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

Diagnosis

• Mini mental status exam
• Six item screen

Differential Diagnosis

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, but still commonly used:
      1. Most common: Cholinesterase inhibitors, memantine hydrochloride, lipid lower agents, antiplatelet (except aspirin)
      2. Others: 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