Types of dementiaTypes of dementia

Vasileios Papaliagkas MD/PhD, Georgios Vasileios Papaliagkas MD/PhD, Georgios Anogianakis MD/PhDAnogianakis MD/PhD

Department of Experimental PhysiologyDepartment of Experimental PhysiologyDirector:Professor G.AnogianakisDirector:Professor G.Anogianakis

Vascular dementiaVascular dementia Multi-infarct Multi-infarct

dementiadementia: Multi-: Multi-infarct dementia is infarct dementia is the most common the most common form of Vascular form of Vascular dementia. dementia.

Multi-infarct Multi-infarct dementia is caused by dementia is caused by a number of small a number of small strokes, called mini-strokes, called mini-strokes or Transient strokes or Transient Ischaemic Attacks Ischaemic Attacks (TIA). (TIA).

Risk factors (Merck Risk factors (Merck manual) manual) High blood pressureHigh blood pressure DiabetesDiabetes AtherosclerosisAtherosclerosis Atrial fibrillation, a type of Atrial fibrillation, a type of

irregular heart rhythmirregular heart rhythm High levels of fats (lipids), including High levels of fats (lipids), including

cholesterolcholesterol Smoking (currently or in the past)Smoking (currently or in the past) Having had a strokeHaving had a stroke

Multi-infarct dementiaMulti-infarct dementia

The strokes cause damage to the cortex of the The strokes cause damage to the cortex of the brain - the area associated with learning, brain - the area associated with learning, memory and language. memory and language.

A person with Multi-infarct dementia is likely to A person with Multi-infarct dementia is likely to have better insight into their condition in the have better insight into their condition in the early stages than people with Alzheimer’s early stages than people with Alzheimer’s disease. Parts of their personality may remain disease. Parts of their personality may remain relatively intact for longer. relatively intact for longer.

Symptoms may include severe depression, mood Symptoms may include severe depression, mood swings and epilepsyswings and epilepsy

Binswager’s diseaseBinswager’s disease

This was thought to be rare, but is now being This was thought to be rare, but is now being reassessed, and may be relatively common. reassessed, and may be relatively common.

As with other vascular dementias, it is As with other vascular dementias, it is associated with stroke-related changes. It is the associated with stroke-related changes. It is the “white matter” deep within the brain that is “white matter” deep within the brain that is affected. It is caused by high blood pressure, affected. It is caused by high blood pressure, thickening of the arteries and inadequate blood thickening of the arteries and inadequate blood flow. flow.

Diagnosis- Merck ManualDiagnosis- Merck Manual

Once dementia is diagnosed, doctors Once dementia is diagnosed, doctors suspect vascular dementia in people suspect vascular dementia in people who have risk factors for or who have risk factors for or symptoms of a stroke. symptoms of a stroke.

CT, MRI CT, MRI may be done to check for may be done to check for evidence of a stroke. evidence of a stroke.

Definite diagnosis can only be made Definite diagnosis can only be made by examining the brain after death.by examining the brain after death.

Disease ProgressDisease Progress

Gradual progressGradual progress Person’s abilities deteriorate after a Person’s abilities deteriorate after a

stroke, and then stabilize until the stroke, and then stabilize until the next strokenext stroke

On average people with VascularOn average people with Vasculardementia decline more rapidly than dementia decline more rapidly than people with AD.people with AD.

Treatment-1Treatment-1

PreventionPrevention Treating risk factors can help Treating risk factors can help

prevent and slow or stop the prevent and slow or stop the progression of vascular dementia. progression of vascular dementia.

Stopping smokingStopping smoking

Treatment-2Treatment-2

No specific treatment for vascular No specific treatment for vascular dementia. dementia.

Sometimes cholinesterase inhibitors and Sometimes cholinesterase inhibitors and memantine, the drugs used for AD, are memantine, the drugs used for AD, are given because some people with vascular given because some people with vascular dementia also have AD. dementia also have AD.

For people who have had a stroke, doctors For people who have had a stroke, doctors may recommend that they take aspirinmay recommend that they take aspirin

Alcohol related dementiaAlcohol related dementia A form of dementia A form of dementia

related to therelated to theexcessive drinking of excessive drinking of alcohol. alcohol.

