Lecture Notes: Understanding Dementia and Alzheimer's Disease

Overview of Dementia

• Definition: Dementia is not a single disease, but a group of disorders causing progressive memory and cognitive decline.
• Formal Classification: Known as major neurocognitive disorders in DSM-5.
• Diagnosis Process:
  1. Determine if dementia is present using DSM criteria.
  2. Identify the specific type of dementia.
• Diagnostic Criteria (Mnemonic: Dyer):
  • Clear cognitive decline (memory, language, attention, planning).
  • Use of tests like Mini Mental State Exam (MMSE) and Montreal Cognitive Assessment (MOCA).
  • Cognitive deficits must cause functional impairment in IADLs (SHAFT: shopping, housekeeping, accounting, food, transportation) and later ADLs (DEATH: dressing, eating, ambulating, toileting, hygiene).
  • Rule out delirium and other psychiatric conditions (depression, schizophrenia).

Types of Dementia

• Main Types:
  • Alzheimer's Disease
  • Vascular Dementia
  • Lewy Body Dementia
  • Frontotemporal Dementia
  • Mixed Dementia

Focus on Alzheimer's Disease

• Misconception: Alzheimer's is not a catch-all term for dementia; it is a distinct condition.
• Diagnostic Mnemonic: GRANDPA UOK:
  1. G - Gradual onset.
  2. R - Relentless progression.
  3. A, N, D - Amnesia & Neurocognitive Deficits (4 A's: Amnesia, Aphasia, Apraxia, Agnosia).
     • Amnesia: Loss of memory (retrograde, anterograde, short-term, declarative).
     • Aphasia: Loss of language abilities; expressive and receptive challenges.
     • Apraxia: Difficulty with voluntary motor skills; impacts tasks like typing, driving.
     • Agnosia: Difficulty recognizing and translating sensory perception.
  4. P - Psychiatric symptoms; mood changes, sleep disruptions, psychosis-like symptoms.
  5. A - Activity changes; purposeless behaviors, sundowning.
  6. U - Unable to function; leads to disability.
  7. O - Objective biomarkers; cortical atrophy, hippocampal atrophy, amyloid beta plaques, tau tangles.
  8. K - Knowledge of illness; often unaware of cognitive decline.

Epidemiology and Progression

• Prevalence: Less than 1% of the total population, but high in elderly.
• Risk Factors:
  • Age: Risk doubles every 5 years after age 65.
  • APOE4 gene increases risk significantly.
  • Gender: More common in women.
• Progression:
  • Steady deterioration; average life expectancy post-diagnosis is 5 years.
  • Causes functional decline leading to immobility, infection risk, and incontinence.

Treatment and Management

• Treatment:
  • Symptom reduction, not cure.
  • Medications: Cholinesterase inhibitors, memantine.
  • Limited impact; antidepressants and antipsychotics for mood/behavior.
• Management:
  • Focus on social/environmental interventions.
  • Work with caregivers, assess for burnout.
  • Set realistic goals; coordinate residential care, legal considerations.

Closing Remarks

• Alzheimer's disease is just one form of dementia; further types to be discussed in future content.
• Recommended resources: Book "Memorable Psychiatry".