- Last edited on October 3, 2022
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geri:dementia:home [on May 19, 2020] |
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| <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. | ||
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| - | ===== Differential Diagnosis ===== | ||
| - | 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.]])] | ||
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| - | - **Rule out [[cl:1-delirium|delirium]].** Is there an acute onset and fluctuating course + inattention + disorganized thinking? Is there altered level of consciousness? | ||
| - | * Urinary Tract Infections ([[https://www.aafp.org/afp/2011/1001/p771.html|UTIs]]) are especially common in the elderly and frequent culprits of delirium! Don't forget that a negative urine culture does not always mean there is no UTI, especially if the patient is symptomatic.[([[https://www.ncbi.nlm.nih.gov/pubmed/28457846|Heytens, S., De Sutter, A., Coorevits, L., Cools, P., Boelens, J., Van Simaey, L., ... & Claeys, G. (2017). Women with symptoms of a urinary tract infection but a negative urine culture: PCR-based quantification of Escherichia coli suggests infection in most cases. Clinical Microbiology and Infection, 23(9), 647-652.]])] | ||
| - | - **Rule out [[mood:1-depression:home|depression]]** ("pseudodementia"). Consider atypical presentations: anxiety, irritability, unexplained physical complaints, worsening cognition. Once the depression is treated, the dementia symptoms go away! | ||
| - | - **Rule out any substance use disorders** | ||
| - | - **Rule out any reversible causes** | ||
| - | * 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) | ||
| - | * Consider neuroimaging such as [[neurology:ct-scan|CT]] or [[neurology:mri|MRI]] | ||
| - | * Consider rapid plasma reagin (RPR), LFTs | ||
| - | - **Is it dementia, mild cognitive impairment (MCI), or normal aging?** | ||
| - | * Dementia: objective findings of cognitive loss with impairment of ADLs | ||
| - | * [[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 | ||