Dementia

Clinical Features

1. Loss of mental capacity
2. Slow and steady course
3. Hallucinations, delusions, repetitive behaviors, and depression are all common
4. May coexist w/ delirium
5. Poor score on Mini-Mental Status Exam

DDX

1. Degenerative
   1. Alzheimer's disease
   2. Huntington's disease
   3. Parkinson's disease
2. Vascular
   1. Multiple infarcts
   2. Hypoperfusion (MI, profound hypotension)
   3. Subdural hematoma
   4. SAH
3. Infectious
   1. Meningitis (sequelae of bacterial, fungal, or tubercular)
   2. Neurosyphilis
   3. Viral encephalitis (herpes, HIV), Creutzfeldt-Jakob disease
4. Inflammatory
   1. SLE
   2. Demyelinating disease
5. Neoplastic
   1. Primary tumors / metastatic disease
   2. Carcinomatous meningitis
   3. Paraneoplastic syndromes
6. Traumatic
   1. Traumatic brain injury
   2. Subdural hematoma
7. Toxic
   1. ETOH
   2. Meds (anticholinergics, polypharmacy)
   3. Meds considered "never appropriate" in advanced dementia include: cholinesterase inhibitors, memantine hydrochloride, antiplatelets agents (except aspirin), lipid-lowering agents, sex hormones, hormone antagonists, leukotriene inhibitors, cytotoxic chemotherapy, immunomodulators
8. Metabolic
   1. B12 or folate deficiency
   2. Thyroid Disease
   3. Uremia
9. Psychiatric
   1. Depression (pseudodementia)
10. Hydrocephalic
    1. Normal-pressure hydrocephalus (communicating hydrocephalus)
    2. Noncommunicating hydrocephalus

Work-Up

1. Must rule-out treatable causes of dementia / delirium (see DDX)
   1. CBC
   2. Chemistry
   3. LFTs
   4. UA
   5. CXR
   6. ?Utox
   7. ?CT/LP

Treatment

• Treat underlying cause (if possible)

See Also

Altered Mental Status