文档介绍：Dementia Diagnosis and Treatment in Primary Care
Bill Lyons
Bree Johnston
Division of Geriatrics
SF VAMC/UCSF
Copyright May 2001
UCSF Division of Geriatrics Primary Care Lecture Series May 2001
Overview
Epidemiology
Age associated Cognitive Changes
Diagnosis
Differential Diagnosis
Etiology
Workup
Non-pharmacologic Treatments
Drug Treatments
Terminal Care
This talk will not be covering:
Pathophysiology
ics
Screening issues:
Who to screen
How to screen
UCSF Division of Geriatrics Primary Care Lecture Series May 2001
You agree to give a short talk about dementia at a local church.
The following questions are asked:
Is it true that everybody gets “senile” if they live long enough?
My Dad had Alzheimer’s disease. What is my risk of getting it?
Sometimes when I talk to my husband, I can’t remember the names of some of those old TV show actors. Am I getting demented?
UCSF Division of Geriatrics Primary Care Lecture Series May 2001
Epidemiology
Prevalence:
1% at age 60
Doubles every five years
30-50% by age 85
Prevalence curve flattens out at about age 90
4th leading cause of death in the elderly
Life expectancy after diagnosis 3-15 years, recent data suggests shorter life expectancy Wolfson, NEJM April, 2001
Epidemiology of Alzheimer’s
Accounts for 60-70% of dementia in US
Risk factors:
Older age
Family history
(e4 allele and other chromosomal defects)
3x risk with 1st degree relative
Female gender
Lower education level
Head trauma?
Vascular Dementias
Diagnostic criteria murky
Overlap with AD
Risk factors
Older age
Male > female, Black race> white race
HTN
Cigarettes, AF, DM, hyperlipidemia
Ischemic stroke survivors: 9X increased dementia risk
Other Causes of Dementia
Dementia with Lewy Bodies
#2 in autopsy studies, males > females
Parkinsonism, little benefit from sinemet, fluctuating impairment, visual hallucinations, neuroleptic sensitivity, rapid progression
Frontotemporal Dementias: . Pick’s disease
Personality changes, euphoria, apathy, dis