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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 w/ delirium
  • Poor score on Mini-Mental Status Exam

Differential Diagnosis



Rule-out treatable causes of dementia / delirium

  • Mini mental status exam
  • Six item screen
  • CBC
  • Chemistry 10
  • LFTs
  • UA
  • ECG
  • CXR
  • ETOH
  • Utox
  • Head CT
  • Consider
    • LFTs, TSH
    • B12, RPR, ESR, ANA, Folate, Thiamine, HIV
    • neuropsych eval
    • Consider LP, urine heavy metals, EEG


  • Treat underlying cause (if possible)

See Also

Altered Mental Status


  1. 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