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07-SEPTEMBER-2008 03:17:44 - Dementia For other uses, see Dementia disambiguation. DEMENTIA Classification and external resources ICD-10 F00.-F07. ICD-9 290-294 DiseasesDB 29283 MedlinePlus 000739 MeSH D003704 Dementia from Latin de- apart, away + mens genitive mentis mind is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Although dementia is far more common in the geriatric population, it may occur in any stage of adulthood. This age cutoff is defining, as similar sets of symptoms due to organic brain dysfunction are given different names in populations younger than adulthood see, for instance, developmental disorders. Dementia is a non-specific illness syndrome set of symptoms in which affected areas of cognition may be memory, attention, language, and problem solving. Higher mental functions are affected first in the process. Especially in the later stages of the condition, affected persons may be disoriented in time not knowing what day of the week, day of the month, month, or even what year it is, in place not knowing where they are, and in 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 percent of cases of dementia are due to causes which may presently be reversed with treatment. Causes include many different specific disease processes, in the same way that symptoms of organ dysfunction such as shortness of breath, jaundice, or pain are attributable to many etiologies. Without careful assessment of history, the short-term syndrome of delirium can easily be confused with dementia, because they have many symptoms in common. Some mental illnesses, including depression and psychosis, may also produce symptoms which must be differentiated from both delirium and dementia.1 Contents 1 Diagnosis 1.1 Mini-mental state examination 1.2 Modified Mini-Mental State examination 3MS 1.3 Abbreviated mental test score 1.4 Other examinations 1.5 Laboratory tests 1.6 Imaging 2 Types 2.1 Cortical dementias 2.2 Subcortical dementias 3 Treatment 3.1 Medications 3.1.1 Off label 4 Prevention 5 Risk to self and others 6 Services 7 See also 8 References 8.1 Notes 8.2 Bibliography 8.3 External links Diagnosis Proper differential diagnosis between the types of dementia cortical and subcortical - see below will require, at the least, referral to a specialist, e.g. a geriatric internist, geriatric psychiatrist, neurologist, neuropsychologist or geropsychologist. However, there exist some brief tests 5-15 minutes that have reasonable reliability and can be used in the office or other setting to screen cognitive status for deficits which are considered pathological. Examples of such tests include the abbreviated mental test score AMTS, the mini mental state examination MMSE, Modified Mini-Mental State Examination 3MS,2 the Cognitive Abilities Screening Instrument CASI,3 and the clock drawing test.4. An AMTS score of less than six out of a possible score of ten and an MMSE score under 24 out of a possible score of 30 suggests a need for further evaluation. Scores must be interpreted in the context of the person's educational and other background, and the particular circumstances; for example, a person highly depressed or in great pain will not be expected to do well on many tests of mental ability. Mini-mental state examination Main article: Mini-mental state examination The U.S. Preventive Services Task Force USPSTF reviewed tests for cognitive impairment and concluded:5 MMSE sensitivity 71% to 92% specificity 56% to 96% A copy of the MMSE can be found in the appendix of the original publication.6 Modified Mini-Mental State examination 3MS A copy of the 3MS is online.7 A meta-analysis concluded that the Modified Mini-Mental State 3MS examination has:8 sensitivity 83% to 94% specificity 85% to 90% Abbreviated mental test score Main article: abbreviated mental test score A meta-analysis concluded:8 sensitivity 73% to 100% specificity 71% to 100% Other examinations Many other tests have been studied91011 including the clock-drawing test example form. Although some may emerge as better alternatives to the MMSE, presently the MMSE is the best studied. However, access to the MMSE is now limited by enforcement of its copyright. Another approach to screening for dementia is to ask an informant relative or other supporter to fill out a questionnaire about the person's everyday cognitive functioning. Informant questionnaires provide complementary information to brief cognitive tests. Probably the best known questionnaire of this sort is the Informant Questionnaire on Cognitive Decline in the Elderly IQCODE.12 Further evaluation includes retesting at another date, and administration of other and sometimes more complex tests of mental function, such as formal neuropsychological testing. Laboratory tests Routine blood tests are also 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. The problem is complicated by the fact that these cause confusion more often in persons who have early dementia, so that reversal