Dementia
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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
Diagnosis
Differential Diagnosis
- 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 (herpes, HIV), Creutzfeldt-Jakob disease
- Inflammatory
- SLE
- Demyelinating disease
- Neoplastic
- Primary tumors / metastatic disease
- Carcinomatous meningitis
- Paraneoplastic syndromes
- Traumatic
- Traumatic brain injury
- Subdural hematoma
- Toxic
- ETOH
- Meds (anticholinergics, polypharmacy)
- Meds considered "never appropriate" in advanced dementia include, but still commonly used[1]:
- Most common: Cholinesterase inhibitors, memantine hydrochloride, lipid lower agents, antiplatelet (except aspirin)
- Others: hormone antagonists, leukotriene inhibitors, cytotoxic chemotherapy, immunomodulators
- Metabolic
- B12 or folate deficiency
- Thyroid Disease
- Uremia
- Psychiatric
- Depression (pseudodementia)
- Hydrocephalic
- Normal-pressure hydrocephalus (communicating hydrocephalus)
- Noncommunicating hydrocephalus
Work-Up
- Must rule-out treatable causes of dementia / delirium (see DDX)
- CBC
- Chemistry
- LFTs
- UA
- CXR
- ?Utox
- ?CT/LP
Treatment
- Treat underlying cause (if possible)
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