Dementia

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Dementia
Classifications and external resources

Dementia (from Latin de- "apart, away" + mens

(genitive mentis) "mind") is the progressive
F00. (http://www.who.int/classifications/apps/icd/icd10online/?
ICD-10
gf00.htm+f00)-F07.
decline in cognitive function due to damage or
(http://www.who.int/classifications/apps/icd/icd10online/?
disease in the brain beyond what might be
gf00.htm+f07)
expected from normal aging. Particularly affected
290 (http://www.icd9data.com/getICD9Code.ashx?icd9=290)ICD-9
areas may be memory, attention, language and
294 (http://www.icd9data.com/getICD9Code.ashx?icd9=294)
problem solving, although particularly in the later
DiseasesDB 29283 (http://www.diseasesdatabase.com/ddb29283.htm)
stages of the condition, affected persons may be
MedlinePlus 000739
disoriented in time (not knowing what day of the
(http://www.nlm.nih.gov/medlineplus/ency/article/000739.htm)
week, day of the month, what month or even what
year it is), place (not knowing where they are) and
person (not knowing who they are). Symptoms of dementia can be classified as either reversible or irreversible depending upon
the etiology of the disease. Less than 10% of all dementias are reversible. Dementia is a non-specific term that encompasses
many disease processes, just as fever is attributable to many etiologies.

Contents

1 Epidemiology
2 Symptoms
3 Diagnosis
4 Types
4.1 Most common causes
4.2 Less common causes
4.3 Treatable causes
5 Treatment
6 References
7 External links

Epidemiology
The prevalence of dementia in the global community is rising as the global life expectancy is rising. Particularly in Western
countries, there is increasing concern about the economic impact that dementia will have in future, older populaces. In Australia,
the 2006 estimated prevalence of dementia is 1.03% of the population as a whole. It is a disease which is strongly associated
with age; 1% of those aged 60-65, 6% of those aged 75-79, and 45% of those aged 95 or older suffer from the disease[1].

Symptoms
Often dementia can be first evident during an episode of delirium. There is a higher prevalence of eventually developing
dementia in individuals who experience an acute episode of confusion while hospitalized.
Dementia can affect language, comprehension, motor skills, short-term memory, ability to identify commonly used items,
reaction time, personality traits, and executive functioning. Even without signs of general intellectual decline, delusions are
common in dementia (15-56% incidence rate in Alzheimer's type, and 27-60% incidence rate in multi-infarct dementia). Often
these delusions take the form of monothematic delusions, like mirrored self-misidentification.
Elderly people can also react with dementia-like symptoms to surgery, infections, sleep deprivation, irregular food intake,
dehydration, loneliness, change in domicile or personal crises. This is called delirium, and many if not most dementia patients
also have a delirium on top of the physiologial dementia, adding to the symptoms. The delirium can go away or greatly improve
when treated with tender care, improved food and sleeping habits, but this does not affect the alterations in the brain. Affected
persons may also show signs of psychosis or depression. It is important to be able to differentiate between delirium and
dementia.

Diagnosis
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) and the mini mental state examination (MMSE).
An AMTS score of less than six and an MMSE score under 24 suggests a need for further evaluation. Of course, this must be
interpreted in the context of the person's educational and other background, and particular circumstances. Routine blood tests are
usually performed to rule out treatable causes. These tests include vitamin B12, folic acid, thyroid-stimulating hormone (TSH),
C-reactive protein, full blood count, electrolytes, calcium, renal function and liver enzymes. Abnormalities may suggest vitamin
deficiency, infection or other problems that commonly cause confusion or disorientation in the elderly. Chronic use of
substances such as alcohol can also predispose the patient to cognitive changes suggestive of dementia.
A CT scan or magnetic resonance imaging (MRI scan) is commonly performed. This may suggest normal pressure
hydrocephalus, a potentially reversible cause of dementia, and can yield information relevant to other types of dementia, such as
infarction (stroke) that would point at a vascular type of dementia. Sometimes neuropsychological testing is helpful as well.
The final diagnosis of dementia is made on the basis of the clinical picture. For research purposes, the diagnosis depends on both
a clinical diagnosis and a pathological diagnosis (ie, based on the examination of brain tissue, usually from autopsy).

