classification of dementia
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C H A I R P E R S O N : D R . K R I S H N A M U R T H YP R E S E N T E R : D R . P R I M A D SOUZA
CLASSIFICATION OF
DEMENTIA
03.08.2011
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Dementia is defined as a progressive impairment of
cognitive functions occurring in clear consciousness
Derived from the Latin word dementatus, meaning outof one's mind
Prevalence: moderate to severe dementia
5% in the general population >65 yrs
20-40% in the general population >85 yrs
Male to female ratio is 0.6 to 0.8
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Alzheimer's disease: 50% - 60%
Vascular dementia: 15%
Mixed vascular and Alzheimer's dementia:15%
Fronto-temporal dementias: 5%
Other dementias: 10% (Lewy body dementia, Pick's
disease, NPH, alcoholic dementia, infectious dementia)
Reversible dementias: 5%
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Better understanding of the disorder, uniformity
Underlying pathology, severity
Investigation and management
Availability and timely application of effective treatment
Prognosis and planning..
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Decline in memory- registration, storage and retrieval of
new information
Impairment of thinking, reasoning capacity and
reduction in flow of ideas
Impair personal activities of daily living
Evident for at least 6 months
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F00 Dementia in Alzheimers disease
F00.0 with early onset
F00.1 with late onset
F00.2 atypical or mixed type
F00.9 unspecified
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F01 Vascular dementia
F01.0 Vascular dementia of acute onset
F01.1 Multi- infarct dementia
F01.2 Subcortical vascular dementia
F01.3 Mixed cortical and sub cortical
F01.8 Other vascular dementia
F01.9 Unspecified
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F02 Dementia in other diseases classified elsewhere
F02.0 Dementia in Picks disease
F02.1 Dementia in Creutzfeldt-Jacob disease
F02.2 Dementia in Huntingtons disease
F02.3 Dementia in Parkinsons disease
F02.4 Dementia in HIV disease
F02.8 Dementia in other diseases classified elsewhere
F03 Unspecified dementia
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Multiple cognitive deficits including memory impairement
Plus atleast one of: aphasia, apraxia, agnosia or disturbance
in executive functioning
Sufficiently severe to cause impairement in occupational or
social functioning
Decline from previously higher level of
functioning
Exclude delirium
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294.1x Dementia of Alzheimers type
294.10 without behavioral disturbance
294.11 with behavioral disturbance
Specify subtype:
With early onset: onset is at 65yrs or below
With late onset: onset after age 65 yrs
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290.4x Vascular dementia
290.41 with delirium
290.42 with delusions
290.43 with depressed mood
290.40 uncomplicated
Specify: with behavioral disturbances
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Dementia due to General medical conditions:
.10 without behavioral disturbance
.11 with behavioral disturbance
294.1x Dementia due to HIV Disease
294.1x Dementia due to Head trauma
294.1x Dementia due to Parkinsons disease
294.1x Dementia due to Huntingtons disease
294.1x Dementia due to Picks disease
294.1x Dementia due to CJD
294.1x Dementia due to other GMC
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Dementia due to substance use
Dementia due to multiple etiologies
294.8 Dementia NOS
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Cortical
Sub cortical
Mixed
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SUBCORTICAL
No aphasia
Impaired recall> recognition Calculation preserved late
Executive functiondisproportionately affected
Cognitive processing slowed
early Personality apathetic
Mood depressed
Speech dysarthric
Posture bowed Coordination impaired
Motor speed slowed
Chorea, tremor, tics,dystonia
CORTICAL
Aphasia early
Recall = recognition Involved early
Consistent with otherinvolvement
Normal till late in disease
Unconcerned
Euthymic
Articulate until late
Upright
Normal until late
Normal
absent
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Primary:
Diseases, injuries & insults that affect the brain directly or
with prediliction
Alzheimers, Picks, dementia with Lewy bodies, Parkinsons
Secondary:
Systemic diseases/ disorders that attack the brain as one of
multiple organs or systems of the body involved
HIV dementia, nutritional deficiency, metabolic
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Degenerative dementias:
Alzheimer's disease
Frontotemporal dementias (e.g., Pick's disease)
Parkinson's disease
Lewy body dementia
Miscellaneous:
Huntington's disease
Wilson's disease
Metachromatic leukodystrophy
Neuroacanthocytosis
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Cardiovascular:
Infarction (single, multiple or lacunar)
Binswanger's disease (subcortical arteriosclerotic encephalopathy)
Hemodynamic insufficiency
Physiologic:
Normal pressure hydrocephalus
Metabolic:
Vitamin deficiencies (e.g., vitamin B12, folate)
Endocrinopathies (e.g., hypothyroidism)
Chronic metabolic disturbances (e.g., uremia)
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Tumor:
Primary or metastatic: e.g., meningioma or metastatic breast or
lung cancer
Traumatic: Dementia pugilistica
posttraumatic dementia
Subdural hematoma
Infections:
Prion diseases: e.g., Creutzfeldt-Jakob disease
Acquired immune deficiency syndrome
Syphilis
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Demyelinating diseases:
Multiple sclerosis
Drugs and toxins:
Alcohol Heavy metals
Irradiation
Pseudodementia due to medication (e.g.anticholinergics)
Carbon monoxide
Psychiatric:
Pseudodementia of depression
Cognitive decline in late-life schizophrenia
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Mild dementia:
Consistent forgetfulness that is more marked for recent events
Inability to function effectively in interests and more complex
activities (work, community, home, social activities)
Maintained social judgment
May require prompting to perform activities of daily living he or
she is able to complete independently these tasks
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Moderate dementia:
Short-term memory is poor
Long-term memory may be only slightly affected
Impaired social judgment
Cannot perform independently outside of the home
Activities in the home are usually limited to simple chores Interests are severely curtailed
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Severe dementia:
Severe memory loss-Severe deficits in long-term short-term
memory
Disorientation usually to time and place
Inability to independently function inside or outside of the
home,
Requirement of help with activities of daily living (toileting,
bathing, and eating)
Possible incontinence
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Profound dementia:
Patient is unintelligible & unable to follow simple
commands
Incontinent
Unable to ambulate or to accomplish purposeful tasks
May be bedbound, unresponsive, have swallowing
difficulties and contractures.
