Dementia: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
''Rule-out treatable causes of dementia / [[delirium]]'' | |||
*[[Mini mental status exam]] | *[[Mini mental status exam]] | ||
*[[Six item screen]] | *[[Six item screen]] | ||
*CBC | |||
*Chemistry | |||
*LFTs | |||
*UA | |||
*CXR | |||
*?Utox | |||
*?CT/[[LP]] | |||
== Work-Up == | == Work-Up == | ||
Revision as of 05:51, 6 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
- 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
Diagnosis
Rule-out treatable causes of dementia / delirium
- Mini mental status exam
- Six item screen
- CBC
- Chemistry
- LFTs
- UA
- CXR
- ?Utox
- ?CT/LP
Work-Up
- Mini-mental status exam
- Score less than 24 suggests cognitive impairment
- May be influenced by education and age
- Score less than 29 if greater than 9 years of schooling suggests cognitive impairment
- Score less than 26 if 5-9 years of schooling suggests cognitive impairment
- Score less than 22 if less than 4 years of schooling suggests cognitive impairment
- CBC
- Chem 10
- UA/Utox
- ECG, CXR
- ETOH
- CT/MRI
- 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
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