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====== Introduction to Dementia ====== | ====== Introduction to Dementia ====== | ||
+ | {{INLINETOC}} | ||
===== Primer ===== | ===== Primer ===== | ||
- | **Dementia** is a progressive neurocognitive decline of sufficient magnitude to interfere with normal social or occupational functions, or with usual daily activities. It is a broad diagnostic category that includes Alzheimer's disease, Lewy Body dementia (15%), Frontotemporal dementia, Vascular dementia, Parkinson's disease, and Creutzfeldt–Jakob disease. | + | **Dementia** is a progressive neurocognitive decline of sufficient magnitude to interfere with normal social or occupational functions, or with usual daily activities. It is a broad diagnostic category that includes [[geri:dementia:alzheimers|Alzheimer's disease]], [[geri:dementia:lewy-body|Lewy Body dementia]], [[geri:dementia:frontotemporal|frontotemporal dementia]], [[geri:dementia:vascular|vascular dementia]], [[geri:dementia:parkinsons|Parkinson's disease]], and [[geri:dementia:creutzfeldt-jakob-disease-cjd|Creutzfeldt–Jakob disease]] (among many others). |
- | <WRAP group> | + | ==== Prevention ==== |
- | <WRAP half column> | + | About 35% of dementia is attributable to nine modifiable factors across the lifespan.[([[https://www.ncbi.nlm.nih.gov/pubmed/28735855|Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., ... & Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673-2734.]])] These factors include: education, midlife hypertension, midlife obesity, hearing loss, late-life depression, diabetes, physical inactivity, smoking, and social isolation.[([[https://www.ncbi.nlm.nih.gov/pubmed/29490494|Steffens, D. C. (2018). A Geriatrics Perspective on Dementia Prevention and Treatment.]])] |
- | ===== Differential Diagnosis ===== | + | The World Health Organization (WHO) Dementia Prevention Guidelines recommends the following to reduce the risk of dementia:[([[https://www.who.int/mental_health/neurology/dementia/guidelines_risk_reduction/en/|World Health Organization. (2019). Risk reduction of cognitive decline and dementia: WHO guidelines. In Risk reduction of cognitive decline and dementia: WHO guidelines.]])] |
- | When being asked to see a patient with demenita, it is good to have a systematic approach. The following is one approach to diagnosing dementia.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596200/|Lee, L., Weston, W. W., Heckman, G., Gagnon, M., Lee, F. J., & Sloka, S. (2013). Structured approach to patients with memory difficulties in family practice. Canadian Family Physician, 59(3), 249-254.]])] | + | - Physical exercise (there is some conflicting data[([[https://www.ncbi.nlm.nih.gov/pubmed/30995986|Kivimäki, M., Singh-Manoux, A., Pentti, J., Sabia, S., Nyberg, S. T., Alfredsson, L., ... & Kouvonen, A. (2019). Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis. bmj, 365, l1495.]])]) |
+ | - Tobacco cessation | ||
+ | - Reduce harmful drinking | ||
+ | - Lose excess weight in midlife | ||
+ | - Adhere to healthy diet (a Mediterranean-style diet may reduce dementia risk) | ||
+ | - Cognitive training can be tried for adults with normal cognition or mild impairment (but the quality of evidence to support this is low) | ||
+ | - Social participation and support are important throughout life (but limited evidence to support) | ||
+ | - Hypertension, diabetes, and depression should be managed according to existing guidelines (but it's not clear whether doing so will specifically lower dementia risk) | ||
+ | |||
+ | Vitamins B and E, polyunsaturated fatty acids, and multivitamins are not recommended for risk reduction of dementia.[([[https://www.cochrane.org/CD011905/DEMENTIA_vitamin-and-mineral-supplementation-preventing-dementia-or-delaying-cognitive-decline-people-mild|McCleery, J., Abraham, R. P., Denton, D. A., Rutjes, A. W., Chong, L. Y., Al‐Assaf, A. S., ... & Di Nisio, M. (2018). Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment. Cochrane Database of Systematic Reviews, (11).]])] | ||
+ | |||
+ | ===== Approach ===== | ||
+ | When being asked to see a patient with dementia, it is good to have a systematic approach. The following is one approach to diagnosing dementia.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3596200/|Lee, L., Weston, W. W., Heckman, G., Gagnon, M., Lee, F. J., & Sloka, S. (2013). Structured approach to patients with memory difficulties in family practice. Canadian Family Physician, 59(3), 249-254.]])] | ||
- **Rule out [[cl:1-delirium|delirium]].** Is there an acute onset and fluctuating course + inattention + disorganized thinking? Is there altered level of consciousness? | - **Rule out [[cl:1-delirium|delirium]].** Is there an acute onset and fluctuating course + inattention + disorganized thinking? Is there altered level of consciousness? | ||
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* Order CBC (anemia), TSH (hypothyroidism), creatinine, electrolytes (hyponatremia), calcium (hypercalcemia), glucose (hyperglycemia), and vitamin B12 (vitamin B12 deficiency) | * Order CBC (anemia), TSH (hypothyroidism), creatinine, electrolytes (hyponatremia), calcium (hypercalcemia), glucose (hyperglycemia), and vitamin B12 (vitamin B12 deficiency) | ||
