Dementia: Difference between revisions
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== | ==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<ref>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</ref>=== | ||
*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 DDX}} | |||
==Evaluation== | |||
''Major workup consists of ruling out treatable causes of [[dementia]] / [[delirium]]'' | |||
''Evaluate for precipitant of acute decompensation (e.g. infection, dehydration, MI) | |||
*[[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]] | |||
*[[CT head]] | |||
*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 underlying cause (if possible) | ||
*Treat pathology that may be contributing to acute decompensation/presentation (e.g. [[UTI]], [[pneumonia]]) | |||
==See Also== | ==See Also== | ||
[[Altered Mental Status]] | *[[Altered Mental Status]] | ||
*[[Dementia Work-Up]] | |||
[[Category:Neurology]] | |||
==References== | |||
<references/> | |||
Latest revision as of 17:11, 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 Evaluate for precipitant of acute decompensation (e.g. infection, dehydration, MI)
- 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
- CT head
- Consider
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