Dementia: Difference between revisions
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== Differential Diagnosis ==
== Differential Diagnosis ==
*Degenerative
{{Dementia DDX}}
**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


==Diagnosis==
==Diagnosis==

Revision as of 19:01, 8 June 2015

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

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

Dementia

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

Treatment

  • Treat underlying cause (if possible)

See Also

Altered Mental Status

References

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