Dementia

Probable diagnosis AD (2):

• Age between 40 and 90 years (u...

Physical exam to assess for neurological deficits, motor and gait abnormalities, tremors, etc.

No disturbances of consciousness

Can start with brief initial screening ...

Major depression

Medication side effect

Chronic alcohol use

Delirium

Subdural hematoma

Normal pressure hydrocephalus

Brain tumor

Thyroid disease

Parkinson disease

Vitamin B₁₂ deficiency

T...

Used to rule out causes

• CBC, CMP

• Thyroid-stimulating hormone

• Vitamin B₁₂ level

Select patients based on clinical suspicion

• HIV, rapid plasma reagin (RPR)

• Erythrocyte sedimentati...

Genetic testing for dementia not recommended, such as testing for APOE4 for Alzheimer, unless there are multiple family members diagnosed with AD at a youn...

Daily schedules and written directions

Emphasis on nutrition, personal hygiene, accident-proofing the home, safety issues, sleep hygiene, and supervision

Socialization (adult daycare)

Se...

Cognitive dysfunction

Medications for AD  (4)[A] show a small improvement in some cognitive measures, but it remains unclear if the improvement is clinically significant and associated with ...

Cholinesterase inhibitors, memantine, atypical antipsychotics, antidepressants, mood stabilizers, methylphenidate, benzodiazepines, melatonin

Antidepressants not clearly superior to placebo...

Socialization, such as adult daycare, to prevent isolation and depression

Sleep hygiene program as alternative to pharmaceuticals for sleep disturbance

Sched...

Progression of cognitive impairment by use of standardized tool (e.g., MMSE, ADAS-Cog)

Development of behavioral problems: sleep, depression, psychosis, aggression

Adverse events of p...

Advance care planning—​​​​​​Discuss safety, management of finances, medical decision making, possible skilled facility placement; legal guardianship, if necessary.

Advance directives,...

AD: usually steady progression leading to profound cognitive impairment:

• Average survival of AD is about 10 years.

VaD: incrementally worsening dementia, but cognitive improvement is unlikely

S...

Wandering

Sundowner syndrome is common in older people (who are sedated) and also in people who have dementia (can have adverse reaction to even small dose of psychoactive substances).

Fal...

Algorithm: Dementia

F03 Unspecified dementia

G30.9 Alzheimer’s disease, unspecified

F01.50 Vascular dementia without behavioral disturbance

G31.83 Dementia with Lewy bodies

52448006 Dementia (disorder)

429998...

Medications for AD show a small, statistically significant improvement in some cognitive measures, but it remains unclear if the improvement is clinically significant.

Do not forget the...