dementia-a disease with no hope? - home :: ams dr shahul hameed mrcpuk,fams consultant neurologist...
TRANSCRIPT
![Page 1: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/1.jpg)
Dementia-A disease with no hope?
Dr Shahul Hameed MRCPUK,FAMS
Consultant Neurologist National Neuroscience Institute(SGH)
![Page 2: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/2.jpg)
Memory Disorders
► Singapore --fastest ageing population
► 15-20% of total population--aged above 65 in 2030
► Prevalence of dementia/cognitive impairment --2-14%
► Malay(9.4%) Indian (8.8%) Chinese(4.2%)
![Page 3: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/3.jpg)
DSM-1V Criteria for Dementia
► Amnesia Gradually
► And declines in one of the following domains
► Aphasia Communication problem
► Apraxia Motor task problems
► Agnosia Problems in recognising
► Executive dysfunctioning— Tasks which was not a problem before
► As a result becoming less independent in self care,home care and community.
![Page 4: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/4.jpg)
ADL
►4 ADLs gets affected in early dementia:(Peres
et al J Am Geriatr Soc.)
►1.Communication
►2.Planning an outing and completing
►3.Using medications safely
►4.Handling money appropriately
![Page 5: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/5.jpg)
Case Study
►67 yrs old lady Retired school teacher
►Lives with her daughter
►Had ischemic stroke 5 years ago-Right Hemiplegia with full functional recovery
►Had Minor short term memory deficits and word finding problems since her stroke
![Page 6: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/6.jpg)
► Daughter notices 2 year history of worsening memory leading to poor personal hygiene and housekeeping.
► Very apathetic,not socializing like before
► She had lost her way in her neighbourhood twice.
► Pmhx: HPT,Hyperlipids.
► Exam: Neuropsych-- MMSE-27/30(1/3 delayed recall,2/3 on 3 step command)
► FAB- 8/18.—Points lost in abstraction,verbal fluency and conflicting instructions tasks.
► Her clock drawing was impaired.
![Page 7: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/7.jpg)
►Diagnosis: Vascular Dementia
►Followup:
►Acetylcholinesterase inhibitor
►Next 3 months improvement in her intiative for activities of daily living and social outings—Family feels she has improved
![Page 8: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/8.jpg)
VCI
► VCI- Heterogenous group of cognitive disorders related to small and large cerebral vessel disease
► CIND—VASCULAR DEMENTIA
► VaD: Multiinfarct Dementia
► Post stroke Dementia
► Strategic infarct Dementia
► Subcortical Vascular Dementia(Binswanger’s Disease).
► Prevalence of post stroke dementia 14% -32% (Barba
et al,stroke. Henon et al Neurology.)
![Page 9: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/9.jpg)
► VCI-Pattern of cognitive deficits varies considerably
► Single strategic large vessel infarct have specific cognitive profile.
► while subcortical lesions-Dysexecutive syndromes—Slow information processing speed,emotional lability.
► Impaired ability to plan,organize,intiate and shift between tasks.
► MMSE are often insensitive to these abnormalities (Royall et al J Am Geriatr Soc )
► Dysexecutive type of impairment rapidly apparent on FAB (Dubois et al Neurology)
![Page 10: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/10.jpg)
► The clinical course of post stroke dementia is difficult to
predict with upto one-third of people having a change in their diagnostic category(NCI,CIND,DEMENTIA) within one year after stroke ( Tham et al,J,Neurol Sci )
Risk factors for progression to VCI in stroke :
Age
Cognitive reserve before the stroke
Polypharmacy
Hypotension during acute stroke
Depression
Strategic infarcts like temporal lobe
(Del Ser et al,Stroke. Brodaty et al Am J Geriat Psychiatry)
![Page 11: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/11.jpg)
![Page 12: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/12.jpg)
►Treatment:
►Minimize the risk of future strokes
►Control vascular risk factors
►Cholinesterase inhibitors
►NMDA Antagonist-Memantine
►Selective serotonin reuptake inhibitors has shown to improve executive dysfunction in VCI and depressive symptoms in AD (Opler et
al J Clin Psych.)
![Page 13: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/13.jpg)
![Page 14: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/14.jpg)
Case Study ►60 yrs Chinese Housewife
►Presented with- Word finding difficulty
►Memory problems
►Informant-Husband noticed-Progressive problems for past 2 years
►Difficulties in conversation
►Difficulties in cooking
►Misplacing things in house
![Page 15: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/15.jpg)
►PmHx: HPT,Asthma
►Examination: Neuroexam- Normal
►Neuropsychology: MMSE-22/30
►Impairment in Language-Anomia
►Impaired Semantic Verbal fluency
►Impairment in executive function
►ADLs-- Well preserved,Still drives car to go and play mahjong with her friends. Goes to movies(but when asked about the story line-can’t recollect).
![Page 16: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/16.jpg)
►MRI BRAIN
Focal Atrophy of left temporal lobe and
Left Hippocampus.
