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| __NOTOC__ | | __NOTOC__ |
| {{Template:Dementia}} | | {{Template:Dementia}} |
| | | {{CMG}} {{SAI}} |
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| ==Overview== | | ==Overview== |
| ==History and symptoms==
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| The final diagnosis of dementia is made on the basis of the clinical picture, increasingly with neuroimaging results for backup. For research purposes, the diagnosis depends on both a clinical diagnosis and a pathological diagnosis (i.e., based on the examination of brain tissue, usually from [[autopsy]]).
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| Proper differential diagnosis between the types of dementia (see below) will require, at the least, referral to a specialist, e.g. a geriatric internist, geriatric psychiatrist, neurologist, neuropsychologist or geropsychologist. However, there are some brief (5-15 minutes) tests that have good reliability and can be used in the office or other setting to evaluate cognitive status. Examples of such tests include the [[abbreviated mental test score]] (AMTS), the [[mini mental state examination]] (MMSE), Modified Mini-Mental State Examination (3MS)<ref name="pmid3611032">Teng E L, Chui H C. The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry 1987;48:314–18. PMID 3611032</ref>, the Cognitive Abilities Screening Instrument (CASI)<ref name="pmid8054493">Teng E L, Hasegawa K, Homma A, et al. The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr 1994;6:45–58. PMID 8054493</ref>, and the clock drawing test<ref name="pmid9598672>{{cite journal |author=Royall, D.; Cordes J.; & Polk M. |title=CLOX: an executive clock drawing task |journal=J Neurol Neurosurg Psychiatry |volume=64 |issue=5 |pages=588-94 |year=1998 |pmid=9598672 |url=http://jnnp.bmj.com/cgi/content/full/64/5/588}}</ref>.
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| An [[abbreviated mental test score|AMTS]] score of less than six (out of a possible score of ten) and an [[Mini-mental state examination|MMSE]] score under 24 (out of a possible score of 30) suggests a need for further evaluation. Scores must be interpreted in the context of the person's educational and other background, and the particular circumstances (for example, a person in great pain will not be expected to do well on many tests of mental ability).
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| ===Mini-mental state examination===
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| {{main|Mini-mental state examination}}
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| The [http://www.ahrq.gov/clinic/uspstfix.htm U.S. Preventive Services Task Force (USPSTF)] reviewed tests for cognitive impairment and concluded <ref name="pmid12779304">{{cite journal |author=Boustani, M.; Peterson, B.; Hanson, L.; Harris, R.; & Lohr, K.|title=Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force |journal=Ann Intern Med |volume=138 |issue=11 |pages=927-37 |year=2003 |pmid=12779304 |url=http://www.annals.org/cgi/content/full/138/11/927}}</ref>:
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| * [[Mini-mental state examination|MMSE]]
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| : sensitivity 71% to 92%
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| : specificity 56% to 96%
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| A copy of the [[Mini-mental state examination|MMSE]] can be found in the appendix of the original publication.<ref name="pmid1202204">{{cite journal |author=Folstein MF, Folstein SE, McHugh PR |title="Mini-mental state". A practical method for grading the cognitive state of patients for the clinician |journal=Journal of psychiatric research |volume=12 |issue=3 |pages=189-98|year=1975 |pmid=1202204 |doi=10.1016/0022-3956(75)90026-6}}</ref>
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| ===Modified Mini-Mental State examination (3MS)===
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| A copy of the 3MS is online.<ref>{{cite web |url=http://www.cjns.org/27febtoc/predicting_appendix_.html |title=Appendix: The Modified Mini-Mental State (3MS) |accessdate=2007-09-06 |format= |work=}}</ref> A [[meta-analysis]] concluded that the Modified Mini-Mental State (3MS) examination has:<ref name="pmid17178826">Cullen B, O'Neill B, Evans JJ, Coen RF, Lawlor BA. A review of screening tests for cognitive impairment.
