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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

Inappropriate Medications in Dementia[1]

  • Most common: Cholinesterase inhibitors, memantine hydrochloride, lipid lower agents, antiplatelet (except aspirin)
  • Others: hormone antagonists, leukotriene inhibitors, cytotoxic chemotherapy, immunomodulators

Clinical Features

  • Loss of mental capacity
  • Slow and steady course
  • Hallucinations, delusions, repetitive behaviors, and depression are all common
  • May coexist with delirium
  • Poor score on Mini-Mental Status Exam

Differential Diagnosis

Dementia Acronym

D = drug-induced

E = emotions (depression especially)

M = metabolic and endocrine issues

E = eyes and ears (sensory problems)

N = nutritional issues (B12 and Vit. D)

T = tumors

I = infections

A = alcohol

S = sleep disorders and rarely seizures



Major workup consists of ruling out treatable causes of dementia / delirium Evaluate for precipitant of acute decompensation (e.g. infection, dehydration, MI)


  • Treat underlying cause (if possible)
  • Treat pathology that may be contributing to acute decompensation/presentation (e.g. UTI, pneumonia)

See Also


  1. 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