Dementia differentiating dementia from other diseases

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Overview

This topic will discuss the evaluation of patients with cognitive impairment and dementia. With an aging population and growing awareness of dementias, clinicians should be equipped to test for cognitive impairment and ask about functional decline to avoid failure to recognize cases of related dementias. Mild cognitive impairment (MCI) is an intermediate clinical state between normal cognition and dementia is mostly because of reversible causes like depression.

Dementia

  • Delirium is distinguished from dementia (chronic organic brain syndrome) which describes an "acquired" (non-congenital) and usually irreversible cognitive and psychosocial decline in function.
  • Dementia usually results from an identifiable degenerative brain disease (for example Alzheimer disease or Huntington's disease). Dementia is usually not associated with a change in level of consciousness, and a diagnosis of dementia requires a chronic impairment.
  • Sundowning: Typically observed in patients suffering from dementia. It's an impairment in behavioral patterns in the evening hours. Similar symptomology can be observed in the patients suffering from other ailments such as impaired circardial rhythm. New onset in change in behavioral patterns should always be assessed carefully and diagnosis of delirium should be considered.[1]
The difference between delirium and similar psychiatric illness
Attributes Delirium Alzheimer's disease Depression Psychotic Disorders
Onset Sudden/acute/subacute Gradual Gradual Acute or gradual[2]
Progression Shifts in severity, likely to resolve in days to weeks. Worsens over period of time Acute or chronic with acute exacerbation Chronic with acute exacerbation
Hallucinations May be present, mostly visual Mostly absent (exceptions: Lewi body dementia, etc.) May be present if associated with psychotic features Present
Delusions[3] Fleeting Mostly not present May be present Present
Psychomotar activity Increased or decreased, may shift from increased to decreased states. May or may not change Change Change
Attention Poor attention span and impaired short term memory. Progressive worsening short term memory. Attention span is likely to be affected in severe cases May be altered May be altered
Consciousness Altered, rapidly shifts Mostly intact until severe stages Normal Normal
Attention Altered, rapidly shifts Mostly intact until severe stages May be altered May be altered
Orientation Altered, rapidly shifts Mostly intact until severe stages Not altered Not altered
Speech Not coherent Errors Slow Normal or pressured
Thought Disorganized Impoverished Normal Disorganized
Perceptions Altered, rapidly shifts Mostly intact until severe stages Normal May be altered
EEG Moderate to severe background slowing Normal or mild diffuse slowing Normal Normal
Reversibility Mostly Very rarely Yes Rarely

[4]

References

  1. ↑ "ABC of psychological medicine: Delirium".
  2. ↑ Carr DB, Gray S, Baty J, Morris JC (December 2000). "The value of informant versus individual's complaints of memory impairment in early dementia". Neurology. 55 (11): 1724–6. doi:10.1212/wnl.55.11.1724. PMID 11113230.
  3. ↑ Wang PN, Wang SJ, Fuh JL, Teng EL, Liu CY, Lin CH, Shyu HY, Lu SR, Chen CC, Liu HC (March 2000). "Subjective memory complaint in relation to cognitive performance and depression: a longitudinal study of a rural Chinese population". J Am Geriatr Soc. 48 (3): 295–9. doi:10.1111/j.1532-5415.2000.tb02649.x. PMID 10733056.
  4. ↑ "Delirium in elderly adults: diagnosis, prevention and treatment".

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