![Page 17: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/17.jpg)
►FDG-PET SCAN
Asymetrical decreased glucose
Metabolism in left temporal
Lobe
Normal metabolism in frontal
Lobes,basal ganglia and
Occipital lobes.
![Page 18: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/18.jpg)
►CSF Routine Exam- Normal
CSF Biomarkers Beta 42 amyloid– LOW
Phospharylated Tau- High
Total Tau– High.
Diagnosis: Alzheimers Disease Dementia
(Logopenic Progressive Aphasia)
Followup: Acetylcholinesterase inhibitor
Cognitive and Global function-stable for past 4 years.
![Page 19: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/19.jpg)
►Logopenic progressive aphasia (LPA) is a form of progressive primary aphasia characterized by slow speech and impaired syntactic comprehension and naming.
► It is similar to Wernickes aphasia and is associated with atrophy to the left posterior temporal cortex and inferior parietal lobe.
►An atypical form of AD is the most common cause of logopenic progressive aphasia.
![Page 20: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/20.jpg)
Amyloid hypothesis
![Page 21: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/21.jpg)
Biomarkers ►Imaging: Volumetric MRI
► FDG-PET Brain
► PiB PET Scan
►CSF: Beta 42 amyloid
► Total Tau
► Phosphorylated Tau
![Page 22: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/22.jpg)
Dynamic biomarker model Clifford jack et al
![Page 23: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/23.jpg)
Case Study
►Mr L C M 65 years old Working Executive
►Presented with 1 year history of memory problems
►Needs to make lists when goes to shopping (not before)
►Occasionally misplaces objects at home
►Wife Complains: ‘He forgets details of conversation we have’
►He has diifuculty in remembering numbers
![Page 24: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/24.jpg)
Case Study
► Sometimes takes time to recall words during conversation-self reported
► Mr LCM functionally independent,drives to work,sometimes plays organ in church,little exercise.
► Past Medical History : HPT on Norvasc : Insomnia on Diazepam
Regularly
► Family History: Mother died of AD at age 80 ►
![Page 25: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/25.jpg)
Case Study
► Clinical Exam- Normal
► Neuropyschology tests:
► MMSE 22/30
► MOCA 25/30
► Verbal memory & Visual memory tasks—Impaired
► Attention,Language,Executive Function,Visuoconstruction,Visuomotor speed,NPI,ADCS ADL inventory –All Unimpaired.
![Page 26: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/26.jpg)
Case Study
►Basic blood tests all Normal
►MRI Brain –Normal
►? Diagnosis
![Page 27: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/27.jpg)
MCI
►Subjective complaint of Memory loss
►Gradual in onset -6 months
►Objective impairment of memory
►Generally preserved other cognitive domains
►Preserved basic daily day to day function
►Not Demented
►
![Page 28: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/28.jpg)
Copyright restrictions may apply.
Petersen, R. C. et al. Arch Neurol 2009;66:1447-1455.
Current flowchart for the diagnosis of mild cognitive impairment (MCI) and its subtypes
![Page 29: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/29.jpg)
Donepezil delays progression to AD in MCI subjects with depressive symptoms. Lu PH; Edland SD; Teng E; Tingus K; Petersen RC; Cummings JL
Neurology. 2009 Jun 16;72(24):2115-21.
► Results suggest that depression is predictive of progression from amnestic mild cognitive impairment (aMCI) to Alzheimer disease (AD) and treatment with donepezil delayed progression to AD among depressed subjects with aMCI. Donepezil appears to modulate the increased risk of AD conferred by the presence of depressive symptoms
![Page 30: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/30.jpg)
Physical Exercise ► Effect of physical activity on cognitive function in older adults at risk for Alzheimer
disease: a randomized trial. ► Lautenschlager NT; Cox KL; Flicker L; Foster JK; van Bockxmeer FM; Xiao J; Greenop KR; Almeida ► JAMA. 2008 Sep 3;300(9):1027-37. ► ► CONTEXT: Many observational studies have shown that physical activity reduces the risk of cognitive decline;
however, evidence from randomized trials is lacking. OBJECTIVE: To determine whether physical activity reduces the rate of cognitive decline among older adults at risk. DESIGN AND SETTING: Randomized controlled trial of a 24-week physical activity intervention conducted between 2004 and 2007 in metropolitan Perth, Western Australia. Assessors of cognitive function were blinded to group membership. PARTICIPANTS: We recruited volunteers who reported memory problems but did not meet criteria for dementia. Three hundred eleven individuals aged 50 years or older were screened for eligibility, 89 were not eligible, and 52 refused to participate. A total of 170 participants were randomized and 138 participants completed the 18-month assessment. INTERVENTION: Participants were randomly allocated to an education and usual care group or to a 24-week home-based program of physical activity. MAIN OUTCOME MEASURE: Change in Alzheimer Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores (possible range, 0-70) over 18 months. RESULTS: In an intent-to-treat analysis, participants in the intervention group improved 0.26 points (95% confidence interval, -0.89 to 0.54) and those in the usual care group deteriorated 1.04 points (95% confidence interval, 0.32 to 1.82) on the ADAS-Cog at the end of the intervention. The absolute difference of the outcome measure between the intervention and control groups was -1.3 points (95% confidence interval,-2.38 to -0.22) at the end of the intervention. At 18 months, participants in the intervention group improved 0.73 points (95% confidence interval, -1.27 to 0.03) on the ADAS-Cog, and those in the usual care group improved 0.04 points (95% confidence interval, -0.46 to 0.88). Word list delayed recall and Clinical Dementia Rating sum of boxes improved modestly as well, whereas word list total immediate recall, digit symbol coding, verbal fluency, Beck depression score, and Medical Outcomes 36-Item Short-Form physical and mental component summaries did not change significantly.
