View source for Dementia

==Background==
===DSM-IV Definition===
*Major impairment in learning and memory plus impairment in handling complex tasks, impairment in reasoning ability, impaired spatial ability and orientation, or impaired language
*Symptoms significantly interfere with work, usual social activities, relationships
*Significant decline from previous level of functioning
*Disturbances are insidious and progressive
*Disturbances are not occurring exclusively during the course of delirium
*Disturbances are not accounted for by major psychiatric diagnosis
*Disturbances are not accounted for by systemic disease or another brain disease

===Inappropriate Medications in Dementia<ref>Tjia J et Al. Use of Medications of Questionable Benefit in Advanced Dementia. JAMA Intern Med. Published online September 08, 2014. doi:10.1001/jamainternmed.2014.4103</ref>===
*Most common: Cholinesterase inhibitors, memantine hydrochloride, lipid lower agents, antiplatelet (except aspirin)
*Others: hormone antagonists, leukotriene inhibitors, cytotoxic chemotherapy, immunomodulators

==Clinical Features==
*Loss of mental capacity 
*Slow and steady course 
*Hallucinations, delusions, repetitive behaviors, and depression are all common 
*May coexist with [[delirium]] 
*Poor score on [[Mini-Mental Status Exam]]

==Differential Diagnosis==
===Dementia Acronym===
D = drug-induced

E = emotions (depression especially)

M = metabolic and endocrine issues

E = eyes and ears (sensory problems)

N = nutritional issues (B12 and Vit. D)

T = tumors

I = infections

A = alcohol

S = sleep disorders and rarely seizures

{{Dementia DDX}}

==Evaluation==
''Major workup consists of ruling out treatable causes of [[dementia]] / [[delirium]]''
''Evaluate for precipitant of acute decompensation (e.g. infection, dehydration, MI)
*[[Mini mental status exam]]
*[[Six item screen]]
*CBC 
**Megaloblastic anemia points to [[vitamin B12 deficiency]]
**Normocytic anemia with an elevated RDW may indicated B12 deficiency as well if there are some RBCs with a small MCV and many with a large MCW.
*Chemistry 10
*[[LFTs]] 
*[[Urinalysis]] 
*[[ECG]]
*[[CXR]] 
*ETOH
*[[Urine toxicology screen]] 
*[[CT head]]
*Consider
**[[LFTs]], TSH
**B12, RPR, ESR, ANA, Folate, Thiamine, HIV
**Neuropsych eval
**Consider [[LP]], urine heavy metals, EEG

==Management==
*Treat underlying cause (if possible)
*Treat pathology that may be contributing to acute decompensation/presentation (e.g. [[UTI]], [[pneumonia]])

==See Also==
*[[Altered Mental Status]]
*[[Dementia Work-Up]]
[[Category:Neurology]]

==References==
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