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geri:dementia:home [2020/05/19 10:18]
psychdb [Differential Diagnosis]
geri:dementia:home [2020/05/19 10:18] (current)
psychdb [Prevention]
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 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).]])] 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?​
 +    * 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
 ===== 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">​