
Bloods
Imaging
Others
Management
Pharmacological
Prognosis
5y mortality <32%
Source
Prof S Pridmore 2013
Toronto Notes 2012
A/Prof George Razay 2015
- 4-8% of >65y
- 60-70% of dementia cases
Risk Factors
- Age
- Race (Hispanics > Africans > Caucasian)
- Genetics (APO E4)
- F > M
- Head injury
- Down's syndrome
- Vascular risk factors (HTN, CHD)
Aetiology
- Amyloid plagues
- Neurofibrillary tangles
Clinical Features
- Gradual decline (STM loss --> aphasia --> agnosia --> Difficulty ADL
Symptoms
- Cognitive loss
- Executive function loss
- Delusions
- Hallucinations (often visual)
- Change in personality
- Behavioural issues (wandering, altered sleep pattern, incontinence, agitation, aggressiveness)
- MMSE
Investigations
Bloods
- Urea and electrolytes
- Thyroid function tests
- B12 and folate
- FBC
- Syphilis serology
Imaging
- SPECT (where regional dementias are suspected). SPECT studies have 90-100% sensitivity in discriminating AD patients from healthy controls
- MRI (may help to exclude vascular dementia)
Others
- EEG (usually abnormal in early AD, in contrast to frontotemporal dementia)
Management
- Treat medical problems and prevent others
- Provide orientation cues (e.g. clock, calendar)
- Provide education and support for patient and family (day programs, respite care, support groups, home care)
- Consider long-term care plan (nursing home) and power of attorney/living will
Pharmacological
- Cholinesterase inhibitors (e.g. donepezil) for mild to severe disease
- NMDA receptor antagonist (e.g. memantine) for moderate to severe disease
- Low-dose neuroleptics (haloperidol, risperidone) and antidepressants if behavioural or emotional symptoms prominent - start low and go slow • reassess pharmacological therapy every 3 months
Prognosis
5y mortality <32%
Source
Prof S Pridmore 2013
Toronto Notes 2012
A/Prof George Razay 2015