Disease - Dementia

From CambridgeNotes

Dementia = Global deterioration of higher mental functioning in clear consciousness, that is progressive and (usually) irreversible

History and Examination

  • Decreased short and long term memory
  • Decreased reasoning and judgement
  • Reduced ability to perform daily living skills
  • Depression, anxiety, aggression, disinhibition
  • Disrupted sleep pattern
  • Psychotic phenomenon

Differential Diagnosis

  • Dementia caused by:
    • Alzheimer’s (~50% cases) - late focal neurology, normal BP
    • Vascular dementia – stepwise deterioration and early focal neurology in patients with hypertension and other risk factors
    • Lewy body dementia – fluctuating cognitive function, often associated with visual hallucinations
    • Frontal lobe dementia including Pick’s disease
    • Alcoholic dementia
    • Normal Pressure Hydrocephalus
    • Other e.g. Infection (HIV, syphilis), Trauma (boxers)
  • Normal age-associated memory impairment
  • Depressive pseudo-dementia
  • Sub-acute confusional states e.g. Subdural bleed, myxoedema, vitamin deficiencies

Treatment

  • Multi-disciplinary care is best! Need to include social services etc.
  • Manage symptoms
  • Slow onset e.g. donepezil (anti-cholinesterase)
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