It affectsIt affectsmemory, learning and memory, learning and other mental functions. other mental functions.

Korsakoff’s syndrome Korsakoff’s syndrome and and Wenicke/Korsakoff Wenicke/Korsakoff syndrome syndrome are particular are particular forms of alcohol related forms of alcohol related brain injury which may be brain injury which may be related to alcohol related related to alcohol related dementiadementia

Causes-1Causes-1

Not clear whether alcohol hasNot clear whether alcohol hasa direct toxic effect on the brain cells, ora direct toxic effect on the brain cells, orwhether the damage is whether the damage is due to lack of due to lack of thiamine, vitamin B1thiamine, vitamin B1..

Nutritional problems, which often Nutritional problems, which often accompany consistent or episodic heavy accompany consistent or episodic heavy use of alcohol, are thought to be use of alcohol, are thought to be contributing factors. contributing factors.

Causes-2Causes-2

Key brain parts may suffer damage Key brain parts may suffer damage through vitamin deficiencies, through vitamin deficiencies, particularly marked levels ofparticularly marked levels ofthiamine deficiency and thiamine deficiency and

the direct effect that alcohol has on the direct effect that alcohol has on the absorption and use ofthe absorption and use ofthiaminethiamine

SymptomsSymptoms

• • Impaired ability to learn thingsImpaired ability to learn things• Personality changes• Personality changes• Memory problems• Memory problems• Difficulty with clear and logical • Difficulty with clear and logical thinking thinking • Balance problems • Balance problems • Decreased initiative and • Decreased initiative and spontaneityspontaneity

Who gets it?-1Who gets it?-1

Anyone who drinks excessive Anyone who drinks excessive amounts of alcohol for yearsamounts of alcohol for years

Males who drink more than sixMales who drink more than sixstandard alcoholic drinks a day, and standard alcoholic drinks a day, and women who drink more than fourwomen who drink more than four

Risk clearly increases along with the Risk clearly increases along with the levels of alcohol that sbdy drinkslevels of alcohol that sbdy drinks

Who gets it?-2Who gets it?-2

The National Health & Medical The National Health & Medical Research Council of AustraliaResearch Council of Australiarecommends that for health reasons recommends that for health reasons adult males should drink no more adult males should drink no more than than four standard drinks per day four standard drinks per day and and

adult females should drinkadult females should drinkno more than no more than two standard drinks two standard drinks per dayper day

Who gets it?-3Who gets it?-3

It is not currently possible to understand It is not currently possible to understand and predict who will and who won’t develop and predict who will and who won’t develop alcohol relatedalcohol relateddementia.dementia.

Some people who develop alcohol related Some people who develop alcohol related dementia might also show some degree of dementia might also show some degree of recovery over time if they reduce alcohol recovery over time if they reduce alcohol intake to safe levels or abstain from intake to safe levels or abstain from alcohol and maintain good health.alcohol and maintain good health.

TreatmentTreatment

At an early stage of the disease, At an early stage of the disease, problems may be reduced or problems may be reduced or reversed reversed

if the person abstains from alcohol, if the person abstains from alcohol, improves their diet and replaceimproves their diet and replacevitamins especially thiamine and vitamins especially thiamine and vitamin B1.vitamin B1.

Lewy body dementiaLewy body dementia

It is caused by the degeneration and It is caused by the degeneration and death of nerve cells in thedeath of nerve cells in thebrain. brain.

The name comes from the presence The name comes from the presence of abnormal spherical structures, of abnormal spherical structures, called called Lewy bodiesLewy bodies, which develop , which develop inside nerve cellsinside nerve cells

Lewy bodies also occur in Parkinson's Lewy bodies also occur in Parkinson's disease. In Parkinson's disease, they disease. In Parkinson's disease, they occur only in one part of the brain occur only in one part of the brain (deep within the brain stem), (deep within the brain stem),

but in Lewy body dementia, they but in Lewy body dementia, they occur occur throughout the outer layer of throughout the outer layer of the brain (cerebral cortex). the brain (cerebral cortex).

CauseCause

Not any knownNot any known ΝΝo known risk factorso known risk factors ΝΝo evidence thato evidence that dementia with Lewy dementia with Lewy

bodies is an inheritedbodies is an inherited disease.disease.