Types
The most common types of dementia are as follows and vary according to the history and the presentation of the disease: (Where
available the ICD-10 codes are provided. The first code refers to the dementia, and the second to the underlying condition.)

Most common causes

(F00/G30) Alzheimer's disease

(F01) Vascular dementia (also known as multi-infarct dementia), including Binswanger's disease
(F02.3/G20) Dementia with Lewy bodies (DLB)
Alcohol Induced Persisting Dementia
(F02.0/G31.0) Frontotemporal lobar degeneration (FTLD), including Pick's disease
Frontotemporal dementia (or frontal variant FTLD)
Semantic dementia (or temporal variant FTLD)
Progressive non-fluent aphasia

Less common causes

It can also be a consequence of:

(F02.1/A81.0) Creutzfeldt-Jakob disease

(F02.2/G10) Huntington's disease
(F02.3/G20) Parkinson's disease
(F02.4/B22.0) HIV infection (leading to AIDS dementia complex)
(F07.2) Head trauma
(Q90) People with Down's syndrome have an increased risk of developing dementia of the Alzheimer's type. This risk
increases as the person ages.

Treatable causes
Less than 5% of a sample of dementia cases have a potentially treatable cause. These include:

(F02.8/E01-E03) Hypothyroidism
(F02.8/E51) Vitamin B1 (thiamine) deficiency
(F02.8/E53.8) Vitamin B12, Vitamin A deficiency
(F03/F32-F33) Depressive pseudodementia (note: dementia and depression can coexist in many patients and can be
difficult to differentiate.)
(G91.2) Normal pressure hydrocephalus

Tumor

Treatment
Except for the treatable types listed above, there is no cure to this illness, although scientists are progressing in making a type of
medication that will slow down the process. Cognitive and behavioral interventions may also be appropriate. Educating and
providing emotional support to the caregiver [or carer] is of importance as well.
Snoezelen rooms that provide patients with a soothing and stimulating environment of light, color, music and scent have been
used in the therapy of dementia patients.

References
1. ^ Dementia Estimates and Projections: Australian States and Territories (http://203.89.220.41/upload/Access%20Report%20Feb%
202005.pdf). Alzheimer's Australia (2005-02-01). Retrieved on 2006-10-04.

External links

Dementia Research News from ScienceDaily (http://www.sciencedaily.com/news/mind_brain/dementia/)

The Dementia Services Development Centre, University of Stirling (http://www.dementia.stir.ac.uk/)
Dementia tutorial for U.K. practitioners by the Alzheimer's Society (http://www.ehr.chime.ucl.ac.uk/demcare/index.html)
Getting Started in Telecare for Patients with Dementia
(http://changeagentteam.org.uk/_library/docs/Housing/Telecare/Telecare_gettingstarted.pdf)(pdf file)
Understanding Dementia: a primer of diagnosis and management
(http://www.dementiaguide.ca/aboutdementia/understanding/)
GPnotebook -1650851840 (http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1650851840)
eMedicine:Consumer 38533-1 (http://www.emedicinehealth.com/articles/38533-1.asp)
MedlinePlus Overview dementia (http://www.nlm.nih.gov/medlineplus/dementia.html)
Merck Geriatrics 5-40a (http://www.merck.com/mrkshared/mmg/sec5/ch40/ch40a.jsp)

Retrieved from "http://en.wikipedia.org/wiki/Dementia"

Categories: Cognitive disorders | Neurology | Psychiatry | Neuropsychology | Pathology

This page was last modified 22:41, 7 December 2006.

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