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geri:dementia:home [2019/06/04 23:49]
psychdb [Table]
geri:dementia:home [2020/06/10 12:34] (current)
psychdb [Approach]
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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.
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 +
 ===== Resources ===== ===== Resources =====