of such problems may ultimately only be temporary. Chronic use of substances such as alcohol can also predispose the patient to cognitive changes suggestive of dementia. Imaging A CT scan or magnetic resonance imaging MRI scan is commonly performed, although these modalities as is noted below do not have optimal sensitivity for the diffuse metabolic changes associated with dementia in a patient who shows no gross neurological problems such as paralysis or weakness on neurological exam. CT or MRI 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. However, the functional neuroimaging modalities of SPECT and PET have shown similar ability to diagnose dementia as clinical exam.13 The ability of SPECT to differentiate the vascular cause from the Alzheimer disease cause of dementias, appears to be superior to differentiation by clinical exam.14 Types Cortical dementias Alzheimer's disease Vascular dementia also known as multi-infarct dementia, including Binswanger's disease Dementia with Lewy bodies DLB Alcohol-Induced Persisting Dementia Korsakoff's syndrome Wernicke's encephalopathy Frontotemporal lobar degenerations FTLD, including Pick's disease Frontotemporal dementia or frontal variant FTLD Semantic dementia or temporal variant FTLD Progressive non-fluent aphasia Creutzfeldt-Jakob disease Dementia pugilistica Moyamoya disease Posterior cortical atrophy or Benson's syndrome. Subcortical dementias Dementia due to Huntington's disease Dementia due to Hypothyroidism Dementia due to Parkinson's disease Dementia due to Vitamin B1 deficiency Dementia due to Vitamin B12 deficiency Dementia due to Folate deficiency Dementia due to Syphilis Dementia due to Subdural hematoma Dementia due to Hypercalcaemia Dementia due to Hypoglycemia AIDS dementia complex Pseudodementia a major depressive episode with prominent cognitive symptoms Substance-induced persisting dementia related to psychoactive use and formerly Absinthism Dementia due to multiple etiologies Dementia due to other general medical conditions i.e. end stage renal failure, cardiovascular disease etc. Dementia not otherwise specified used in cases where no specific criteria is met Dementia and early onset dementia have been associated with neurovisceral porphyrias. Porphyria is listed in textbooks in the differential diagnosis of dementia. Because acute intermittent porphyria, herary coproporphyria and variegate porphyria are aggravated by environmental toxins and drugs the disorders should be ruled out when these etiologies are raised. 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. Cholinesterase inhibitors are often used early in the disease course. Cognitive and behavioral interventions may also be appropriate. Educating and providing emotional support to the caregiver or carer is of importance as well see also elderly care. A Canadian study found that a lifetime of bilingualism has a marked influence on delaying the onset of dementia by an average of four years when compared to monolingual patients. The researchers determined that the onset of dementia symptoms in the monolingual group occurred at the mean age of 71.4, while the bilingual group was 75.5 years. The difference remained even after considering the possible effect of cultural differences, immigration, formal education, employment and even gender as influences in the results.15 Medications Acetylcholinesterase inhibitors Tacrine Cognex, donepezil Aricept, galantamine Razadyne, and rivastigmine Exelon are approved by the United States Food and Drug Administration FDA for treatment of dementia induced by Alzheimer disease. They may be useful for other similar diseases causing dementia such as Parkinsons or vascular dementia.16 N-methyl-D-aspartate Blockers. Memantine Namenda is a drug representative of this class. It can be used in combination with acetylcholinesterase inhibitors. Off label Amyloid deposit inhibitors Minocycline and Clioquinoline, antibiotics, may help reduce amyloid deposits in the brains of persons with Alzheimer disease.17 Antipsychotic drugs Haloperidol Haldol, risperidone Risperdal, olanzapine Zyprexa, and quetiapine Seroquel are frequently prescribed to help manage psychosis and agitation. Treatment of dementia-associated psychosis or agitation is intended to decrease psychotic symptoms for example, paranoia, delusions, hallucinations, screaming, combativeness, and/or violence.1819 Antidepressant drugs Depression is frequently associated with dementia and generally worsens the degree of cognitive and behavioral impairment. Antidepressants may be helpful in alleviating cognitive and behavior symptoms by reuptaking neurotransmitter regulation through reuptake of serotonin, noradrenaline and dopamine. Antianxiety drugs Many patients with dementia experience anxiety symptoms. Although benzodiazepines like diazepam Valium have been used for treating anxiety in other situations, they are often avoided because they may increase agitation in persons with dementia or are too sedating. Buspirone Buspar