Subcortical dementia

Subcortical dementia: Description, Causes and Risk Factors:Subcortical dementiaThe subcortical dementias are a heterogeneous group of disorders in which the predominant pathological lesions occur in subcortical structures such as basal ganglia, brainstem nuclei, and the cerebellum. When the cerebral cortex is involved, the lesions are most often in the frontal lobes. These pathologic lesions are associated with cognitive changes that include bradyphrenia, personality change (apathy, depression, and irritability), memory impairment, and impaired manipulation of acquired knowledge (calculation, abstraction). Aphasia, apraxia, and agnosia are commonly seen in the cortical dementias, but are absent in the subcortical dementias. Progress in research on the anatomy and connectivity of cortical-subcortical structures has led to refinement in our understanding of the cortical dementias. Despite the connectivity between the cortical and subcortical structures, patterns of cognitive impairment in subcortical dementias remain distinct.Several important transmitters, including dopamine and noradrenaline, have their cells of origin in subcortical nuclei and project to diencephalic and telencephalic structures via subcortical tracts. The basal ganglia and substantia nigra also receive extensive projections from the limbic system, and disruption of these pathways may partly account for the disturbances in mood and motivation associated with subcortical dementias. Surgical ablation of the dorsomedial thalamic nucleus results in complex changes in drive, problem solving ability, personality, and feeling. The medial and rostral parts of the thalamus subserve recent memory function, and a normally functioning circuit from the hippocampus via thalamus and limbic system to the cortex is necessary for establishing a recent memory trace.The distinction between cortical and subcortical syndromes of dementia is controversial. Clinical reports suggest that subcortical syndromes (eg, Parkinson's disease) involve less severe intellectual and memory dysfunction and lack the aphasia, agnosia, and apraxia typical of the cortical dementias (eg, dementia of the Alzheimer type). A recent neuropsychological investigation using a standardized procedure failed to confirm the distinction. We examined patients with Alzheimer's disease, patients with Parkinson's disease, and normal controls by using a neuropsychological procedure specifically designed to quantitatively evaluate the proposed clinical differences. The results differentiated these dementia syndromes, and the pattern of performance was consistent with the cortical-subcortical hypothesis.Symptoms:Symptoms of subcortical dementia are unusual blood pressures, blood abnormalities, stroke, disease of large blood vessels in the neck, heart valve disease, depression, clumsiness, irritability or apathy.Characteristicsymptoms include forgetfulness, slowing of thought processes, mild intellectual impairment, apathy, inertia,depression (sometimes with irritability), and the inability tomanipulate knowledge.Difficulties in problem solving andabnormalities of judgment and insight may occur.Diagnosis:Although there are some brief tests, a more reliable diagnosis needs to be carried out by a specialist, such as a geriatric internist, geriatric psychiatrist, neurologist, neuropsychologist or geropsychologist.The following tests are commonly used:AMTS (Abbreviated Mental Test Score) A score lower than six out of ten suggests a need for further evaluation.
  • MMSE (Mini Mental State Examination) A score lower than twenty-four out of thirty suggests a need for further evaluation).
  • 3MS (Modified Mini-Mental State Examination).
  • CASI (Cognitive Abilities Screening Instrument).
  • It is important that the patient's score is interpreted in context with his socio-economic, educational and cultural background. The tester must also factor in the patient's present physical and mental state - does the patient suffer from depression, is he in great pain?
Poor physical performance in the very elderly - researchers from the University of California found that people aged at least 90 years who had poor physical performance tend to have a much higher risk of either having or soon developing dementia. They reported their findings in Archives of Neurology, October 2012 issue. They assessed a sample of over-90s for walking, standing up from a chair, standing and controlling balance, and gripping something.Treatment:Although subcortical dementia is a progressive deterioration of the brain, a diagnosis must be made before treatment is given. The amount of damage this disease causes directly relates to the cause of the dementia. Subcortical dementia will eventually cause overall brain malfunction, but this can be slowed down if there are medications available to slow down the initial disease. There is no medication for subcortical dementia itself but there are medications that can greatly reduce any uncomfortable symptoms associated with it.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

2 Comments

  1. bienvenido andino villasante

    Would love to know what “cognitive detereiotion vulve subcortinal” means related to a step or scale, say, from 1 to 7, as described in the Global Deteriotion Scale….
    and also, if possible, what that means for the applicaction of a driving licence for a person driving cars since more than 60 years…any law about from the EU?

    Reply
    • editor-m

      In order to estimate the cognitive impairment according to one of the scales the complete neurological and psychological examination is required as long as the deterioration may vary from minimal to significant grades.
      Unfortunately persons with dementia are strongly recommended to avoid driving. You can find more information here:
      https://www.gov.uk/dementia-and-driving
      https://www.gov.uk/driving-medical-conditions

      Reply

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