Dementia

– Dementia can be defined as an intellectual state of weakness acquired, progressive, more or less irreversible

– In cortical dementia (Alzheimer’s type) the subject has lost its tools; in the subcortical dysfunction, but it still has not used

– Syndrome frontotemporal corresponds to Pick’s disease. The temporoparietal syndrome corresponds to Alzheimer’s disease

– Dementia subcortical -> Parkinson’s disease; Huntington; progressive supranuclear palsy

– Reappearance of primitive reflexes (palm-chin reflex, grasp reflex, sucking reflex)

– The most common cause of treatable dementia (pseudo-dementia) is depression -> psychomotor retardation; depression in semantic memory (word meanings), implicit memory (implied) and indexed memory is retained.

– Schizophrenia (and other chronic psychotic disorders) evolving into dementia if inadequately treated

1- Topography:

A- SYNDROME TEMPOROMANDIBULAR PARIETAL:

* Memory Disorders (first recent developments)

* Progressive Disorientation: temporal and spatial; and prosopagnosia

* Disorders intellectual efficiency (impaired judgment of attention and concentration, difficulty solving problems)

* Disorders language; Gestures disorders (apraxia); constructive disorders; gnostic disorders

* Sometimes delusions interpretive, imaginative, hallucination

B- SYNDROME FRONTO-TEMPORAL:

* First brand through personal neglect

* Then disinhibition; impulsiveness and loss of mental flexibility

* Food disturbed behavior (excess and incoherence); repetitive and stereotyped behavior

* Total Indifference and a great lack of attention; apathy; euphoria (Moria)

* Memory, orientation and praxis have long preserved.

C- SYNDROME SUB-CORTICAL:

* This is an anticipatory pathology

* Intellectual Slow

* Aboulie (loss of control)

* Great apathy

* Recall memory disorders mainly

* Front dysexecutive Syndrome: Dissociation between volition (think of the action) and the action itself.

* Language is largely preserved.

2- Etiology:

A- Normal pressure hydrocephalus:

intellectual decline with increased apathy; gait and balance with retropulsion; sphincter disorders

B- Endocrine Causes:

Hypothyroidism ; Other rarer: hyperthyroidism, dysparathyroïdie, hypoglycemia repeatedly, folate deficiency ….

C- Creutzfeld Jakob Disease:

pyramidal and extrapyramidal disorder, myoclonus; EEG characteristics nickname with rhythmic discharges (cycles 1 / s)

D- Korsakoff syndrome:

anterograde amnesia memory; false recognitions and fabrications. It is due to vitamin B1 deficiency (bilateral destruction of the mammillary bodies); alcoholism is the main cause. Evolution to dementia.