Dementia: Difference between revisions
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== Clinical Features == | == 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== | ==Diagnosis== | ||
| Line 11: | Line 11: | ||
== Differential 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<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 | |||
*Metabolic | |||
**B12 or folate deficiency | |||
**[[Thyroid Disease]] | |||
**Uremia | |||
*Psychiatric | |||
**Depression (pseudodementia) | |||
*Hydrocephalic | |||
**Normal-pressure hydrocephalus (communicating hydrocephalus) | |||
**Noncommunicating hydrocephalus | |||
== Work-Up == | == Work-Up == | ||
*Must rule-out treatable causes of dementia / [[delirium]] (see DDX) | |||
**CBC | |||
**Chemistry | |||
**LFTs | |||
**UA | |||
**CXR | |||
**?Utox | |||
**?CT/LP | |||
==== Treatment ==== | ==== Treatment ==== | ||
Revision as of 05:44, 6 June 2015
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