is often initially tried for mild-to-moderate anxiety. Selegiline, a drug used primarily in the treatment of Parkinson's disease, appears to slow the development of dementia. Selegiline is thought to act as an antioxidant, preventing free radical damage. However, it also acts as a stimulant, making it difficult to determine whether the delay in onset of dementia symptoms is due to protection from free radicals or to the general elevation of brain activity from the stimulant effect. Prevention Main article: Prevention of dementia Since there is no cure for dementia, the best an individual can do is to prevent it from developing in the first place. The main method to prevent dementia is to live an active life, both mentally and physically. It appears that the regular moderate consumption of alcohol beer, wine, or distilled spirits may reduce risk.20 Furthermore, there are medications which might contribute to prevent the onset of dementia, including hypertension medications, anti-diabetic drugs, and NSAIDs.21 A study has shown a link between high blood pressure and developing dementia. The study, published in the Lancet Neurology journal July 2008, found that blood pressure lowering medication reduced dementia by 13%.22 Studies published in US journals suggested that a Merranean diet or long-term beta-carotene supplements could ward off dementia.23 Risk to self and others Driving with dementia could lead to severe injury or even death to self and others. Doctors should advise appropriate testing on when to quit driving.24 Florida's Baker Act allows law enforcement and the judiciary to force mental evaluation for those suspected of suffering from dementia or other mental incapacities.citation needed Services Adult daycare centers as well as special care units in nursing homes often provide specialized care for dementia patients. Adult daycare centers offer supervision, recreation, meals, and limited health care to participants, as well as providing respite for caregivers. See also Caregiving and dementia References Notes ^ American Family Physician, March 1, 2003 Delirium ^ Teng E L, Chui H C. The Modified Mini-Mental State 3MS examination. J Clin Psychiatry 1987;48:314-18. PMID 3611032 ^ Teng E L, Hasegawa K, Homma A, et al. The Cognitive Abilities Screening Instrument CASI: a practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr 1994;6:45-58. PMID 8054493 ^ Royall, D.; Cordes J.; Polk M. 1998. CLOX: an executive clock drawing task. J Neurol Neurosurg Psychiatry 64 5: 588-94. PMID 9598672. ^ Boustani, M.; Peterson, B.; Hanson, L.; Harris, R.; Lohr, K. 2003. Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 138 11: 927-37. PMID 12779304. ^ Folstein MF, Folstein SE, McHugh PR 1975. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research 12 3: 189-98. doi:10.1016/0022-39567590026-6. PMID 1202204. ^ Appendix: The Modified Mini-Mental State 3MS. Retrieved on 2007-09-06. ^ a b Cullen B, O'Neill B, Evans JJ, Coen RF, Lawlor BA. A review of screening tests for cognitive impairment. J Neurol Neurosurg Psychiatry. 2007 Aug;788:790-9. Epub 2006 Dec 18. PMID 17178826 ^ Sager, M.; Hermann, B.; La Rue, A.; Woodard, J. 2006. Screening for dementia in community-based memory clinics. WMJ 105 7: 25-9. PMID 17163083. ^ Fleisher, A.; Sowell B.; Taylor C.; Gamst A.; Petersen R.; Thal L. 2007. Clinical predictors of progression to Alzheimer disease in amnestic mild cognitive impairment. Neurology 68: 1588. doi:10.1212/01.wnl.0000258542.58725.4c. PMID 17287448. ^ Karlawish, J. Clark, C. 2003. Diagnostic evaluation of elderly patients with mild memory problems. Ann Intern Med 138 5: 411-9. PMID 12614094. ^ Jorm, A.F. 2004. The Informant Questionnaire on Cognitive Decline in the Elderly IQCODE: A review. International Psychogeriatrics, 16, 1-19. ^ Bonte, FJ; Harris TS, Hynan LS, Bigio EH, White CL 3rd July 2006. Tc-99m HMPAO SPECT in the differential diagnosis of the dementias with histopathologic confirmation. Clinical Nuclear Medicine 31 7: 376-8. doi:10.1097/01.rlu.0000222736.81365.63. PMID 16785801. Retrieved on 2007-12-21. ^ Dougall, NJ; Bruggink S, Ebmeier KP Nov-Dec 2004. Systematic review of the diagnostic accuracy of 99mTc-HMPAO-SPECT in dementia. The American Journal of Geriatric Psychiatry 12 6: 554-70. doi:10.1176/appi.ajgp.12.6.554. PMID 15545324. Retrieved on 2007-12-21. ^ Bilingualism Has Protective Effect In Delaying Onset Of Dementia By Four Years, Canadian Study Shows. Medical News Today 2007-01-11. Retrieved on 2007-01-16. ^ Lleo A, Greenberg SM, Growdon JH. Current pharmacotherapy for Alzheimer's disease. Annu Rev Med. 2006;57:513-33. Review. PMID 16409164 ^ Choi, Y., Kim, H.S., Shin, K.Y., Kim, E.M., Kim, M., Kim, H.S., Park, C.H., Jeong, Y.H., Yoo, J., Lee, J.P., Chang K.A., Kim S., Suh, Y.H. Related Minocycline Attenuates Neuronal Cell Death and Improves Cognitive Impairment in Alzheimer's Disease Models. Neuropsychopharmacology. 