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| J Neurol Neurosurg Psychiatry. 2007 Aug;78(8):790-9. Epub 2006 Dec 18. PMID 17178826</ref>
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| : sensitivity 83% to 94%
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| : specificity 85% to 90%
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| ===Abbreviated mental test score===
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| {{main|abbreviated mental test score}}
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| A [[meta-analysis]] concluded:<ref name="pmid17178826"/>
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| : sensitivity 73% to 100%
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| : specificity 71% to 100%
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| ===Other examinations===
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| Many other tests have been studied <ref name="pmid17163083">{{cite journal |author=Sager, M.; Hermann, B.; La Rue, A.; & Woodard, J.|title=Screening for dementia in community-based memory clinics |journal=WMJ |volume=105 |issue=7 |pages=25-9 |year=2006|pmid=17163083}}</ref><ref name="pmid17287448">{{cite journal |author=Fleisher, A.; Sowell B.; Taylor C.; Gamst A.; Petersen R.; & Thal L. |title=Clinical predictors of progression to Alzheimer disease in amnestic mild cognitive impairment |journal=Neurology|volume= |issue= |pages= |year= |pmid=17287448}}</ref> <ref name="pmid12614094">{{cite journal |author=Karlawish, J. & Clark, C.|title=Diagnostic evaluation of elderly patients with mild memory problems |journal=Ann Intern Med |volume=138 |issue=5 |pages=411-9|year=2003 |pmid=12614094 | url=http://www.annals.org/cgi/content/full/138/5/411}}</ref> including the clock-drawing test[http://jnnp.bmj.com/cgi/content/full/64/5/588/F3 example form]). Although some may emerge as better alternatives to the MMSE, presently the MMSE is the best studied. However, access to the MMSE is now limited by enforcement of its copyright ([[mini mental state examination |details]]).
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| Further evaluation includes retesting at another date, and administration of other (and sometimes more complex) tests of mental function, such as formal neuropsychological testing.
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| === Associated Conditions === | | Adequate time should be arranged in a follow-up appointment. A family member or close friend familiar with the patient should accompany them to the visits and remember what the patient is told. The initial step at the follow-up visit is an assessment of cognitive function, followed by a complete physical examination, including neurologic examination.<ref name="pmid8663868">{{cite journal |vauthors=Geldmacher DS, Whitehouse PJ |title=Evaluation of dementia |journal=N Engl J Med |volume=335 |issue=5 |pages=330–6 |date=August 1996 |pmid=8663868 |doi=10.1056/NEJM199608013350507 |url=}}</ref> |
| * Behavioral disorders
| | ==History and Symptoms== |
| * [[Delirium]]
| | A positive history of memory loss and disorientation are suggestive of dementia. The most common symptoms of dementia include [[memory loss]], [[disorientation]], nominal [[dysphasia]], getting lost, misplacing items, [[apathy]], personality change, mood changes, constructional [[dyspraxia]] and poor abstract thinking. |
| * [[Delusion]]
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| * [[Depression]]
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| * [[Hallucinations]]
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| === Criteria for Diagnosis === | | The Global Deterioration Scale (GDS) is a validated and reliable instrument describing the clinical progression of dementia<ref name="pmid7114305">{{cite journal |vauthors=Reisberg B, Ferris SH, de Leon MJ, Crook T |title=The Global Deterioration Scale for assessment of primary degenerative dementia |journal=Am J Psychiatry |volume=139 |issue=9 |pages=1136–9 |date=September 1982 |pmid=7114305 |doi=10.1176/ajp.139.9.1136 |url=}}</ref> |
| * [[Amnesia]]
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| * Impairment of abstract thinking
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| * Limited judgment ability
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| * Orientation disturbances
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| * Impairment of higher cognitive functions:
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| *:* Acalculia
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| *:* [[Agnosia]]
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| *:* [[Aphasia]]
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| *:* [[Apraxia]]
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| *:* Personality changes
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| === Severity of Dementia ===
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| * '''Mild''': Independet personal hygiene and judgment are retained, but a reduced performance in social activities or household activities is noticed
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| * '''Medium''': Some monitoring necessary, living independently is dangerous
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| * '''Severe''': Permanent care and monitoring absolutely necessary, serious loss of independence
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| ==References== | | ==References== |
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| {{reflist|2}} | | {{reflist|2}} |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
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| | [[Category:Neurology]] |
| | [[Category:Psychiatry]] |
| | [[Category:Needs overview]] |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Sabeeh Islam, MBBS[2]
Overview
Adequate time should be arranged in a follow-up appointment. A family member or close friend familiar with the patient should accompany them to the visits and remember what the patient is told. The initial step at the follow-up visit is an assessment of cognitive function, followed by a complete physical examination, including neurologic examination.[1]
History and Symptoms
A positive history of memory loss and disorientation are suggestive of dementia. The most common symptoms of dementia include memory loss, disorientation, nominal dysphasia, getting lost, misplacing items, apathy, personality change, mood changes, constructional dyspraxia and poor abstract thinking.
The Global Deterioration Scale (GDS) is a validated and reliable instrument describing the clinical progression of dementia[2]
References
Template:WH
Template:WS