Dementia - Canadian Psychiatric Association Annual Conference 2016

I forget the names of these gentlemen but I checked and I still do a mean clock face.  This was by far the best ‘academic’ presentation with far too much information for me to type down all the key points.  The three brilliant and humble doctors who did the presentation really need to write a book for aging practitioners. I took a series of screen shots with my iPhone of their presentations hoping to ‘catch’ the essence of all the advances made in this area of psychiatry.  Having been around a few years I’m fairly up to date with the general areas along with my own sub speciality interests. I keep abreast of traumatic brain injury and chemical brain assaults but chose to attend this lecture series because  in creasing numbers of my patients are older and several are worried about dementing.  I tell them that we used to say a patient didn’t have an alcohol problem unless they drank more than their physician.  Today, just has addiction psychiatry has advanced with leaps and bounds rather than staggering forward I was thoroughly amazed at how much has developed in the fields of dementia.  Every day there are breakthroughs with medications for rats which are indeed addressing plaques and making them more capable of mazes.  We’re on the cusp of real human breakthroughs with already many psychological, sociological and biological approaches to something that was once thought to be ‘natural’ but now is more and more known to be more complex.  I will find the program and list the names of these gentleman.  They really were impressive. I hope the slides give some inkling of this. I captured those bits that I wanted to remember personally and share them here. There was a whole wealth of material. Great slides, great topics, great presentations and incredible research.  Thank you so much.

Brain - Behaviour Relationships

Depression and Cognitive Complaints Following Mild Traumatic Brain Injury, by Jonathan M. Silver, MD, Thomas McAllister, MD, and David B. Arciniegas,MD (Am. J. Psychiatry 2009 :166:653-661 is a truly elegant paper discussing this subject from experience with detail. It's an essential read for anyone treating pateints with depression and mTBI.
What I am essentially copying here is from Table 1 in this paper. I have seen this information elsewhere and it's standard in neuropsychiatry and behavioural neurology texts.  Like everything else in this paper it was presented here in a readable and easy to comprehend and clinically useful way.


Structure                     Function                           Consequence of Injury                                      


ROSTRAL and VENTRAL  BRAINSTEM, THALAMUS

Reticulothalamic system    Arousal                    Impairment of Counsciousness

Reticulocortical system       Arousal, facilitating cortical activity         Hypoarousal,  inattention, impaired information processing
                                                                         Attention

Hypothalamus        Autonomic,, neuroendocrine,                   Dysautonomous, thermoregulation problems, altered feeding behaviours,
                                                    Circadian, some lower level social           endocrine dysfunction, sleep wave cycle disturbances, pathological affect
                              functions                                                        (laughter and anger)

Ventral forebrain             Cholingeric supply to medial and             Impaired information processing in multiple cognitive domains, neo cortical areas                                         particularly attention, memory, and executive functions

TEMPORAL LOBES

Entrorhinal-hippocampal Complex        Multimodal informationa filtering                Impaired sensory gating, attention, working memory and
                                                                      Declarative memory, some aspects of        declarative memory
                                                                      Attention and working memory

Amygdala          Generation of contextually relevant           Affective placidity, Kluver-Bucy-like presentations, alternatively
                                                                       emotional and social behaviour                   anxiety

Anterior/Polar cortex              Semantic memory, semantic aspects        Disturbances in semantic memory, functional communication
                                                                        of language, sensory limbic integration    impairments, impaired sensory-limbic, facial, social and emotional
                                                                        face recognition, social and emotional      processing, impaired social/empathic function
                                                                        processing, "theory of mind"

FRONTAL LOBES

Ventral frontal cortices       Comportment, control of primitive              Disinhibition, irritability, emotional dysregulation, agitation, aggression
                                                                        ("limbic") behaviours

Anterior Cingulate cortex         Motivation                             Apathy

Inferolateral prefrontal cortex          Working memory                                          Working memory impairments

Dorsolateral prefrontal cortex             Executive function                                         Impairments in complex cognition, including executive control of attention,
                                                                                                                                                    memory, language, motor planning, as well as sequencing, set shifting
                                                                                                                                                     abstraction, judgment, insight

White Matter                                                 Connections between cortical areas         Impaired cognitive, emotional and behavioural functions, supported by
                                                                           particularly in frontal and temporal           affected white matter, slow, inefficient information processing.
                                                                           areas, facilitation of information
                                                                           processing

My columns got smunched by the editor so it's best to go to the paper. The rest of it is an excellent and must see read.  I've just listed these areas to show where the lesions are being deliniated in a beyond Broca way that's clinically relevant.

This is geographical presentation but then there are the neurochemical transmissions with both facilitating and dampening process.  Coupled to this is the endocrine modulating effects and the fluid these systems sit in, a kind of 'soup' which is affected by quite a variety of spices in addition to sometimes being affected by heat or cold.