Dementia 38390 224624897 2008-07-09T18:32:58Z Gracillis 4775916 [[th:ภาวะสมองเสื่อม]] {{otheruses}} {{DiseaseDisorder infobox | Name = DEMENTIA| ICD10 = {{ICD10|F|00||f|00}}-{{ICD10|F|07||f|00}}| ICD9 = {{ICD9|290}}-{{ICD9|294}} | ICDO = | Image = | Caption = | OMIM = | MedlinePlus = 000739 | eMedicineSubj = | eMedicineTopic = | DiseasesDB = 29283 | MeshID = D003704 | }} '''Dementia''' (from [[Latin]] ''de-'' "apart, away" + ''[[mens]]'' ([[genitive case|genitive]] ''mentis'') "mind") is the progressive decline in [[cognition|cognitive function]] due to damage or [[disease]] in the [[brain]] beyond what might be expected from normal [[aging]]. Although dementia is far more common in the [[geriatric]] population, it may occur in any stage of adulthood. This age cutoff is defining, as similar sets of symptoms due to organic brain dysfunction are given different names in populations younger than adulthood (see, for instance, [[developmental disorders]]). Dementia is a non-specific illness [[syndrome]] (set of [[symptoms]]) in which affected areas of cognition may be [[memory]], [[attention]], [[language]], and [[problem solving]]. Higher mental functions are affected first in the process. Especially in the later stages of the condition, affected persons may be [[disorientation|disoriented]] in time (not knowing what day of the week, day of the month, month, or even what year it is), in place (not knowing where they are), and in person (not knowing who they are). Symptoms of dementia can be classified as either reversible or irreversible, depending upon the [[etiology]] of the disease. Less than 10 percent of cases of dementia are due to causes which may presently be reversed with treatment. Causes include many different specific disease processes, in the same way that symptoms of organ dysfunction such as shortness of breath, [[jaundice]], or [[pain]] are attributable to many etiologies. Without careful assessment of history, the short-term syndrome of [[delirium]] can easily be confused with dementia, because they have many symptoms in common. Some [[mental illnesses]], including [[depression (mood)|depression]] and [[psychosis]], may also produce symptoms which must be differentiated from both delirium and dementia.<ref>[http://www.aafp.org/afp/20030301/1027.html American Family Physician], [[March 1]], [[2003]] Delirium</ref> ==Diagnosis== Proper differential diagnosis between the types of dementia ([[Cerebral cortex|cortical]] and [[Cerebral cortex#Laminar pattern|subcortical]] - see below) will require, at the least, referral to a specialist, e.g. a geriatric internist, geriatric psychiatrist, [[neurologist]], [[neuropsychologist]] or geropsychologist. However, there exist some brief tests (5-15 minutes) that have reasonable reliability and can be used in the office or other setting to screen cognitive status for deficits which are considered [[pathology|pathological]]. Examples of such tests include the [[abbreviated mental test score]] (AMTS), the [[mini mental state examination]] (MMSE), Modified Mini-Mental State Examination (3MS),<ref name="pmid3611032">Teng E L, Chui H C. The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry 1987;48:314–18. PMID 3611032</ref> the Cognitive Abilities Screening Instrument (CASI),<ref name="pmid8054493">Teng E L, Hasegawa K, Homma A, et al. The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr 1994;6:45–58. PMID 8054493</ref> and the clock drawing test.<ref name="pmid9598672>{{cite journal |author=Royall, D.; Cordes J.; & Polk M. |title=CLOX: an executive clock drawing task |journal=J Neurol Neurosurg Psychiatry |volume=64 |issue=5 |pages=588–94 |year=1998 |pmid=9598672 | url=http://jnnp.bmj.com/cgi/content/full/64/5/588}}</ref>. An AMTS score of less than six (out of a possible score of ten) and an MMSE score under 24 (out of a possible score of 30) suggests a need for further evaluation. Scores must be interpreted in the context of the person's educational and other background, and the particular circumstances; for example, a person highly depressed or in great pain will not be expected to do well on many tests of mental ability. ===Mini-mental state examination=== {{main|Mini-mental state examination}} The [http://www.ahrq.gov/clinic/uspstfix.htm U.S. Preventive Services Task Force (USPSTF)] reviewed tests for cognitive impairment and concluded:<ref name="pmid12779304">{{cite journal |author=Boustani, M.; Peterson, B.; Hanson, L.; Harris, R.; & Lohr, K. |title=Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force |journal=Ann Intern Med |volume=138 |issue=11 |pages=927–37 |year=2003 |pmid=12779304 | url=http://www.annals.org/cgi/content/full/138/11/927}}</ref> * MMSE : [[Sensitivity (tests)|sensitivity]] 71% to 92% : [[Specificity (tests)|specificity]] 56% to 96% A copy of the MMSE can be found in the appendix of the original publication.<ref name="pmid1202204">{{cite journal |author=Folstein MF, Folstein SE, McHugh PR |title="Mini-mental state". A practical method for grading the cognitive state of patients for the clinician |journal=Journal of psychiatric research |volume=12 |issue=3 |pages=189–98 |year=1975 |pmid=1202204 |doi=10.1016/0022-3956(75)90026-6}}</ref> ===Modified Mini-Mental State examination (3MS)=== A copy of the 3MS is online.