Dementia: Introduction

by Carlo Raj, MD

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    00:02 Let’s take a look at dementia.

    00:05 What is dementia? A deterioration in mental state characterized by deficits of higher cortical function.

    00:13 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.

    00:24 This is dementia.

    00:29 What kind of issues might you be looking for in dementia? Alzheimer’s disease.

    00:34 It’s not necessarily synonymous with dementia, but, but it is the most common cause of dementia up to 75%.

    00:41 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.

    00:48 So obviously, we’ll be spending a lot of time with it.

    00:51 Dementia is not a feature of normal aging, and is always -- always -- indicative of a pathology.

    00:57 Do you understand as to how rare it is for us to describe in pathology something being always? So dementia is always pathological, not something that we’re going to look forward to like in a male with BPH.

    01:12 Now, mild cognitive impairment is a transition stage to AD, stands for Alzheimer’s disease.

    01:22 Well, here, we have mild cognitive type of dementia or impairment.

    01:28 It is a transitional stage into Alzheimer’s disease and 10% will convert per year, which is a pretty high number.

    01:39 Dementia, differential diagnoses: Was it degenerative? Was it vascular or metabolic? For example, 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.

    01:57 So, all of these are differentials for dementia.

    02:00 Toxic dementia, infectious.

    02:02 We’ll be dealing with a lot of this.

    02:04 Neoplastic or paraneoplastic, traumatic, or the discussion that we have had at some point in time has been hydrocephalus.

    02:13 All of these could be differential diagnoses for dementia.

    02:18 Differential diagnoses for degenerative dementia.

    02:22 So what does that mean? Well, as we get into further pathogenesis of Alzheimer’s, we will see as to that it’s degenerative, causing destruction or atrophy of the cerebral cortex.

    02:36 Or a rare but still one that you want to know as being a differential for degenerative would be frontotemporal dementia, formally known as Pick’s disease.

    02:47 Huntington’s disease, 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.

    03:08 Parkinson’s disease, degenerative or Parkinson’s plus syndromes.

    03:14 And dementia with Lewy bodies or known as your Lewy body dementia, and these are issues we’ll take a look at.

    03:21 These are degenerative dementias.

    03:23 What about metabolic dementias? How about copper accumulating in your brain? What if there is a thiamine deficiency as a result of alcoholism? Resulting in an issue called Wernicke-Korsakoff, metabolic.

    03:37 Hypercalcemia, this is important.

    03:39 Hypercalcemia will never result in tetany, all right? That’s hypocalcemia.

    03:44 But hypercalcemia, you can expect there to be possible metabolic dementia.

    03:49 Addison’s disease.

    03:51 Now, there is that reversible.

    03:53 Quite interesting.

    03:55 Ever heard of dementia that’s reversible? That’s rare, right? Dementia is always pathological, but at some point in time if it’s reversible, here’s a decent list of differentials.

    04:03 Hypothyroidism, decrease in T3 and T4, may appear as being metabolic.

    04:08 Well, it is metabolic but it could present as dementia.

    04:12 You’re able to correct the thyroid hormones.

    04:13 You’d be able to correct the dementia.

    04:15 Unbelievable, huh? Vitamin B12 deficiency.

    04:19 Remember subacute combined degeneration? Here’s an important one in which that you can reverse by giving intramuscular B12 or cobalamin.

    04:26 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.

    04:38 You kill off the bacteria then doxycycline, and then maybe perhaps, you have reversible dementia.

    04:43 And then, of course, our spirochete here known as your Treponema pallidum referring to tabes dorsalis.

    04:48 These are important reversible type of dementias.

    04:54 Let’s talk about toxic dementia.

    04:56 Drug intoxication, alcohol, heavy metal intoxication.

    05:00 All of these may result in toxic type of dementia.

    05:04 We’ll talk about in great detail, normal pressure hydrocephalus.

    05:08 So, that’s rather interesting, actually, is the fact the patient is going to present with hydrocephalus.

    05:12 But this is chronic and you’ll see why.

    05:16 Interesting that you could have hydrocephalus, but yet the intracranial pressure is normal.

    05:21 That is what’s meant by normal pressure hydrocephalus.

    05:23 We’ll be spending time there, not to worry.

    05:26 Infectious causes of dementia.

    05:29 You want to be a little careful here.

    05:30 Creutzfeldt-Jakob disease.

    05:32 We call it infectious but we know that it’s a prion disease, don’t we.

    05:35 And prion diseases oftentimes behave as being infectious.

    05:38 Are they interesting? HIV, big deal.

    05:41 Neurosyphilis, we’ve talked about plenty.

    05:43 This is subacute sclerosing panencephalitis, SSPE, infectious type of dementia.

    05:52 Let’s talk about dementia and its epidemiology.

    05:54 5% of people between -- Look at the ages here, almost always going to be elderly -- 65 and 70.

    06:01 So, the older we get, the greater the risk of developing dementia.

    06:04 Alzheimer’s disease, 75% to the most common cause of dementia is going to be Alzheimer’s.

    06:12 In addition, what about -- you still have 25%.

    06:15 20% which is still a whopping number, is your strokes or cerebral vascular accidents or diseases.

    06:23 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.

    06:32 How well can you actually treat and cure Alzheimer’s? Never.

    06:36 Fifty billion dollars and rising and rising.

    About the Lecture

    The lecture Dementia: Introduction by Carlo Raj, MD is from the course Dementia. It contains the following chapters:

    • Dementia: Introduction
    • Degenerative and Metabolic Dementias
    • Toxic and Infectous Dementia

    Included Quiz Questions

    1. Lewy body dementia
    2. Hypercalcemia
    3. Wernicke-Korsakoff syndrome
    4. Addison disease
    5. Wilson disease
    1. Vitamin B12 deficiency
    2. Alzheimer disease
    3. Pick disease
    4. Lewy body dementia
    5. Parkinson-plus syndromes
    1. Alzheimer's disease
    2. Hypothyroidism
    3. Vitamin B12 deficiency
    4. Lyme disease
    5. Neurosyphilis
    1. Creutzfeldt-Jakob disease (CJD)
    2. HIV
    3. Neurosyphilis
    4. Subacute sclerosing panencephalitis (SSPE)
    5. Lyme disease

    Author of lecture Dementia: Introduction

     Carlo Raj, MD

    Carlo Raj, MD

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