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Organic Mental Disorders

Dementia
Progressive, usually irreversible,
global cognitive deficits.
Memory
Dysphasia
Agnosia
Apraxia
Impaired executive function
Personal disintegration

Etiology
Degenerative
Alzheimers, Parkinsons,

Intracranial
Infection
Prion disease, neurosyphilis, HIV,

Endrocrine
Metabolic
Vitamin B12 Deficiency
Toxins - alcohol

Clinical features

Investigations
FBC; LFT; U&E; glucose; erythrocyte
sedimentation
rate (ESR); thyroid-stimulating hormone
(TSH); calcium; magnesium;
phosphate; Venereal Disease Research
Laboratory (VDRL) test for syphilis;
HIV; vitamin B12 and folate; C-reactive
protein; blood culture; LP; EEG;
chest X-ray (CXR); ECG; CT (optima and axial
protocol); MRI; SPECT.

Management
Etiologic:
cholinesterase inhibitors: tacrine,
donepezil, revastigmine, metrifonate
HAART
Treatment of co-morbid conditions:
depression, agitation, psychosis
Adjunctive treatments:
vit.E, hydergine, selegeline, ginkgo
biloba

Alzheimers
DAT dementia of Alzheimer type
Most common cause 70%
A degerative disease of the brain
with prominent cognitive and
behavioral impairment sufficiently
severe to interfere with social and
occupational function
Possible factors : Smoking, estrogen,
NSAID, vit E

Pathophysiology
Amyloid plaques
Neurofibrillary tangles
Genetics 40% have a positive
family history

Clinical features
Early symptoms
Failing memory, changes in behavior wandering, irritability

Middle symptoms
Aphasia, apraxia(awkwardness with the sequence of dressing),
agnosia(trouble locating body parts)

Late symptoms
Fully dependent
Physical deterioration
Incontinence

Psychiatry symptoms
Delusions, hallucinations, depression

Behavioral dan personality changes aggression, sexual


disinhibition

Assessment

Detailed history
MSE
Cognitive testing
Physical examination
Blood tests
EEG
Brain imaging

Pharmacological
intervention
First generation AChEIs
Tacrine
SE- GI problems, hepatotoxic

Second generation
Donepezil piperidine derivative, long half life, highly selective
SE- GI, bradycardia, KI-asthma
Dose 1x daily 5-10mg/day

Rivastigmine
Short half life
SE- GI
Dose- start with 1.5mg BD

Galantamine
Selectively inhibit AChE
4-12mg BD

NMDA receptor partial antagonistt


Memantine

Others
Vit E, selegiline

Dementia with lewy bodies


Common form of senile dementia
that shares clinical and pathological
feature of Dat and parkinsons

Clinical features
Dementia, parkinsonism, fluctuating
cognitive performance
Complex hallucinations-visual(60%)
Transient disturbance of
conciousness

Pathological features

Management
No compelling data indicate that
medications can decreaase cognitive
decline
Use drugs with caution!

Vascular dementia
Second common cause after DAT
Risk factors
hypertension, smoking,
hypercholesterolemia, diabetes mellitus,
and cardiovascular and cerebrovascular
disease.

Management
Establish causative factors.

Medical or surgical diseases that are


contributory need to be treated
early.
Daily aspirin may delay course of disease.
General
health
interventions
include
changing diet, stopping smoking, managing
hypertension, optimizing diabetic control,
and increasing exercise.