Dementia

Overview of Dementia
Diagnostic Criteria for Dementia
Impaired social or occupational function Impaired memory, plus one or more area of the following cognitive functions Abstract/problem solving Judgment Language Personality Clear consciousness
Differentiate Depression from Dementia
Depression	Dementia
Relatively rapid onset Depressive symptoms start before dementia Patient complains more than family Appears depressed Response of "I don't know" Inconsistent Cognitive impairment Response to antidepressant	very slow onset depressive symptoms develop after cognitive decline Patient tends to deny any memory problem May or may not appear depressed Try to give an excuse or general answer Cognitive impairment fairly consistent Antidepressant may have no effect

Causes of Dementia

Alzheimer's dementia

Multiinfarct dementia

Normal Pressure Hydrocephalus

3 main symptoms: Dementia, Gait Apraxia, Incontinence
Language functions preserved
Most common cause of gait abnormality plus Dementia is multiinfarct dementia
May progress over months to years then reach a plateau
MRI shows large ventricles
LP may result in temporary improvement
Treatment is VP or LP shunt

HIV dementia

Other causes of Dementia

Toxic/Metabolic/Nutritional:
- Alcohol or drugs, Vitamin deficiencies, Hormonal disturbances.
- More likely to have change in level of consciousness
Primary progressive Aphasia:
- progressive aphasia without true dementia
Jacob Creutzfeld Disease:
- progressive dementia with seizures, myoclonus, ataxia, visual disturbance, motor neuron dysfunction
Chronic infections, vasculitis:
- Cryptococcal, fungal.
- Progressive multifocal leukoencephalopathy
Bilateral Subdural hematoma
Brain tumor: especially frontal glioma
Neurodegenerative Disorders
- Parkinson's disease
- Lewy body dementia
- Progressive supranuclear palsy
- Frontotemporal dementias (e.g., Pick's disease, primary progressive aphasias)
- Cortical-basal degeneration
- Hippocampal sclerosis