Dementia Due to Head Trauma

Dementia Due to Head Trauma

·        = Presence of dementia directly due to head trauma

·        Severity and type of cognitive or behavioural impairment depends on location and extent of injury

·        Symptoms include aphasia, attention problems, irritability, anxiety, depression, apathy, aggression, other personality change

·        Is usually non-progressive unless repeated head trauma (eg boxer). Progressive decline following single trauma suggests another problem (eg hydrocephalus or major depressive episode)

Management

·        Fatigue and stress result from: 

o   Poor concentration, impaired executive function and ¯memory due to injury

o   Sleep requirements increase, but patients try and do the same amount as before

o   No knowledge about what to expect (both patients and families)

·        Fatigue + stress ® frustration, anxiety and depression.  So reduce factors leading to fatigue and stress

·        Management focuses on:

o   Education 

o   Proper assessment of cognitive deficits by a psychologist (eg cognitive testing = neuropsychological testing)

o   Support from informed family, friends and employers

o   Regular breaks/sleeps.  Take things in small bites and structure day around these

o   Teach relaxation methods 

o   Compensating for cognitive losses: structured day (¯ability to plan), lists, diaries

o   Continual reassurance

o   Medication: 

§  Use for depression if symptoms do not resolve with counselling and support. SSRIs have least side effects. TCA if headaches, or sleep is a problem (side effects include daytime sedation and ¯cognitive function) 

§  Maybe Methylphenidate (Ritalin) - ­arousal to extend time possible to work

Prognosis

·        Only 20 – 30% return to full function 1 – 2 years after a mild head injury

·        Degree of cognitive difficulty in first month NOT a good prognostic indicator

·        Need to consider PTSD as differential or co-existent diagnosis 

·         Good prognostic indicators: strong social support, early intervention by a specialist HI recovery service

·        Bad prognostic indicators: persisting cognitive difficulties at 6 – 9 months