* Creatinine (to assess renal function and ability to clear medications) | * Creatinine (to assess renal function and ability to clear medications) | ||
- | * Consider neuroimaging such as [[neurology:investigations:neuroimaging:ct|CT]] or [[neurology:investigations:neuroimaging:mri|MRI]] | + | * Consider neuroimaging such as [[neurology:ct-scan|CT]] or [[neurology:mri|MRI]] |
* Consider rapid plasma reagin (RPR), LFTs | * Consider rapid plasma reagin (RPR), LFTs | ||
+ | * Is there the use of any anticholinergic medications (and [[meds:toxidromes:anticholinergic-cholinergic|anticholinergic toxicity]]?) | ||
- **Is it dementia, mild cognitive impairment (MCI), or normal aging?** | - **Is it dementia, mild cognitive impairment (MCI), or normal aging?** | ||
* Dementia: objective findings of cognitive loss with impairment of ADLs | * Dementia: objective findings of cognitive loss with impairment of ADLs | ||
- | * MCI: objective findings of cognitive loss without impairment of ADLs Normal cognitive aging: no objective findings of cognitive loss | + | * [[cl:3-mild-neurocog-disorder|Mild Cognitive Impairment]]: objective findings of cognitive loss without impairment of ADLs |
- | + | * Normal cognitive aging: no objective findings of cognitive loss | |
- | </WRAP> | + | |
- | <WRAP half column> | + | |
===== Dementia Subtypes ===== | ===== Dementia Subtypes ===== | ||
<panel type="info" title="Common Dementia Subtypes and Presentation" footer="*Includes mixed dementia types (Vascular and Alzheimer's). Mixed types become more common in later–life dementia." no-body="true"> | <panel type="info" title="Common Dementia Subtypes and Presentation" footer="*Includes mixed dementia types (Vascular and Alzheimer's). Mixed types become more common in later–life dementia." no-body="true"> | ||
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</WRAP> | </WRAP> | ||
</WRAP> | </WRAP> | ||
- | |||
- | ===== Prevention ===== | ||
- | About 35% of dementia is attributable to nine modifiable factors across the lifespan.[([[https://www.ncbi.nlm.nih.gov/pubmed/28735855|Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., ... & Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673-2734.]])] These factors include: education, midlife hypertension, midlife obesity, hearing loss, late-life depression, diabetes, physical inactivity, smoking, and social isolation.[([[https://www.ncbi.nlm.nih.gov/pubmed/29490494|Steffens, D. C. (2018). A Geriatrics Perspective on Dementia Prevention and Treatment.]])] | ||
- | |||
- | The World Health Organization (WHO) Dementia Prevention Guidelines recommends the following to reduce the risk of dementia:[([[https://www.who.int/mental_health/neurology/dementia/guidelines_risk_reduction/en/|World Health Organization. (2019). Risk reduction of cognitive decline and dementia: WHO guidelines. In Risk reduction of cognitive decline and dementia: WHO guidelines.]])] | ||
- | - Physical exercise (there is some conflicting data[([[https://www.ncbi.nlm.nih.gov/pubmed/30995986|Kivimäki, M., Singh-Manoux, A., Pentti, J., Sabia, S., Nyberg, S. T., Alfredsson, L., ... & Kouvonen, A. (2019). Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis. bmj, 365, l1495.]])]) | ||
- | - Tobacco cessation | ||
- | - Reduce harmful drinking | ||
- | - Lose excess weight in midlife | ||
- | - Adhere to healthy diet (a Mediterranean-style diet may reduce dementia risk) | ||
- | - Cognitive training can be tried for adults with normal cognition or mild impairment (but the quality of evidence to support this is low) | ||
- | - Social participation and support are important throughout life (but limited evidence to support) | ||
- | - Hypertension, diabetes, and depression should be managed according to existing guidelines (but it's not clear whether doing so will specifically lower dementia risk) | ||
- | |||
- | Vitamins B and E, polyunsaturated fatty acids, and multivitamins are not recommended for risk reduction of dementia.[([[https://www.cochrane.org/CD011905/DEMENTIA_vitamin-and-mineral-supplementation-preventing-dementia-or-delaying-cognitive-decline-people-mild|McCleery, J., Abraham, R. P., Denton, D. A., Rutjes, A. W., Chong, L. Y., Al‐Assaf, A. S., ... & Di Nisio, M. (2018). Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment. Cochrane Database of Systematic Reviews, (11).]])] | ||
===== Behavioural and Psychological Symptoms of Dementia ===== | ===== Behavioural and Psychological Symptoms of Dementia ===== | ||
<alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[geri:dementia:1-bpsd|]]**</alert> | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[geri:dementia:1-bpsd|]]**</alert> | ||
Behavioural and Psychological Symptoms of Dementia (BPSD) will develop in more than 90% of individuals diagnosed with dementia. Symptoms include delusions, hallucinations, aggression, screaming, restlessness, wandering, depression, and anxiety. | Behavioural and Psychological Symptoms of Dementia (BPSD) will develop in more than 90% of individuals diagnosed with dementia. Symptoms include delusions, hallucinations, aggression, screaming, restlessness, wandering, depression, and anxiety. | ||
+ | |||
+ | |||
===== Resources ===== | ===== Resources ===== | ||