26 What is the definition of dementia? • The presence of acquired impairment in memory, associated with impairment in one or more other cognitive domains including: • Executive function • Language • Praxis • Gnosis (knowledge) • Impairment in cognition must be severe enough to interfere with work, usual social activities, or relationship with others. What are the differences between dementia and delirium? • Delirium is an acute disturbance of consciousness. • Delirium develops over a short period and tends to fluctuate during the course of a day. • Delirium is caused by the direct physiological consequences of a general medical condition, substance intoxication, or substance withdrawal.1 What are the most frequent causes of dementia? • Alzheimer’s disease (AD) (50%) • Vascular cognitive impairment (VCI) (25%) • Frontotemporal lobar degeneration (FTLD) • Alcohol-related dementia • Dementia with Lewy bodies (DLB) (15%)2 What is mild cognitive impairment? An isolated memory impairment in the setting of preserved general cognitive and functional abilities. There are variants without memory involvement, but they must not involve more than one cognitive domain to be classified as mild. What are the potentially reversible causes of dementia? • Depression • Pseudodementia • Hypothyroidism • Vitamin B12 deficiency • Normal pressure hydrocephalus • Subdural hematoma • Intracranial mass lesions What is the minimal diagnostic workup recommended in a patient with dementia? CBC, thyroid-stimulating hormone (TSH), calcium (Ca), basic metabolic profile (BMP), serum vitamin B12, rapid plasma reagin (RPR), human immunodeficiency virus (HIV), CT brain How is Alzheimer’s disease (AD) diagnosed? Clinically, by the presence of multiple cognitive deficits, one of which must be memory impairment. In addition to problems with memory, one or more of the following must be displayed: • Aphasia • Apraxia • Agnosia • Problems with executive functioning The deficits must affect the ability to hold a job or volunteer position, fulfill domestic responsibilities, or maintain social relationships. In addition, they must represent a significant decline from the person’s previous level of functioning. The definitive diagnosis is made after autopsy. What are the pathological hallmarks of AD? • Neuritic plaques: amyloid beta protein • Neurofibrillary tangles: hyperphosphorylated tau protein • Multiple neurotransmitter deficiencies: the cholinergic system is especially important.3 Which are the genetic forms of AD? • Amyloid precursor protein mutations: autosomal dominant • Presenilin 1 and 2 mutations: autosomal dominant • Trisomy 21: multifactorial—Characterized by abnormal amyloid precursor protein metabolism What are the risk factors for AD? • Advancing age • Apolipoprotein (Apo) E4 (chromosome 19) • Environmental exposure to aluminum • Head injury • Poor cardiovascular health (diabetes mellitus [DM], hypertension [HTN], hyperlipidemia [HLD], cerebrovascular accidents [CVA]) • Smoking4 What is the utility of imaging studies in AD? • CT scan: nonspecific findings, volume loss/atrophy, useful as a screening tool for differential diagnosis (mass, stroke, hematoma). The possible concern is the radiation exposure. • MRI
Dementia
26.1 General Aspects
26.2 Alzheimer Disease
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