► CONCLUSIONS: In this study of adults with subjective memory impairment, a 6-month program of physical activity provided a modest improvement in cognition over an 18-month follow-up period.
![Page 31: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/31.jpg)
Case Study
► A 52-year-old male tax accountant began to embezzle money at work, regularly withdrawing $150 from his office account in order to buy pornography on the Internet.
► Around the time that he was caught by his supervisor, female employees complained that the patient stared inappropriately at them and often made rude comments about their breasts or weight.
► His work had dramatically deteriorated, and rather than working on his accounts, he spent most of the day downloading pornography onto his computer.
► He was fired from the job but made no attempts to find a new job.
![Page 32: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/32.jpg)
Case Study
► His wife and children reported that over the past year he had lost interest in them and watched television without speaking when at home.
► ► He developed a strong desire for ice cream and
gained 20 lbs.
► His manners deteriorated, and he stuffed his mouth, often choking at the dinner table.
► He insisted on eating food on his plate in a specific order, often with his hands.
![Page 33: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/33.jpg)
Case Study
►Neuroexam: No focal deficits
►MMSE: 22/30
►FAB : 9/18
►Blood and CSF-NAD
►MRI BRAIN:
►
![Page 34: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/34.jpg)
FrontoTemporal Degeneration/FTD
bvFTD – behavioral variant FTD
Semantic Variant FTD
PNFA FTD – Progressive non-fluent aphasia
►Depends on which side and site affected first
►Can be confused with PSY case in early stage
![Page 35: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/35.jpg)
► Third most common cause of degenerative dementia, accounting for 3% to 16% of all dementias
► FTD is more common than AD in patients younger than 60 years, the prevalence of FTD is close to that of AD in patients between ages 60 and 70
► Median survival time from first symptom is shorter in FTD than in AD(ranging from 2 to 8 years) bvFTD - 6 to 8 years SV - 8 to 12 years PNFA - 11 to 12 years
Ratnavalli E, Brayne C, Dawson K, Hodges JR. The prevalence of frontotemporal dementia.
Neurology 2002;58(11):1615–1621.
FrontoTemporal Degeneration/FTD
![Page 36: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/36.jpg)
Case Study
► 70 yr Lady –Alzheimer’s Disease
► On Donepezil
► Caregiver—Husband and Maid
► Pt Complains –Husband having affair with maid
► Pinches him until he gets bruised in hand
► Gets very intimate and kisses him often in public
![Page 37: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/37.jpg)
BPSD
►1.Apathy
►2.Agitation & Aggressivity
►3.Anxiety & Depression
►4.Delusions & Hallucinations
►5.Irritability
►6.Night time behaviors
►7.Disinhibition
![Page 38: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/38.jpg)
PDA
![Page 39: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/39.jpg)
![Page 40: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/40.jpg)
Relative frequencies of the main dementias
DLB with
AD 12%
Pure vascular
dementia 5%
Alzheimer’s disease
Vascular dementia
Dementia with Lewy bodies
Frontotemporal dementia
Other dementias white matter dementias
subcortical (secondary) dementias
transmissible encephalopathies
Gearing et al (1995); Kosunen et al (1996); Nagy et al (1998)
Mixed
vascular
dementia
and AD 10%
Pure DLB 3%
60%
5% 5%
![Page 41: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/41.jpg)
Aetiology Reversible Irreversible
Hypothyroidism Vitamin B12 Deficiency Alcohol related-Korsakoffs NPH Syphilis Toxins Metabolic Neoplasms Subdural hematomas
Alzheimers disease Vascular dementia Fronto temporal dementia Dementia with Lewy Body CJD.
![Page 42: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/42.jpg)
HOPE ► Even in the inevitable moments when all seems hopeless, men know that
without hope they cannot really live, and in agonizing desperation they cry for the bread of hope.
► MARTIN LUTHER KING JR., A Testament of Hope
![Page 43: Dementia-A disease with no hope? - Home :: AMS Dr Shahul Hameed MRCPUK,FAMS Consultant Neurologist National Neuroscience Institute(SGH) Memory Disorders](https://reader033.vdocuments.us/reader033/viewer/2022042918/5f5d02344eefb87466701c65/html5/thumbnails/43.jpg)
THANK YOU