Dementia

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 ageing. Particulary 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.

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.

Abbreviated Mental Test Score (AMTS)
Ask these questions of the patient. Each question correctly answered scores one point.

• What is your age?
• What is the time to the nearest hour?
• Give the patient an address, and ask them to repeat it at the end of the test
• What is the year?
• What is the name of the hospital or number of the residence where the patient is situated?
• Can the patient recognise two persons (the doctor, nurse, home help, etc.)
• What is your date of birth?
• What 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.)?
• Count backwards from 20 down to 1?

A score of less than six on this test suggests dementia. Routine blood tests should be performed to rule out treatable causes.

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
• Frontotemporal dementia
• dementia with Lewy bodies
• 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
• Hypothyroidism
• Normal pressure hydrocephalus
• Vitamin B12 deficiency
• Vitamin B6 (thiamine) deficiency
• Tumour

or in very rare cases:

• Frontal lobe type
• Down's syndrome
• Creutzfeldt-Jakob disease
• AIDS

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