Alzheimer's disease: CT scan of brain showing cortical atrophy, widened sulci, and enlarged lateral ventricles.

Dementia

Dementia is a clinical syndrome charactirized by loss of previously acquired intellectual functions in the abscence of impairment of conciousness.

The term dementia is mostly associated with elderly but some disorders occur in the mid life, namely Alzheimer's disease,
Pick's disease, Huntington's Chorea. These conditions are also collectively called Pre-senile Dementia and have a strong familial disposition. Huntington's Chorea is transmitted by an Autosomal dominant gene.

Main features of Dementia

Loss of general intelligence

Memory impairment

Personality changes

Emotional changes

Loss of general intellegence: Judgement and problem solving ability is reduced. Thinking is slow

Memory impairment: Minor degree of memory impairment is often the first sign of this disease. Forgetfulness in relation to day to day work and concerning personal possesions is prominent. People's names are forgotten, appointments are missed. Decling memory may lead to secondary delusions.

Personality changes: Decline in personal manners and social awareness. Behaviour may become rude, tactless, and may be insensitive to feeling of others. Episodes of aggression, sexual indiscretion or even infringement of law may be seen. Deterioration in personal hygiene, urinary and faecal incontinence are common. General decline in interest of the surroundings. Patient may sit for hours without initiating any purposeful activity.

Emotional changes: Mood changes, depression, anxiety, irritability may be prominent in the early stages. In advanced dementia the emotional reaction may be blunted and patients becomes incapable of responding to emotionally charged events in their environment.

Causes of Dementia

Degenerative diseases:
Senile dementia, Alzheimer's disease, Pick's disease, Huntington's chorea, Creutzfeldt-Jacob disease, Parkinson's disease.

Space occupying lesions:
Cerebral tumour, Subdural haematoma.

Infections : AIDS, Cerebral syphilis, Viral encephalitis
Others : Post Traumatic dementia, Boxer's encephalopathy, Secondary to Head Injury.
Cerebrovascular disease, Cerebral emboli.
Hypothyroidism, Hypopituitarism.
Liver disease, Renal failure, Alcoholism
Vitamin deficiency: Folic acid, B12

Dementia - Drug Therapy

Cerebrovascular dementia: CT brain scan showing multiple diffuse areas of cerebral infarction.