Topic 3: Reversible Dementia, Amnestic disorderd

Define dementia

Development of multiple cognitive deficits manifested by

- Memory impairment WITH one or more of following

- Aphasia, Apraxia, Agnosia, disturbance of executive function (4As)

Defne Aphasia, Apraxia, Agnosia,

• Aphasia- inability to speak 

• Apraxia- inability to perform actions due to brain damage 

• Agnosia- inability to interpret sensations and thus recognise things

List the reversible causes of dementia

1. Vitamin B12 and folic acid deficiency

2. Chronic subdural hematoma

3. Hypothyroidism, hyperparathyroidism (hypercalcemia)

4. Normal pressure hydrocephalus: Characteristic triad of Broad-based gait, urinary

incontinence and dementia.

5. Pseudodementia

6. Intracranial tumors with space occupying effect.

● Paraneoplastic syndrome caused by extracranial tumor rather caused delirium.

7. Autoimmune encephalitis

e.g. Anti-NMDA receptor antibodies

8. Medications (e.g. Anti-cholinergic)

Semi reversibl causes

Niacin and thiamine deficiency related chronic alcoholism

List irreversible causes

1. Alzheimer’s disease: Possibly caused by oral bacterial.

Porphyromonus gingivalis è Prevention = use TURMERIC (anti-inflammatory)

2. Other primary dementias…

What is the dementia workup?

Many steps focus on trying to exclude the reversible dementias.

1. Medical history: Clinical symptoms

2. Ischemic score of Hachinski

3. CT

4. Laboratory exams

5. Clinical Rating Scores for dementia (CDR), MMSE

6. Electrophysiology: It can detect Creutzfeldt Jakob Disease 

Treatment for reversible dementia

Memory training

Pharmacology: mementine + cholinesterase inhibitors (donepezil, rivastigmine, galantamine)

Mementine moderates the advance cases of alzheimer and vascular dementia. It causes side effects like dizziness, hallucinations, headache. 

what does patients with dementia lose first and last? 

First orientation in time

Last autopsychic 

Define Amnestic disorders

Deficits in memory caused by brain damage or disease

List acute causes of amnesia

• durgs eg benzos

• ECT

• head trauma

chronic causes

• infxns

• brain tumor

• neurodegeneration

• psychosocial events

• nutritional deficiences eg b12, b9 niacin

Clinical features of amnesia

• isolated memory loss doesn’t affect intelligence, general knowledge, judgement, awareness, personality

• can understand written & spoken words

• cant learn new skills

• may understand they have a memory disorder

Main features of amnesia

 Difficulty learning new information following the onset of amnesia (anterograde amnesia)

 Difficulty remembering past events and previously familiar information (retrograde amnesia)

 False memories (confabulation), either completely invented or made up of genuine memories misplaced in time

List the types of amnesia

• Retrograde amnesia: loss of memory-access to events that occurred and/or information acquired prior to the

  incident.

• Anterograde amnesia: loss of memory-access to events that occurred and/or information acquired after the

  incident.

• Global amnesia: loss of memory-access to events that occurred and/or information acquired prior and after

  the incident.

• Drug induced: injection for surgery.

• Dissociative: psychological/distress events.

• Post-traumatic amnesia: generally due to a head injury (example: a fall, a knock on the head).

• Lacunar amnesia: loss of memory about one specific event.

diagnosis of amnesia

• Clinical history

• Lab –vitamins, infections

• Imaging – MRI,CT to check for brain damage or abnormalities

Ttx of amnesia

• Occupational therapy

• Memory training

• Smart technology, such as a smartphone or a hand-held tablet device

•  Low-tech memory aids include notebooks, wall calendars, pill minders, and photographs of people and places

• No medications are currently available for treating most types of amnesia.