Dementia: Difference between revisions
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==Management== | ==Management== | ||
*Treat underlying cause (if possible) | *Treat underlying cause (if possible) | ||
*Treat pathology that may be contributing to acute decompensation/presentation (e.g. [[UTI]], [[pneumonia]]) | |||
==See Also== | ==See Also== | ||
Revision as of 17:09, 19 August 2019
Background
DSM-IV Definition
- Major impairment in learning and memory plus impairment in handling complex tasks, impairment in reasoning ability, impaired spatial ability and orientation, or impaired language
- Symptoms significantly interfere with work, usual social activities, relationships
- Significant decline from previous level of functioning
- Disturbances are insidious and progressive
- Disturbances are not occurring exclusively during the course of delirium
- Disturbances are not accounted for by major psychiatric diagnosis
- Disturbances are not accounted for by systemic disease or another brain disease
Inappropriate Medications in Dementia[1]
- Most common: Cholinesterase inhibitors, memantine hydrochloride, lipid lower agents, antiplatelet (except aspirin)
- Others: hormone antagonists, leukotriene inhibitors, cytotoxic chemotherapy, immunomodulators
Clinical Features
- Loss of mental capacity
- Slow and steady course
- Hallucinations, delusions, repetitive behaviors, and depression are all common
- May coexist with delirium
- Poor score on Mini-Mental Status Exam
Differential Diagnosis
Dementia Acronym
D = drug-induced
E = emotions (depression especially)
M = metabolic and endocrine issues
E = eyes and ears (sensory problems)
N = nutritional issues (B12 and Vit. D)
T = tumors
I = infections
A = alcohol
S = sleep disorders and rarely seizures
Dementia
- Degenerative
- Alzheimer's disease
- Huntington's disease
- Parkinson's disease
- Vascular
- Multiple infarcts
- Hypoperfusion (MI, profound hypotension)
- Subdural hematoma
- SAH
- Infectious
- Meningitis (sequelae of bacterial, fungal, or tubercular)
- Neurosyphilis
- Viral encephalitis (HSV, HIV), Creutzfeldt-Jakob disease
- Inflammatory
- SLE
- Demyelinating disease (e.g. multiple sclerosis)
- Neoplastic
- Primary brain tumor / metastatic disease
- Carcinomatous meningitis
- Paraneoplastic syndromes
- Traumatic
- Toxic
- ETOH
- Meds (anticholinergics, polypharmacy)
- Metabolic
- Psychiatric
- Depression (pseudodementia)
- Hydrocephalic
- Normal pressure hydrocephalus (communicating hydrocephalus)
- Noncommunicating hydrocephalus
Evaluation
Major workup consists of ruling out treatable causes of dementia / delirium
- Mini mental status exam
- Six item screen
- CBC
- Megaloblastic anemia points to vitamin B12 deficiency
- Normocytic anemia with an elevated RDW may indicated B12 deficiency as well if there are some RBCs with a small MCV and many with a large MCW.
- Chemistry 10
- LFTs
- Urinalysis
- ECG
- CXR
- ETOH
- Urine toxicology screen
- Head CT
- Consider
- LFTs, TSH
- B12, RPR, ESR, ANA, Folate, Thiamine, HIV
- Neuropsych eval
- Consider LP, urine heavy metals, EEG
Management
- Treat underlying cause (if possible)
- Treat pathology that may be contributing to acute decompensation/presentation (e.g. UTI, pneumonia)
See Also
References
- ↑ Tjia J et Al. Use of Medications of Questionable Benefit in Advanced Dementia. JAMA Intern Med. Published online September 08, 2014. doi:10.1001/jamainternmed.2014.4103