Common SymptomsCommon Symptoms

Visual hallucinations (complex, detailed)Visual hallucinations (complex, detailed)• • ParkinsonismParkinsonism (tremors and stiffness (tremors and stiffness similar to Parkinson’s disease)similar to Parkinson’s disease)• Fluctuation in mental state • Fluctuation in mental state so that the so that the person may be lucid and clear at one time person may be lucid and clear at one time and confused, disoriented and bewildered and confused, disoriented and bewildered at other times. Typically this fluctuation at other times. Typically this fluctuation occurs over a period of hours or even occurs over a period of hours or even minutes and is not due to any underlying minutes and is not due to any underlying acute physical illness.acute physical illness.

Other symptomsOther symptoms

Difficulty with concentration and Difficulty with concentration and attentionattention• Extreme confusion• Extreme confusion• Difficulties judging distances, • Difficulties judging distances, often resulting in fallsoften resulting in falls

Delusions (complex, bizarre)Delusions (complex, bizarre) DepressionDepression

Diagnosis (Merck manual)Diagnosis (Merck manual)

Based on symptoms. Based on symptoms. Lewy body dementia is likely if Lewy body dementia is likely if

mental function fluctuates in people mental function fluctuates in people who have visual hallucinations and who have visual hallucinations and symptoms of Parkinson's diseasesymptoms of Parkinson's disease

Diff.diagnosis with ADDiff.diagnosis with AD

Who gets it?Who gets it?

More common in menMore common in men

Disease progressDisease progress

Dementia with Lewy bodies more rapid Dementia with Lewy bodies more rapid progression from ADprogression from AD

Leads to complete dependance. Leads to complete dependance. Death is usually a result of another Death is usually a result of another

illness, such as pneumonia or an infection. illness, such as pneumonia or an infection. Average lifespan after the onset of Average lifespan after the onset of

symptoms is about symptoms is about seven yearsseven years..

Treatment-1Treatment-1 No cure for dementia withNo cure for dementia with

Lewy bodies. Lewy bodies. Depression and hallucinations can Depression and hallucinations can

usually be reduced by medication.usually be reduced by medication. However, medications to relieveHowever, medications to relieve

hallucinations may increase muscle hallucinations may increase muscle tremors and stiffness. tremors and stiffness.

Conversely, anti-Parkinson drugs mayConversely, anti-Parkinson drugs maymake hallucinations worsemake hallucinations worse. .

Treatment-2Treatment-2

There is evidence that There is evidence that cholinesterase inhibitors cholinesterase inhibitors may be may be helpful for some people with thishelpful for some people with thiscondition.condition.

Careful for side effects of Careful for side effects of antipsychotic drugsantipsychotic drugs

Frontotemporal dementiaFrontotemporal dementia

Disorders that cause the Disorders that cause the degeneration of frontal and degeneration of frontal and sometimes the temporal lobe sometimes the temporal lobe of the brainof the brain

Personality, behavior, and Personality, behavior, and language function are affected language function are affected more and memory less than in more and memory less than in Alzheimer's disease.Alzheimer's disease.

Doctors base the diagnosis on Doctors base the diagnosis on symptoms and results of a neurologic symptoms and results of a neurologic examination, and use imaging tests examination, and use imaging tests to assess the brain damage.to assess the brain damage.

Treatment aims to manage Treatment aims to manage symptoms.symptoms.

Pick's DiseasePick's Disease

In this rare disorder, Pick bodies In this rare disorder, Pick bodies develop in nerve cells. Pick bodies develop in nerve cells. Pick bodies contain abnormal amounts or types contain abnormal amounts or types of tau. of tau.

Pick's disease resembles AD except Pick's disease resembles AD except that it affects only the frontal and that it affects only the frontal and temporal lobes of the brain and temporal lobes of the brain and progresses more rapidlyprogresses more rapidly. .

Pick’s disease-2Pick’s disease-2

CausesCauses

Not known Not known When there is a genetic element, it is When there is a genetic element, it is

autosomal dominant, (on average, half of autosomal dominant, (on average, half of the children of an affected parent will the children of an affected parent will develop the disease, but half will not)develop the disease, but half will not)

Modified by environmental factorsModified by environmental factors The genetic component has been variously The genetic component has been variously

described as affecting 20 to 50 per cent described as affecting 20 to 50 per cent of people with Pick's disease. of people with Pick's disease.

