Dementia Conversion Disorders

DEMENTIA
CONVERSION DISORDERS
Course outline
 Definition
 Etiology
 Risk factors
 Clinical features
 Treatments/management
 Prevention
 prognosis
Group members
NAME REG NUM SIGN
1.cherop sam Anthony 19/U/0545/PHL/PS
2.Kadito Esther oloi
3.Nabaziwa janat
4.Namaganda hope
5.Atim Joan
DEMENTIA
Introduction
A chronic slowly progressive organic mental disorder characterized by
progressive loss of memory and cognitive function, with difficulty in
carrying out every day activities.
Dementia is not normal part of aging. Many people live into their 90s
and beyond without any signs of dementia. However, aging is major risk
factor for the most common dementias such as Alzheimer's
Sub types-
1. Alzheimer’s disease (AD)-most common type of dementia accounting

for 60-80 percent of all the cases.
2. Vascular dementia: Cumulative effect of many small strokes: sudden
onset and stepwise deterioration is characteristic (but often hard to
recognize)
3. Lewy body dementia: Fluctuating cognitive impairment, detailed visual
hallucinations, and later, parkinsonism.
4. Fronto-temporal dementia: Patients display executive impairment,
behavioral/ personality change,disinhibition; hyperorality, stereotyped
behavior, and emotional unconcern.
Dementia with Lewy Bodies or DLB
• Lewy bodies are abnormal aggregations (or clumps) of the protein α-synuclein in
neurons. This is called dementia with Lewy bodies or DLB.
• Lewy bodies may be found in the midbrain (within the substantial nigra) or within
the cortex.
• People with DLB more likely to have initial or early symptoms of sleep
disturbances, well-formed visual hallucinations and visuospatial impairment.
• About 5% of individuals with dementia show evidence of DLB alone, but most
people with DLB also have Alzheimer's disease pathology.
Front temporal Dementias (FTD)
• Nerve cells in the front (frontal lobe) and side regions (temporal
lobes) of the brain are especially affected, and these regions become
markedly atrophied (shrunken).
• Typical early symptoms include marked changes in personality and

behavior and/or difficulty with producing or comprehending
language. Unlike Alzheimer’s, memory is typically spared in the early
stages of disease.
Parkinson’s Disease (PD)
• Problems with movement (slowness, rigidity, tremor and changes in
gait) are common symptoms of PD.
• Cognitive symptoms develop later in the disease.

Causes
Primary degeneration of the brain(Most common cause of
dementias is impairment to neurons' normal functions that include
lose of connections (synapses), impaired energy metabolism, and
neuronal death (neurodegeneration).
Vascular disorders
Infections e.g. syphilis, TB, HIV/AIDS, meningitis
Metabolic disorders e.g. hypothyroidism
Deficiencies of vitamin B12 and B1
Brain trauma (chronic subdural haematoma,hydrocephalus)
Toxic agents e.g. carbon monoxide, alcohol
Risk factors
 Aging
 Family History
 Mild Cognitive Impairment (MCI)
 Cerebrovascular disease (vascular dementia)
 High cholesterol, high blood pressure (especially in midlife)
 Type 2 diabetes
 Physical or mental inactivity
 Head and Brain Trauma/Injury
Clinical features
Impairment of short and long term memory
Impaired judgment, poor abstract thinking
Language disturbances (aphasia)
Personality changes: may become apathetic or withdrawn,
may have associated anxiety or depression because of failing memory,
may become aggressive
Wandering and incontinence in later stages
Diagnosis
Is made by:
I. History from the patient with a thorough collateral narrative—ask about the timeline
of decline and the domains affected.
II. Medication review is important to exclude drug-induced cognitive impairment
Physical exam
I. Non-cognitive symptoms such as agitation, aggression, or apathy indicate late disease.
II. Cognitive testing: Use a validated dementia screen such as the MMSE(mini mental
state exam);it’s a 30 point which assesses cognitive impairment.
III. Carry out a mental state examination to identify anxiety, depression, or hallucinations.
Examination may identify a physical cause, risk factors (e.g. for vascular dementia), or
parkinsonism.
MMSE
• ORIENTATION;year,season,months,date,country,town/5
• Registration; examiner names three objects e.g. (apple,table,pen) and
asks patient to repeat.1 point for each correct answer. Alternative spells
words backward e.g. WORLD
• Attention and calculation; e.g. subtract 7 from 100 then repeat from
result
• Recall; ask for the names of the three objects learned earlier
• Lunguage;name two objects (eg pen,watch);ask a patient to read and
obey a written command on a piece of paper
• Copying; ask the patient to copy a pair of interceting pentagons.
Investigations
• IMAGING
 MRI
Ct scan
LAB STUDIES
CBC,ESR,THYROID HORMONE TESTS,VIT B 12 BLOOOD TEST,LIVER FUNTION
TEST,HIV TEST,ELECTROLYTE TEST(To Check Kidney Function),TOXICOLOGY
SCREEN TEST(For Drug),ANTINUCLEAR ANTI BODIES(Auto Immune
Disease),LUMBER PUNTURE (To Check Some Proteins In Spinal Fluid)
CONFIRMATION;USUALLY WITH AUTOPSY/BIOPSY
Treatment.
Where possible, identify and treat the cause
Psychosocial interventions:
 Education of family members about the illness and about following a regular
routine programme
 Provision of regular orientation information
 Creation of an environment to support activities of daily living
Assess for and treat other co-occurring health problems e.g. depression, HIV
If restless and agitated
Give Haloperidol 0.5-1 mg every 8 hours with higher dose at night if required
Prevention
• Avoid and treat preventable causes
• regular exercise.
• having a healthy balanced diet.
• cessation of smoking and quitting or limiting of alcohol intake.
• keeping blood pressure within healthy range.
• prevention of head trauma, depression and loneliness.
Prognosis
CONVERSION DISORDERS.
Outline
Definition
Causes
Signs and symptoms
treatment
Definition
Conversion disorder also called functional neurological symptom
disorder, is a medical problem involving the function of the nervous
system; specifically the brain and the body's nerves are unable to
send and receive signals properly.as a result of this communication
problem, patients with conversion disorders may have difficulty
moving their limbs or have problems with one or more of their
senses.
MEANING-Anxiety is converted into physical symptoms
A disturbance of bodily function not conforming to current concepts
of neurological anatomy and physiology
a. Characterized by the presence of one or more neurological symptoms,
unexplained by a known neurological or mental disorder
b. Typically occurring in a setting of stress and producing considerable
dysfunction.
c. Requiring for diagnosis the association of psychological factors present at
the initiation or exacerbation of symptoms
• It is thought that these problems arise in response to difficulties in the

