Dementia resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo, M.D.
Overview
Dementia is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging, it should be disoriented from delirium which involves an acute onset, and usually is reversible. Dementia may affect several cognitive areas, such as memory, attention, language, and problem-solving. In advanced stages of the condition, affected persons may be disoriented in time, place, and/or in person. The diagnosis of dementia is primarily clinical and ruling-out other conditions by imaging and laboratory tests. It is important to always screen for depression, especially in older people, since this may be the underlying problem.
Life Threatening Causes
There are no identified life-threatening causes in dementia that may lead to death within 24 hours since all conditions are chronic.
Common 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
Diagnosis
Shown below is an algorithm summarizing the diagnosis of amnesia according to the the American Academy of Neurology guidelines:[1]
| Progressive decline in cognitive function with chronic onset | |||||||||||||||||||||||||||||||||||||||||||||||||
| No | Severe disimpairment in social functioning? | No | Normal aging | ||||||||||||||||||||||||||||||||||||||||||||||
| Dementia | |||||||||||||||||||||||||||||||||||||||||||||||||
| Measure vitamin B12, and folate, and TSH | Abnormal? | Yes | Vitamin deficiency, hypothyroidism | ||||||||||||||||||||||||||||||||||||||||||||||
| Positive for SIGE CAPS questionary? | Yes | Depression | |||||||||||||||||||||||||||||||||||||||||||||||
| Take history and perform physical examination | |||||||||||||||||||||||||||||||||||||||||||||||||
| Initial short term memory loss | Vascular risk factors, imaging evidence of cerebrovascular involvement | Young age, behavioral symptoms or language impairment | Bradikinesia or features of parkinsonism,
fluctuating cognition, [[visual hallucinations]] | Dementia occuring 1 year after onset of Parkinson disease | |||||||||||||||||||||||||||||||||||||||||||||
| Alzheimer disease | Vascular dementia | Frontotemporal dementia | Dementia with Lewy bodies | Parkinson's disease | |||||||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- Perform laboratory testing to exclude potentially reversible causes of amnesia. Initial tests should include a CBC, urine toxicology, thyroid function, folate, and vitamin B12 level.
- Perform a non-contrasted CT scan to diagnose vascular disease, normal pressure hydrocephalus, tumors, and abscess.[2]
- Perform a minimental status test on physical examination and pay especial attention in concentration domain. Minimental testing has the potential distinguish mild cognitive impairment from dementia.[3]
- Always have in mind depression as a possible cause of memory impairmant. Depression is common cause of amnesia; a SIGE CAPS evaluation may disclose an underlying mood disorder.[4]
Don'ts
- If alcoholism and thiamine deficiency is suspected, do not administer glucose before thiamine. Administration of glucose before thiamine may lead to Wernicke encephalopathy.[5]
References
- ↑ Jahn H (December 2013). "Memory loss in Alzheimer's disease". Dialogues Clin Neurosci. 15 (4): 445–54. PMC 3898682. PMID 24459411.
- ↑ Knopman DS, DeKosky ST, Cummings JL, Chui H, Corey-Bloom J, Relkin N, Small GW, Miller B, Stevens JC (May 2001). "Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 56 (9): 1143–53. doi:10.1212/wnl.56.9.1143. PMID 11342678.
- ↑ Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST (May 2001). "Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 56 (9): 1133–42. doi:10.1212/wnl.56.9.1133. PMID 11342677.
- ↑ Squire LR, Zouzounis JA (December 1988). "Self-ratings of memory dysfunction: different findings in depression and amnesia". J Clin Exp Neuropsychol. 10 (6): 727–38. doi:10.1080/01688638808402810. PMID 3235647.
- ↑ Hack, Jason B.; Hoffman, Robert S. (1998). "Thiamine Before Glucose to Prevent Wernicke Encephalopathy: Examining the Conventional Wisdom". JAMA. 279 (8): 583. doi:10.1001/jama.279.8.583a. ISSN 0098-7484.