SymptomsSymptoms

inappropriate behavior, apathy, inappropriate behavior, apathy, memory loss, carelessness, and poor memory loss, carelessness, and poor personal hygiene. personal hygiene.

inevitable progressive deterioration.inevitable progressive deterioration. From the onset of the disease, life From the onset of the disease, life

expectancy is 2-15 years, with an expectancy is 2-15 years, with an average of 6-12 yearsaverage of 6-12 years. .

Death is usually caused by infectionDeath is usually caused by infection. .

Diff.diagnosis from ADDiff.diagnosis from AD

It can be distinguished from AD if 3 of It can be distinguished from AD if 3 of the following 5 characteristics are the following 5 characteristics are presentpresent

presenile onset (under 65 years old); presenile onset (under 65 years old); initial personality change; initial personality change; hyperorality (loss of normal controls, e.g. hyperorality (loss of normal controls, e.g.

excessive eating, indiscriminate putting excessive eating, indiscriminate putting things in one's mouth); things in one's mouth);

DDisinhibitionisinhibition and and roaming behaviour. roaming behaviour. Mendez et al, 1993

TreatmentTreatment

There is no specific treatment.There is no specific treatment. Generally, treatment focuses on Generally, treatment focuses on

managing symptoms and providing managing symptoms and providing support. support.

Speech therapy may help people with Speech therapy may help people with language problems.language problems.

FTD symptoms-PersonalityFTD symptoms-Personality

Some people become uninhibited, Some people become uninhibited, resulting in increasingly resulting in increasingly inappropriate behavior. inappropriate behavior.

Rude speaking. Rude speaking. Abnormal increase in sex interest.Abnormal increase in sex interest.

Merck Manual

FTD symptoms-BehaviourFTD symptoms-Behaviour Impulsive and compulsive. Impulsive and compulsive. Same action repeated over and overSame action repeated over and over They may walk to the same location every They may walk to the same location every

day. day. They may compulsively pick up and They may compulsively pick up and

manipulate random objects and put manipulate random objects and put objects in their mouth. objects in their mouth.

They may suck or smack their lips. They They may suck or smack their lips. They may overeat or eat only one type of food.may overeat or eat only one type of food.

Merck Manual

FTD symptoms-LanguageFTD symptoms-Language

Most people have difficulty finding Most people have difficulty finding words. words.

They have increasing difficulty using They have increasing difficulty using and understanding language and understanding language (aphasia). (aphasia).

For some, physically producing For some, physically producing speech (dysarthria) is difficult. speech (dysarthria) is difficult.

..Merck Manual

FTD symptoms-FTD symptoms-Language-2Language-2 Paying attention is very difficult. Paying attention is very difficult. For some, language problems are the only For some, language problems are the only

symptom for 10 or more years.symptom for 10 or more years. For others, others symptoms appear For others, others symptoms appear

within a few yearswithin a few years Others have difficulty naming objects Others have difficulty naming objects

(anomia) (anomia) and recognizing faces and recognizing faces (prosopagnosia).(prosopagnosia).

speak less or repeat what they or others speak less or repeat what they or others say. Eventually, they stop speaking.say. Eventually, they stop speaking.Merck Manual

DiagnosisDiagnosis

Symptom-basedSymptom-based CT,MRICT,MRI PET to differentiate from ADPET to differentiate from AD

Merck Manual

TreatmentTreatment

Not specificNot specific Based on symptomsBased on symptoms

AIDS related dementiaAIDS related dementia

People who suffer from AIDSPeople who suffer from AIDSmight develop a complication to the might develop a complication to the disease which is known as AIDS disease which is known as AIDS related dementia, or as AIDSrelated dementia, or as AIDSDementia Complex (ADC).Dementia Complex (ADC).

AIDS dementia complexAIDS dementia complex

ADC is a complicated syndrome made up ADC is a complicated syndrome made up of different mental symptomsof different mental symptomsthat can develop in some people with HIV that can develop in some people with HIV disease. disease.

