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Dementia (from L. demens) is progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Particularly affected areas may be memory, attention, language and problem solving, although particularly in the later stages of the condition, affected persons may be disoriented in time (not knowing what day, week, month or year it is), place (not knowing where they are) and person (not knowing who they are).Affected persons may also show signs of psychosis and delirium.
1 Diagnosis
Proper differential diagnosis between the types of dementia (see below) will require at the least, referral to a specialist, e.g. a geriatrician or neurologist. However, to establish dementia as a possibility the Abbreviated Mental Test Score may be used.
1.1 Abbreviated Mental Test Score (AMTS)
Ask these questions of the patient. Each question correctly answered scores one point.
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Score |
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Give the patient an address, and ask him or her to repeat it at the end of the test | |
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What is the name of the hospital or number of the residence where the patient is situated? | |
Can the patient recognize two persons (the doctor, nurse, home help, etc.) | |
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In which year did the First World War begin (adjust this for a world event the patient would have known during childhood)? | |
What is the name of the present monarch (head of state, etc.)? | |
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A score of less than six on this test suggests dementia. Routine blood tests should be performed to rule out treatable causes.
2 Types
The most common types of dementia are as follows and vary according to the history and the presentation of the disease:
- Alzheimer's disease
- multi-infarct dementia (also known as vascular dementia), including Binswanger's disease
- dementia with Lewy bodiesDementia with Lewy bodies is the second most frequent cause of hospitalization for dementia, after Alzheimer's disease. It consists of a set of disorders characterized by the development of abnormal proteinaceous cytoplasmic inclusions, called Lewy bodies
- Frontotemporal dementiaFronto-temporal dementias selectively affect the frontal lobe of the brain. The disease may then extend backward to the temporal lobe. There are two main types: Pick's disease, which has been recognised for many years, and Dementia of the Frontal Lobe Typ including Pick's disease
- Corticobasal degeneration
- Semantic dementia
Approximately 10% of a sample of suspected dementia cases, will have a potentially treatable cause. These include:
- Depressive pseudodementia
- Acute confusional state or delirium
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