Dementia

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Dementia

• Problem
• Economical
• Social
• Medical
• Late diagnosis
• Insufficient prevention of VaD

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Perspectives of age distribution in population
Source United Nations Department of Economic and
Social Affairs, Population Division. World
Population Prospects. The 2004 Revision. New York
United Nations, 2005.
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Prevalence of dementia
Canadian Study of Health and Aging study methods
and prevalence of dementia. CMAJ
1994150899913.
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The most frequent dementias
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Diagnosis

• Dementia - Gradual and progressive change in
  memory function at disease onset reported by
  patients or relatives for a period greater than 6
  months
• 1 next sign - - aphasia
• - apraxia
• - agnosia

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Diagnosis

• History (from patient from relatives)
• MiniMental State Examination - MMSE
• Clock test
• Activities of daily living- phoning,
  transportation, using of drugs, shopping, etc.)

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MMSE

• Orientation
• 1. Year
• 2. Season
• 3. Month
• 4. Date
• 5. Day

• Orientation
• 6. Country
• 7. County
• 8. City
• 9. Name of the institution
• 10. Floor

1 point for each answer
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MMSE

• Memory
• 11. Reproduction of 3 terms (0-3)
• (apple, table, tree)
• Attention and counting
• 12. Counting 100 7,.... or (terms) (0-5)
• 13. Reproduction of 3 terms from 11. (0-3)

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MMSE

• Higher cognitive functions
• 14. Clock (0-1)
• 15. Pencil (0-1)
• 16. Repeating (0-1)
• 17. Understanding (3-steps) (0-3)
• 18. Understanding (1-step) CLOSE THE EYES
  (0-1)
• 19. Writing the sentence(0-1)
• 20. Picture (0-1)

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MMSE
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MMSE

• Summary
• 25 - 30 normal (24-25 mild cognitive impairment)
• 20 - 24 mild dementia
• 10 - 19 moderate dementia
• 0 - 9 severe dementia

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Clock test
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Clock test

• 1 point - the clock circle 1 point - for
  all the numbers being in the correct order 1
  point - for the numbers being in the proper
  special
• order 1 point - for the two hands of
  the clock 1 point - for the correct time.
• A normal score is 4 or 5 points.

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Clock test
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Clock test
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Others 5 - most of them we can treat

• Hypothyreosis
• Anemia
• Neuroinfections (neuroboreliosis, neurpsyphylis,
  HIV, CJD,...)
• Metabolic, toxic etiology
• Brain tumors
• Autoimunne limbic encephalitis
• Normotension hydrocephalus
• Hypovitaminosis B12
• Chronic alcoholism
• Head injury

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