Incidence of ADC is uncommon in people Incidence of ADC is uncommon in people with the early stages of the disease, but with the early stages of the disease, but may increase as the disease advances to may increase as the disease advances to around 7% in people not taking anti-HIV around 7% in people not taking anti-HIV drugs.drugs.

Symptoms-early stagesSymptoms-early stages Difficulty concentratingDifficulty concentrating

• Difficulty remembering phone numbers or• Difficulty remembering phone numbers orappointmentsappointments• Slowed thinking• Slowed thinking• Taking longer to complete complicated tasks• Taking longer to complete complicated tasks• Difficulty keeping track of daily activities• Difficulty keeping track of daily activities• Irritability• Irritability• Unsteady gait or difficulty keeping balance• Unsteady gait or difficulty keeping balance• Poor coordination and a change in handwriting• Poor coordination and a change in handwriting• Depression• Depression

Middle stages-1 Middle stages-1

Symptoms of motor dysfunction, such asSymptoms of motor dysfunction, such asmuscle weaknessmuscle weakness• Poor performance on regular tasks• Poor performance on regular tasks• Increased concentration and attention • Increased concentration and attention requiredrequired• Reversing of numbers or words• Reversing of numbers or words• Slower responses and frequently • Slower responses and frequently dropping objectsdropping objects

Middle stages-2Middle stages-2

General feelings of indifference or General feelings of indifference or apathyapathy• Slowness in normal activities, such • Slowness in normal activities, such as eating and writingas eating and writing• Walking, balance, and coordination • Walking, balance, and coordination requires an increased effortrequires an increased effort

Late stages Late stages

• • Loss of bladder or bowel controlLoss of bladder or bowel control• Spastic gait, making walking • Spastic gait, making walking increasingly difficultincreasingly difficult• Loss of initiative or interest• Loss of initiative or interest• Withdrawal• Withdrawal• Psychosis or mania• Psychosis or mania• Confinement to bed• Confinement to bed

DiagnosisDiagnosis

A test called the mental statusA test called the mental statusexamination examination

Certain laboratory tests,Certain laboratory tests,including an examination of including an examination of cerebrospinal fluidcerebrospinal fluid(CSF)(CSF)

CT scans, MRI scans and SPECTCT scans, MRI scans and SPECTscans for differential diagnosis with scans for differential diagnosis with other dementiasother dementias

Parkinson’s dementiaParkinson’s dementia

About 40% of people with About 40% of people with Parkinson's disease develop Parkinson's disease develop dementia, usually after age 70 and dementia, usually after age 70 and about 10 to 15 years after about 10 to 15 years after Parkinson's disease has been Parkinson's disease has been diagnosed. diagnosed.

Dementia causes death more often Dementia causes death more often than any other effects of than any other effects of Parkinson's disease.Parkinson's disease.

SymptomsSymptoms Symptoms may be very similar to those of Symptoms may be very similar to those of

Alzheimer's disease and Lewy body Alzheimer's disease and Lewy body dementia. dementia.

Memory is impaired, and people have Memory is impaired, and people have difficulty processing information. People difficulty processing information. People think more slowly. think more slowly.

They may be apathetic and lack They may be apathetic and lack motivation. They may be moody, confused, motivation. They may be moody, confused, disoriented and easily distracted.disoriented and easily distracted.

Merck manual

Creutzfeldt-Jakob Creutzfeldt-Jakob DiseaseDisease This rare disease This rare disease

is a prion disease is a prion disease that causes a that causes a rapidly progressive rapidly progressive dementia dementia

Creutzfeldt-Jakob Creutzfeldt-Jakob disease often disease often leads to severe leads to severe dementia and dementia and death within a death within a year. year.

The most common The most common early symptoms—early symptoms—memory loss and memory loss and confusion—may confusion—may resemble those of resemble those of other dementias.other dementias.

Dementia PugilisticaDementia Pugilistica

Also called chronic progressive traumatic Also called chronic progressive traumatic encephalopathy, encephalopathy,

May develop in people who have repeated May develop in people who have repeated head injuries—boxers, for example. head injuries—boxers, for example.

Symptoms similar to those of Parkinson's Symptoms similar to those of Parkinson's disease, and some of them also develop disease, and some of them also develop normal-pressure hydrocephalus.normal-pressure hydrocephalus.

Thank you very much for Thank you very much for your attentionyour attention