Let’s take a look at dementia.
What is dementia?
A deterioration in mental state
characterized by deficits of
higher cortical function.
What does that mean to you?
It’s important that you know
your cortical functioning
These include memory, language,
your visuospatial skills,
and executive functions.
This is dementia.
What kind of issues might you
be looking for in dementia?
It’s not necessarily
synonymous with dementia, but,
but it is the most common
cause of dementia up to 75%.
Is that clear?
So, just because you hear Alzheimer’s disease,
it doesn’t mean it’s always dementia,
but the most common cause of
dementia is Alzheimer’s disease.
So obviously, we’ll be spending
a lot of time with it.
Dementia is not a feature of normal aging,
and is always -- always --
indicative of a pathology.
Do you understand as
to how rare it is
for us to describe in pathology
something being always?
So dementia is
not something that we’re going to look
forward to like in a male with BPH.
Now, mild cognitive impairment
is a transition stage to AD,
stands for Alzheimer’s disease.
This is pretty much
what you know about with prediabetic
meaning to say impaired
and your patient is then moving
on to overt diabetes mellitus.
Well, here, we have mild cognitive
type of dementia or impairment.
It is a transitional stage
into Alzheimer’s disease
and 10% will convert per year,
which is a pretty high number.
Dementia, differential diagnoses:
Was it degenerative?
Was it vascular or metabolic?
in biochemistry, if you have looked at
some of your glycogen storage diseases
or lipid storage diseases,
and you’ve heard of issues such
as metachromatic leukodystrophy.
So, all of these are
differentials for dementia.
We’ll be dealing
with a lot of this.
Neoplastic or paraneoplastic,
or the discussion that we have had at some
point in time has been hydrocephalus.
All of these could be differential
diagnoses for dementia.
Differential diagnoses for
So what does that mean?
Well, as we get into further
pathogenesis of Alzheimer’s,
we will see as to that
causing destruction or atrophy
of the cerebral cortex.
Or a rare but still one that you want
to know as being a differential for
degenerative would be
formally known as
of course, your --
what’s known as your anticipation
or trinucleotide expansion
with specifically the
trinucleotide being CAG,
and focusing upon the basal ganglia,
where you have issues with Huntington,
and you have that type of chorea
or the jerky movements and such.
Parkinson’s disease, degenerative
or Parkinson’s plus syndromes.
And dementia with Lewy bodies or
known as your Lewy body dementia,
and these are issues
we’ll take a look at.
These are degenerative dementias.
What about metabolic dementias?
How about copper
accumulating in your brain?
Basal ganglia maybe resulting in a
shuffling gait, cogwheel rigidity,
all referring to Wilson’s disease.
What if there is a thiamine
deficiency as a result of alcoholism?
Resulting in an issue called
this is important.
Hypercalcemia will never
result in tetany, all right?
But hypercalcemia, you can expect there
to be possible metabolic dementia.
Now, there is that reversible.
Ever heard of dementia
That’s rare, right?
Dementia is always pathological, but at
some point in time if it’s reversible,
here’s a decent list
decrease in T3 and T4,
may appear as being metabolic.
Well, it is metabolic but it
could present as dementia.
You’re able to correct
the thyroid hormones.
You’d be able to
correct the dementia.
Vitamin B12 deficiency.
Here’s an important one
in which that you can
reverse by giving intramuscular
B12 or cobalamin.
By Lyme disease,
remember Lyme disease is a spirochete up
in the northeast and you have Ixodes tick
introduction of the particular
spirochete called Borrelia burgdorferi.
You kill off the bacteria
and then maybe perhaps, you
have reversible dementia.
And then, of course, our spirochete
here known as your Treponema pallidum
referring to tabes dorsalis.
These are important
reversible type of dementias.
Let’s talk about toxic dementia.
Drug intoxication, alcohol,
heavy metal intoxication.
All of these may result in
toxic type of dementia.
We’ll talk about in great detail,
normal pressure hydrocephalus.
So, that’s rather interesting, actually,
is the fact the patient is going
to present with hydrocephalus.
But this is chronic and you’ll see why.
Interesting that you could
but yet the intracranial
pressure is normal.
That is what’s meant by normal
We’ll be spending time
there, not to worry.
Infectious causes of dementia.
You want to be a little careful here.
We call it infectious but we know that
it’s a prion disease, don’t we.
And prion diseases oftentimes
behave as being infectious.
Are they interesting?
HIV, big deal.
talked about plenty.
This is subacute sclerosing
type of dementia.
Let’s talk about dementia
and its epidemiology.
5% of people between --
Look at the ages here, almost always
going to be elderly -- 65 and 70.
50% of people above the age of 85.
So, the older we get, the greater
the risk of developing dementia.
Alzheimer’s disease, 75% to the
most common cause of dementia
is going to be Alzheimer’s.
In addition, what about
-- you still have 25%.
20% which is still a whopping number,
is your strokes or cerebral
vascular accidents or diseases.
And estimated U.S. cost is ridiculous, huh?
And it’s too high because
it’s difficult to treat
and ends up being a
chronic type of issue.
How well can you actually
treat and cure Alzheimer’s?
Fifty billion dollars
and rising and rising.