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 t...
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 pha...
Advance care planning
Discuss safety, management of finances, medical decision-making, possible skilled facility placement; legal guardianship, if necessary.
Advance directives, health...
AD: usually steady progression leading to profound cognitive impairment. Average survival about 10 years.
VaD: Incrementally worsening dementia, but cognitive improvement is unlikely
Secondary...
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...
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...
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