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Reversible/ Treatable dementias:
5% of dementias
Causes:
Metabolic: hypothyroidism, hypoparathyroidism
Normal pressure hydrocephalus
Nutritional deficiencies: vitamin B12 or folate deficiencies
Tumor or other space-occupying lesion-chronic SDH Infection: syphilis, AIDS
Drugs: any drug with anticholinergic activity
Emotional: depression
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Progressive /irreversible dementia:
Alzheimer disease
Vascular dementia
Dementia with lewy bodies
Fronto-temporal dementia
Huntingtons disease
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Senile dementia:
onset after age 65 yrs
Eg: Alzheimers disease
Presenile dementia:
onset before age 65 yrs
Eg: Picks, Huntingtons, HIV dementia
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1. Diseases in which dementia is associated with clinical
and laboratory signs of othermedical disease
HIV infection
Endocrine: hypothyroidism, Cushings
nutritional deficiencies
CNS infections
Chronic drug/ heavy metal exposure
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2. Diseases in which dementia is associated with other
neurologic signs but not with other obvious medical disease
A. Invariably associated with other neurologic signs
Huntingtons disease
Multiple sclerosis
Parkinsons disease
CJD, myoclonic epilepsy
B. Often associated with other neurologic signs Cerebral infarct, tumors, trauma
Lewy body disease
NPH
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3. Diseases in which dementia is the only evidence of
neurologic disease or medical disease
A. Alzheimer's
B. Picks
C. Some cases of AIDS
D. Fronto-temporal and frontal lobe dementias
E. Degenerative disease of unspecified type
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National Institute of Neurological Communicative
Disease and Stroke and the Alzheimer's Disease and
Related Disorders Association
Definite: based on histological evidence
Probable: based on clinical criteria
Possible: atypical features or coexisting disorders such as
Parkinsons disease
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PSEUDODEMENTIA
Onset well demarcated
History short
Rapidly progressive
H/o previous psychiatricdifficulty or recent crisis
C/o cognitive function
Affective change present
Behavior unaffected
No nocturnal exacerbation
Examination: I dont know,little effort spent
Inconsistent memory loss
Specific memory gaps
DEMENTIA
Indistinct
Long history
Initially unnoticed
Uncommon
Little c/o cognitive loss Apathetic, shallow
emotions
Compatible with memoryloss
Nocturnal accentuation Tries items, struggles with
tasks
Recent>remote, consistent
No specific memory gaps
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Memory impairement accompanied by abnormal memory
test scores
Normal cognitive function
Preserved activities of daily living
No social or occupational impairement
1020% progress to dementia yearly
Risk factors- degree of cognitive impairement
Evaluation similar to dementia
Treatment controversial
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Neurocognitive Disorders
Minor Neurocognitive Disorder (MCI), with the necessary
neurocognitive impairment in only one domain
Major Neurocognitive Disorder or Dementia-involve at
least two domains.
Memory impairment would not be necessary fordiagnosing either of these conditions.
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Subclassified according to etiologye.g.,
Alzheimer disease,
vascular neurocognitive disorder,
Frontotemporal degeneration,
Lewy Body disease,
Mixed (specify which ones),
Not otherwise specified
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Specifiers to better define the clinical condition
Course (transient, remitting, persistent but stable, persistent
and worsening, persistent with fluctuations)
Age of onset (
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4th century AD- Oribasius- a disease of cerebral atrophy thatcaused loss of intellectual capacity and weakness ofmovement
Esquirol: acute, chronic, and senile
Senile dementia was defined as a cerebral affectioncharacterized by a weakening of the sensibility,understanding and will
1845- Wilhelm Griesinger - senile dementia as a disease of thecerebral arteries
1907-Alois Alzheimer was the first to identify specifichistopathological changes associated with progressivedegenerative dementia
Aphasia, apraxia, agnosia, and the histopathological findingof neurofibrillary tangles and milar foci
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CORTICAL SUBCORTICAL
Aphasia early
Recall = recognition Involved early
Consistent with otherinvolvement
Normal till late in disease
Unconcerned
Euthymic
Articulate until late
Upright Normal until late
Normal
absent
No aphasia
Impaired recall> recognition Calculation preserved late
Executive functiondisproportionately affected
Cognitive processing slowed
early Personality apathetic
Mood depressed
Speech dysarthric
Posture bowed
Coordination impaired
Motor speed slowed
Chorea, tremor, tics,dystonia