Alzheimers type A. dvlpmnt of multiple cognitive deficit manifested by both: 1.

memory impairment (impaired learn new things @ recall prev learn in4) 2. 1 : Aphasia Apraxia (impaired ability to carry out motor actvt despite intact sensory fx) Agnosia Disturbance in executive fx (planning, organizing, sequencing, abstracting) B. A1 & A2 cause significant impairment in social, occupational, fx & represent significant from prev level o fx C. Course is characterized by gradual onset & continuing cognitive

DEMENTIA Vascular d/t other GMC A. dvlpmnt of multiple cognitive deficit A. dvlpmnt of multiple cognitive deficit manifested by both: manifested by both: 1. memory impairment (impaired learn 1. memory impairment (impaired learn new things @ recall prev learn in4) new things @ recall prev learn in4) 2. 1 : 2. 1 : Aphasia Aphasia Apraxia (impaired ability to carry out Apraxia (impaired ability to carry out motor actvt despite intact sensory fx) motor actvt despite intact sensory fx) Agnosia Agnosia Disturbance in executive fx (planning, Disturbance in executive fx (planning, organizing, sequencing, abstracting) organizing, sequencing, abstracting) B. A1 & A2 cause significant impairment B. A1 & A2 cause significant impairment in in social, occupational, fx & represent social, occupational, fx & represent significant from prev level o fx significant from prev level o fx C. Focal neuro s&s (exaggerate deep tendon C. Evidence from hx, pe, lab findings that reflexs, xtnsor plantar response, disturbance is direct physiological pseudobulbar palsy, wkns of extremities), consequences of GMC other than OR lab evidence indicate CVA that judge to Alzheimer & CVA
be etiological related to d disturbance

Subst-induce persisting ~ A. dvlpmnt of multiple cognitive deficit manifested by both: 1. memory impairment (impaired learn new things @ recall prev learn in4) 2. 1 : Aphasia Apraxia (impaired ability to carry out motor actvt despite intact sensory fx) Agnosia Disturbance in executive fx (planning, organizing, sequencing, abstracting) B. A1 & A2 cause significant impairment in social, occupational, fx & represent significant from prev level o fx C. Evidence from hx, pe, lab findings that deficits r etiologically related to persisting effect of subst use

D. A1 & A2 not d/t : 1. Other CNS condition that cause progressive deficit in memory & cognition (Parkinson, CVA, Huntington, subdural haematoma, brain tumor) 2. Systemic condition that r known to cause dementia (hypoT, vit b12/folic acid def, neurosyphilis, HIV infxn) 3. Substance induced cond E. Deficits do not occur xclusively during D. Deficits do not occur xclusively during course of delirium course of delirium F. Disturbance is not better accounted by other Axis I d/o

D. Deficits do not occur xclusively during course of delirium

D. Deficits X occur xclusively during course of delirium & persists beyond usual duration of subst intoxication or withdrawal

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Assessment of common prob In4 from carer Assess fx capacity in dementia px Forgetfulns Memory lapses Personality Fail to recognize ppl Fail to cope with prev routine tasks Lack of self care & in personal st&ards Give up prev interest & hobbies Emotional : anxiety, depression, irritability, lack of care & concern Nocturnal confusion Disorientation for time & place Diff in speech Extent to which hv been gradual or hv suddenly worsened Continence Dressing Self-care Cooking ability & nutrition Shoppinh/housework Degree of orientation in home Capacity to mx financial affairs Formal & informal supports Social contacts Safety in home Aggression Is it verbal or physical? To whom it is directed & when is there a reason? What resources r available? Should drugs be use? What kind & how often? R there any contributin medical factors (drugs)? What means of coping with problem r available (pads or laundry services) ? Frequency? What is degree of danger? How do the risk balance against the choice of individual? What alternatives resources of help r available? When should d situation reassessed? What other ways could there be to limit risks of w&ering & self neglect? Is additional community support available? R compulsory precedures appropriate? Can some one be appointed to take on legal powers for financial & other matters?

Incontinence

W&ering Refusal of services

Refusal to accept admission to residential care

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Pseudodementia vs Dementia

Clinical course & hx

Complaints & clinical behavior

Pseudodementia Family always aware of dysfx & its severity Onset can be dated with some precision Symptoms of short duration b4 medical help is sought Rapid progression of symptoms after onset Hx of prev psychiatric dysfx common Px usually complain much of cognitive loss Px complaints of cognitive dysfx usually detailed Px emphasize disability Px highlight failures Px make little effort to perform even simple tasks Px usually communicate strong sense of distress Affective change often pervasive Loss of social skills often early & prominent Behavior often incongruent with severity of cognitive dysfx Nocturnal accentuation of dysfx uncommon Attention & concentration often well preserved Don't know answers typical On tests of orientation, Px often give don't know answers Memory loss for recent & remote events usually severe Memory gaps for specific periods or events common Marked variability in performance on tasks of similar difficulty Course of weeks & months Normal orientation Begins with mood symptoms Unwillingns to answer May b diurnal variation

Clinical features related to memory, cognitive, & intellectual dysfxs

Dementia Family often unaware of dysfx & its severity Onset can be dated only w/in broad limits Symptoms usually of long duration b4 medical help is sought Slow progression of symptoms throughout course Hx of prev psychiatric dysfx unusual Px usually complain little of cognitive loss Px complaints of cognitive dysfx usually vague Px conceal disability Px delight in accomplishments, however trivial Px struggle to perform tasks Px rely on notes, calendars, etc., to keep up Px often appear unconcerned Affect labile & shallow Social skills often retained Behavior usually compatible with severity of cognitive dysfx Nocturnal accentuation of dysfx common Attention & concentration usually faulty Near-miss answers frequent On tests of orientation, px often mistake unusual for usual Memory loss for recent events usually more severe than for remote events Memory gaps for specific periods unusuala Consistently poor performance on tasks of similar difficulty Prolonged progressive course Impaired orientation Mood changes secondary Memory impaired, may confabulate May B hx of mood d/o

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