2007 Apr 4; PMID 17406652 ^ Wei, Z., Mousseau, D.D., Dai, Y., Cao, X., Li, X.M. 2006. Haloperidol induces apoptosis via the sigma2 receptor system and Bcl-XS. Pharmacogenomics J. 64:279-88. Epub 2006 Feb 7. PMID 16462815 ^ Wang, H., Xu, H., Dyck, L.E., Li, X.M. 2005. Olanzapine and quetiapine protect PC12 cells from beta-amyloid peptide25-35-induced oxidative stress and the ensuing apoptosis. Journal Neuroscience Res, 814:572-80. PMID 15948179 ^ Mulkamal, K.J., et al. Prospective study of alcohol consumption and risk of dementia in older adults. Journal of the American Medical Association, 2003 March 19, 289, 1405-1413; Ganguli, M., et al. Alcohol consumption and cognitive function in late life: A longitudinal community study. Neurology, 2005, 65, 1210-12-17; Huang, W., et al. Alcohol consumption and incidence of dementia in a community sample aged 75 years and older. Journal of Clinical Epidemiology, 2002, 5510, 959-964; Rodgers, B., et al. Non-linear relationships between cognitive function and alcohol consumption in young, middle-aged and older adults: The PATH Through Life Project. Addiction, 2005, 1009, 1280-1290; Anstey, K. J., et al. Lower cognitive test scores observed in alcohol are associated with demographic, personality, and biological factors: The PATH Through Life Project. Addiction, 2005, 1009, 1291-1301; Espeland, M., et al. Association between alcohol intake and domain-specific cognitive function in older women. Neuroepidemiology, 2006, 127, 1-12; Stampfer, M.J., et al'. Effects of moderate alcohol consumption on cognitive function in women. New England Journal of Medicine, 2005, 352, 245-253; Ruitenberg, A., et al. Alcohol consumption and risk of dementia: the Rotterdam Study. Lancet, 2002, 3599303, 281-286; Scarmeas, N., et al. Merranean diet and risk for Alzheimer's disease. Annals of Neurology, 2006 published online April 18, 2006. ^ West Virginia Department of Health and Human Resources with further links to experiments respectively ^ Reduce high blood pressure to reduce dementia risk. ^ BBC NEWS | Health | Healthy diet 'cuts dementia risk' ^ Drivers with dementia a growing problem, MDs warn, CBC News, Canada, September 19, 2007 Bibliography External links An Documentary About Dementia Produced by Knowledge Network Alzheimer's Disease Research Dementia Research News from ScienceDaily The Dementia Services Development Centre, University of Stirling Dementia tutorial for U.K. practitioners by the Alzheimer's Society Getting Started in Telecare for Patients with DementiaPDF 897 KiB AlzheimersDementiaInfo - Articles and information regarding Alzheimer's disease and other elder care issues. Understanding Dementia: a primer of diagnosis and management AlzOnline - AlzOnline provides education, information, and support to persons caring for someone with Alzheimer's disease or a related memory problem. CSIP National Older Persons Mental Health Programme Includes an involvement toolkit with tips on how people with dementia can get involved in the planning, development and evaluation of services Dementia Advocacy and Support Network Dementia Care Mapping Bradford Dementia Group Dementia at GPnotebook eMedicine:Consumer 38533-1 MedlinePlus Overview Dementia Merck Geriatrics 5-40a v d e WHO ICD-10 mental and behavioral disorders F · 290-319 Neurological/symptomatic Dementia Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Elopement, Sundowning, Wandering · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse · opioids opioid dependency · sedative/hypnotic benzodiazepine withdrawal · cocaine cocaine dependence · general Intoxication, Drug abuse, Physical dependence, Withdrawal Psychotic disorder Schizophrenia disorganized schizophrenia · Schizophreniform disorder · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood affective Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder Ganser syndrome · Somatoform disorder Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia Hypersomnia, Insomnia · Parasomnia REM behavior disorder, Night terror · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development developmental disorder Specific: speech and language expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp · Scholastic skills dyslexia, dysgraphia, Gerstmann syndrome · Motor function developmental dyspraxia Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech stuttering · cluttering Retrieved from http://en..org/wiki/Dementia Categories: Aging-associated diseases | Cognitive disorders | Neurology | Neurobiological brain disorder | Pathology | PsychiatryHidden categories: All articles with statements | Articles with statements since March 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Avañe'ẽ БългарÑ?ки ÄŒesky Dansk Deutsch Eesti Español Euskara Français Gaeilge Hrvatski Italiano עברית Kurdî / كوردی Lietuvių МакедонÑ?ки Malti Bahasa Melayu Nederlands 日本語 ‪Norsk bokmÃ¥l‬ Polski Português РуÑ?Ñ?кий Sicilianu Simple English SlovenÄ?ina СрпÑ?ки / Srpski Suomi Svenska ไทย Tiếng Việt Türkçe اردو ä¸æ–‡ This page was last modified on 25 August 2008, at 23:1
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