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DEMENTIA                     See  Differential Diagnosis of Dementia    |   mild_cognitive_impairment2011.pdf                   

See also  Alzheimer Dementia ;  Cochrane Review Abstracts   | Dementia Neuropsychiatric Sx Rx

A. Primary Dementia with no other medical or neurological diseases

  1. Alzheimer's Disease: senile degenerative dementia (50%-90 of dementia pts) - Loss of cortical tissue (cerebral atrophy) with increased senile plaques
  2. Pick's disease
    A rare disease that cannot be clinically distinguished from Alzheimer's dementia. The tempo of progression may be more rapid than Alzheimer's disease, & focal neurologic signs of aphasia & hemiparesis may be more prominent.
    The diagnosis is usually made at autopsy based on findings of frontal or temporal lobar atrophy, & the presence of argentophilic intraneuronal inclusions & swollen achromatic neurons. No Rx.
  3. Degenerative CNS disease of unspecified type

B. Vascular Dementia, with signs of vascular disease (5-10% of dementia)

  1. Multi-infarct dementia, Thalamic infarction, Lacunar state (hypertensive small-vessel disease), Binswanger's disease (subcortical arteriosclerotic encephalopathy)
  2. Vasculitis: SLE, polyarteritis nodosa, CNS granulomatous angiitis, Behcet's disease.

C. Secondary Dementia, associated with neurological disease

  1. CVA (stroke), Brain tumor, abscess, hematoma; Head trauma, anoxic brain, hypoglycemic brain, encephalitis.
  2. Communicating (low pressure) or obstructive hydrocephalus
  3. Late Parkinson's disease; Huntington's chorea; Jakob Creutzfeldt disease
  4. Misc: Schilder's disease, Lipid storage disease, Myoclonic epilepsy, Spastic paraplegia, etc.
  5. Tuberous sclerosis, Wilson's disease.

D. Dementia with evidence of chronic infection

E. Secondary Dementia, associated with other medical diseases

  1. Hypothyroidism, Cushing's disease
  2. Nutritional deficiency: pellagra, vit.B12 deficiency, Wenicke Korsakoff's syndrome (Thiamine deficiency in alcoholics)
  3. Chronic meningoencephalitis: CNS syphilis, cryptococcosis, etc.
  4. Toxic dementia: drug & narcotic poisoning, chronic barbiturate, alcohol (5-10%), heavy metal, bromidism, organic toxins, dialysis dementia.
  5. Hepatolenticular degeneration, familial or acquired.

G. Psychiatric dementia

Investigation for the causes of dementia:      Top  |  HomePage

H&P esp. drug & neuro-psych. evaluation, screen blood tests including CBC, TFT, LFT, BUN, Creat, biochemical profile, vit. B12 & folic acid levels, syphilis RPR & HIV serology, Brain CT or MRI, heavy metal screen. EEG, CSF examination if indicated; neuropsychologic testing.

RX:  

(REF: Harrison's Med Text 1994)

May 20, 2009 — Cholinesterase inhibitors are associated with previously underrecognized serious adverse events in older adults with dementia, which must be carefully balanced against the generally modest benefits of these drugs, according to the results of a population-based cohort study reported in the May 11 issue of the Archives of Internal Medicine.

"Cholinesterase inhibitors are commonly prescribed to treat dementia, but their adverse effect profile has received little attention," write Sudeep S. Gill, MD, MSc, from the Institute for Clinical Evaluative Sciences in Toronto, Ontario, Canada, and colleagues. "These drugs can provoke symptomatic bradycardia and syncope, which may lead to permanent pacemaker insertion. Drug-induced syncope may also precipitate fall-related injuries, including hip fracture."

     

Criteria for the clinical diagnosis of probable Alzheimer's disease

The diagnosis of probable Alzheimer's disease is supported by

Laboratory results as follows: normal lumbar puncture as evaluated by standard techniques; normal pattern or nonspecific changes in EEG, such as increased slow-wave activity; and evidence of cerebral atrophy on CT with progression documented by serial observation

Other clinical features Plateaus in the course of consistent with the progression of the illness ¦diagnosis of probable Alzheimer's disease, after exclusion of causes of dementia other than Alzheimer's disease, include: Associated symptoms of depression, insomnia, incontinence, delusions, illusions, hallucinations, sexual disorders, weight loss, and catastrophic verbal, emotional, or physical outbursts

Other neurologic abnormalities in some patients, especially with more advanced disease and including motor signs such as increased muscle tone, myoclonus, or gait disorder

Seizures in advanced disease

CT normal for age

     

Other Medsites:
Alzheimer Dementia Sites  

Ref:

Alzheimer Disease: Current Concepts and Emerging Diagnostic and Therapeutic Strategies
C.M. Clark and J.H.T. Karlawish  
ANNALS OF INTERNAL MEDICINE 4 March 2003 Volume 138 Number 5


Update on Alzheimer's disease - Promising advances in detection and treatment
James R. Burke, MD, PhD; Joel C. Morgenlander, MD
VOL 106 / NO 5 / OCTOBER 15, 1999 / POSTGRADUATE MEDICINE  

Determining the cause of memory loss in the elderly - From in-office screening to neuropsychological referral
Kathleen A. Welsh-Bohmer, PhD; Joel C. Morgenlander, MD
VOL 106 / NO 5 / OCTOBER 15, 1999 / POSTGRADUATE MEDICINE

Managing common behavioral problems in dementia - How to improve quality of life for patients and families
James R. Burke, MD, PhD; Joel C. Morgenlander, MD
VOL 106 / NO 5 / OCTOBER 15, 1999 / POSTGRADUATE MEDICINE  

Caregiver burden and burnout - A guide for primary care physicians
Richard T. Kasuya, MD; Patricia Polgar-Bailey, FNP, MSN, MPH; Robbyn Takeuchi, MSW
VOL 108 / NO 7 / DECEMBER 2000 / POSTGRADUATE MEDICINE

       

2011