Dementia natural history, complications and prognosis

Dementia Microchapters
Patient Information
Overview
Classification
Causes Alzheimer's Disease Parkinson's Disease Binswanger's Disease Dementia with Lewy bodies Thiamine deficiency Vascular dementia Marijuana abuse AIDS Neurosyphilis Normal pressure hydrocephalus Vitamin B12 deficiency Vitamin B6 deficiency
Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: ,Sabeeh Islam, MBBS[2]

Dementia Microchapters
Patient Information
Overview
Classification
Causes Alzheimer's Disease Parkinson's Disease Binswanger's Disease Dementia with Lewy bodies Thiamine deficiency Vascular dementia Marijuana abuse AIDS Neurosyphilis Normal pressure hydrocephalus Vitamin B12 deficiency Vitamin B6 deficiency
Differential Diagnosis

Overview

The natural course is of progressive decline with some plateaus. Some data exist showing that current medications slow the rate of progression or temporarily improve cognition, but overall the current treatment options do not provide solid evidence of improving cognitive function. Cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists should be discontinued if there are intolerable adverse effects or there is poor compliance. Family education and referral to resources such as the Alzheimer's Association are vital, as patient care requires coordination between physician, caregiver, family, friends, social worker, psychologist, and community supports

Natural History

The history should focus on identifying the time course of cognitive decline and its relationship to basic and instrumental activities of daily living. Prior history of stroke should be ascertained, as well as its timing relative to the onset of cognitive symptoms. Factors that concerns the diagnosis of dementia include Stepwise deterioration, Nocturnal confusion, Personality change, Depression, Somatic complaints, Emotional incontinence (pseudobulbar affect),Hypertension, and Associated atherosclerosis

Complications

Complications of dementia include

• Urinary tract infection (UTI)
• weight loss
• Institutionalization
• pneumonia

• Falls and their complications
• Elder abuse
  

Prognosis

The prognosis of dementia is poor even with treatment. One study mentions that patients with dementia were less likely to have interventions such as PEG tubes, hospitalization, catheterizations, parenteral therapy, and venipunctures when their proxy's estimate of their life expectancy was shorter rather than greater than six months

Advanced Dementia Prognostic Tool (ADEPT) is a 12-item additive score that includes information on patient age, gender, level of functional dependence, nutritional status, and presence or absence of various symptoms and medical conditions, such as congestive heart failure and shortness of breath.