patients life, and the conversion is considered a disorder in the diagnostic
and statistical manual of mental disorders fourth edition(DSM-IV)
• Formerly known as Hysteria
causes
• Genetic factor
• Biochemical factor
• Psychosocial factor
• Family dynamics
Signs and symptoms
Conversion disorder can present with motor or sensory symptoms
including any of the following
Motor symptoms or deficits
 Impaired coordination or balance
 Weakness/paralysis of a limb or the entire body(hysterical paralysis )
 Impairment or loss of speech(hysterical aphonia)
 Difficulty in swallowing or a sensation of a lump in the throat
 Urinary retention
• Psychogenic non epileptic seizures or convulsions
• Fixed dystonia.
• Tremor, myoclonus or other movement disorders
• Gait problems(Astasia-abasia)
• Syncope(fainting)
Sensory symptoms or deficits
• Impaired vision(hysterical blindness)
• Double vision
• Impaired hearing(deafness)
• Numbness(loss of sensation).
Verbal tics eg throat clearing,coughing,sniffing,whistling or hissing
Diagnostic measures
• Medical history and physical exam
• CT and MRI scans. These tests provide detail on possible head
injuries,strokes,brain tumors and brain diseases that may be causing
symptoms
• EEG. This test looks for evidence of seizures or other electrical
changes in the brain.
Dsm- 5 diagnostic criteria for conversion
disorders
• One Or More Symptoms That Affect Body Movement Or Your Senses
• Symptoms Cant Be Explained By A Neurological Or Other Medical
Condition Or Another Mental Health Disorder
• Symptoms Cause Significant Distress Or Problems In Social, Work Or
Other Areas Or They're Significant Enough That Medical Evaluation Is
Recommended.
Management.
Pharmacological management
Anxiolytics (clonazepam,valium,lorazepam)
Antidepressants
Non pharmacological management
Psychotherapy
Cognitive behavioral therapy
Individual psychotherapy
Group therapy
• Hypnosis
• Trans cranial magnetic stimulation(uses magnetic fields to stimulate nerve cells)
• Rehabilitation therapy
• Relaxation therapy
Prognosis
• There is reason for hope: most people who experience functional
symptoms get better.
• Factors that are associated with a positive outcome include;
Patient received a good explanation of the condition and accepted the
treatment recommendations
Patient was diagnosed early
Patient had a good response to treatments
References:
NIH: https://www.nia.nih.gov/health/alzheimers/basics
2021 Alzheimer’s disease facts and figures

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DEMENTIA

1. Alzheimer’s disease (AD)-most common type of dementia accounting

• Typical early symptoms include marked changes in personality and

• Cognitive symptoms develop later in the disease.

• It is thought that these problems arise in response to difficulties in the

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