Describe different types of dementia 2. Describe signs and symptoms of dementia

1. Describe different types of dementia 2. Describe signs and symptoms of dementia

3. Explain risk factors and prevention of dementia 4. Identify some tools available to assess the presence of dementia Abstracts Dementia is defined as an acquired syndrome of decline in memory and at least one other cognitive domain such as language, visuo-spatial, or executive function sufficient to interfere with social or occupational functioning in an alert person. Dementia involve a mental decline that affects more than one of the four core mental functions :  recent memory the ability to learn and recall new information  language the ability to write and speak or to understand written or spoken words  visuspatial function the ability to see and understand spatial relationships among objects, ex : skill needed to use a map  executive function the ability to plan, reason, solve problems and focus on a task As people age there are normal changes on memory. There are changes in the way our brains store information and it is often harder to recall information. However, normal memory changes do not interfere with your ability to function on daily living. When this occurs it is not normal aging. Mild cognitive impairment MCI is a transition phase between normal aging and dementia. People with MCI present with subjective memory loss and have evidence of memory impairment on cognitive testing. However, general intelligence is preserved and there are no changes in the ability to carry out activities of daily living ADL. Alzheimer’s disease and cerebrovascular ischemiavascular dementia are the two most common causes of dementia. Between 60 and 70 of individuals with dementia have Alzheimer’s disease; about 20 to 30 have either vascular dementia or a combination of vascular dementia and Alzheimer’s disease. A definitive diagnosis of dementia alzheimer is possible only through brain autopsy, so completing a thorough assessement encompassing many components lends to the best probable diagnosis. Assessment for dementia includes history from patients, history from a reliable family member caregiver, physical examination, cognitive assessment and functional assessment. Laboratory and imaging test are used to rule out reversible causes of dementia. Scenario 1 : A 60-years-old man, came to the hospital with difficulty in memory. This patient had a 6-months history of memory impairment. He has been a cerebrovascular diseases stroke since a year ago. He has been a high blood pressure and diabetes mellitus. Learning Task : 1. How to diagnose this patients? 2. How to differentiate this patients? 3. Please explain the etio-pathogenesis and pathophysiology 4. What test should be used ? Self Assessment : 1. Describe taking a good history on the memory impairment 2. Describe the neurologic and neurobehaviour examination 3. Describe the causes of dementia 59 Faculty of Medicine Udayana University, DME 4. Describe how to manage this dementia 5. Describe the prognosis for this patient Scenario 2 : A 60 years old woman came with complaint of slowly progressed memory and cognitive impairment approximately since 5 years ago. He has not been a high blood pressure or head injury. Learning Task : 1. How to diagnose this patients? 2. How to differentiate this patients? 3. Please explain the etio-pathogenesis and pathophysiology 4. What test should be used ? Self Assessment : 1. Describe taking a good history on the memory impairment 2. Describe the neurologic and neurobehaviour examination 3. Describe the causes of dementia 4. Describe how to manage this dementia 5. Describe the prognosis for this patient MOVEMENT DISORDERSNEUROGERIATRIC Dr dr DPG Purwa Samatra Sp SK Movement disorders are commom in clinical practice. Movement. Movement disorders divided, based on movement type. Based on these movement disorders divided : hyperkinetic movement disorders and hypokinetic movement disorders. Hypokinetic : Akinesibradykinesis Rigidity Postural Instability Stiff-man syndromefreezing Hyperkinetic : Chorea Myoclonus Dystoniia Tics Tremor PARKINSONISM Parkinsonism is a syndrome manifested by a comination following six cardinal features. A combination of these signs is used to clinically define : definitte, probable and possible. Parkinson disease PD , first rcognized as a unique clinical entity by James Parkinson in 1817, who in his An Essay on the Shaking Palsy. Diagnostic criteria of Parkinsonism 60 Faculty of Medicine Udayana University, DME 1. Tremor at arest 2. Bradykinesia 3. Rigidity 4. Postural instability 4. Flexor position 5. Freezing motor blocks Definite : At least two of these features must be present, one of them being 1 or 2 Possible : At least two of feture 3 to 6 must be present Probable: Feature 1 or 2 alone is present Etiologi : Common causes of Parkinsonism : 1. Idiopathic Parkinson Disease primary 2. Drug-induced Parkinsonism secondary Parkinsonism 3. Multiple system atrophy 4. Progressive supranuclear palsy Pathogenesis Parkinson desease and Parkinsonism doe to degeneration of substansia nigra part of basal ganglia, with a resulting deficiency of striatal dopamine. Clinical features begin to emerge when approximately 60 loss dopamine. Another sgn of Parkinsonism are non motor symptom : autonomic dysfunction, cognitive abnormalitas, sleep disorders, depressive disorders, gastrointestinal abnormalit Pathophysiology of Parkinonism : decrease of dopaminergyc neurons at substantia nigra, as a part of basal ganglia. The basal ganglia comprice four structures: The striatum putamen,nucleus caudatus, the pallidum, the subthalamic nucleus and nigral subtstance. The Hoehn Yahr Scale: the common way to rate progression of symptoms in PD 17

1. Stage one