<ref>{{cite web |url=http://www.cjns.org/27febtoc/predicting_appendix_.html |title=Appendix: The Modified Mini-Mental State (3MS) |accessdate=2007-09-06 |format= |work=}}</ref> A [[meta-analysis]] concluded that the Modified Mini-Mental State (3MS) examination has:<ref name="pmid17178826">Cullen B, O'Neill B, Evans JJ, Coen RF, Lawlor BA. A review of screening tests for cognitive impairment. J Neurol Neurosurg Psychiatry. 2007 Aug;78(8):790-9. Epub 2006 Dec 18. PMID 17178826</ref> : sensitivity 83% to 94% : specificity 85% to 90% ===Abbreviated mental test score=== {{main|abbreviated mental test score}} A meta-analysis concluded:<ref name="pmid17178826"/> : sensitivity 73% to 100% : specificity 71% to 100% ===Other examinations=== Many other tests have been studied<ref name="pmid17163083">{{cite journal |author=Sager, M.; Hermann, B.; La Rue, A.; & Woodard, J. |title=Screening for dementia in community-based memory clinics |journal=WMJ |volume=105 |issue=7 |pages=25–9 |year=2006 |pmid=17163083}}</ref><ref name="pmid17287448">{{cite journal |author=Fleisher, A.; Sowell B.; Taylor C.; Gamst A.; Petersen R.; & Thal L. |title=Clinical predictors of progression to Alzheimer disease in amnestic mild cognitive impairment |journal=Neurology |volume= 68|issue= |pages= 1588|year= 2007|pmid=17287448 |doi=10.1212/01.wnl.0000258542.58725.4c}}</ref><ref name="pmid12614094">{{cite journal |author=Karlawish, J. & Clark, C. |title=Diagnostic evaluation of elderly patients with mild memory problems |journal=Ann Intern Med |volume=138 |issue=5 |pages=411–9 |year=2003 |pmid=12614094 | url=http://www.annals.org/cgi/content/full/138/5/411}}</ref> including the clock-drawing test ([http://jnnp.bmj.com/cgi/content/full/64/5/588/F3 example form]). Although some may emerge as better alternatives to the MMSE, presently the MMSE is the best studied. However, access to the MMSE is now limited by enforcement of its copyright. Another approach to screening for dementia is to ask an informant (relative or other supporter) to fill out a questionnaire about the person's everyday cognitive functioning. Informant questionnaires provide complementary information to brief cognitive tests. Probably the best known questionnaire of this sort is the [[Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)]].<ref>Jorm, A.F. (2004). The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): A review. International Psychogeriatrics, 16, 1-19.</ref> Further evaluation includes retesting at another date, and administration of other (and sometimes more complex) tests of mental function, such as formal [[neuropsychological]] testing. ===Laboratory tests=== Routine [[blood test]]s are also usually performed to rule out treatable causes. These tests include [[vitamin B12]], [[folic acid]], [[thyroid-stimulating hormone]] (TSH), [[C-reactive protein]], [[full blood count]], [[electrolyte]]s, [[calcium in biology|calcium]], [[renal function]], and [[liver enzyme]]s. Abnormalities may suggest [[vitamin deficiency]], [[infection]] or other problems that commonly cause confusion or disorientation in the elderly. The problem is complicated by the fact that these cause confusion more often in persons who have early dementia, so that "reversal" of such problems may ultimately only be temporary. Chronic use of substances such as [[alcoholic beverage|alcohol]] can also predispose the patient to cognitive changes suggestive of dementia. ===Imaging=== A [[Computed axial tomography|CT scan]] or [[magnetic resonance imaging]] (MRI scan) is commonly performed, although these modalities (as is noted below) do not have optimal sensitivity for the diffuse metabolic changes associated with dementia in a patient who shows no gross neurological problems (such as paralysis or weakness) on neurological exam. CT or MRI may suggest [[normal pressure hydrocephalus]], a potentially reversible cause of dementia, and can yield information relevant to other types of dementia, such as infarction ([[stroke]]) that would point at a vascular type of dementia. However, the [[functional neuroimaging]] modalities of [[SPECT]] and [[PET]] have shown similar ability to diagnose dementia as clinical exam.<ref>{{cite journal |last=Bonte |first=FJ |coauthors=Harris TS, Hynan LS, Bigio EH, White CL 3rd |year=2006 |month=July |title=Tc-99m HMPAO SPECT in the differential diagnosis of the dementias with histopathologic confirmation |journal=Clinical Nuclear Medicine |volume=31 |issue=7 |pages=376–8 |accessdate= 2007-12-21 |pmid=16785801 |doi=10.1097/01.rlu.0000222736.81365.63 }}</ref> The ability of SPECT to differentiate the vascular cause from the Alzheimer disease cause of dementias, appears to be superior to differentiation by clinical exam.<ref>{{cite journal |last=Dougall |first=NJ |coauthors=Bruggink S, Ebmeier KP |year=2004 |month=Nov-Dec |title=Systematic review of the diagnostic accuracy of 99mTc-HMPAO-SPECT in dementia |journal=The American Journal of Geriatric Psychiatry |volume=12 |issue=6 |pages=554–70 |accessdate= 2007-12-21 |pmid=15545324 |doi=10.1176/appi.ajgp.12.6.554 }}</ref> ==Types== ===Cortical dementias=== * [[Alzheimer's disease]] * [[Vascular dementia]] (also known as ''multi-infarct dementia''), including [[Binswanger's disease]] * [[Dementia with Lewy bodies]] (DLB) * [[Alcohol dementia|Alcohol-Induced Persisting Dementia]] ** [[Korsakoff's syndrome]] ** [[Wernicke's encephalopathy]] * [[Frontotemporal lobar degenerations]] (FTLD), including [[Pick's disease]] ** [[Frontotemporal dementia]] (or frontal variant FTLD) ** [[Semantic dementia]] (or temporal variant FTLD) ** [[Progressive non-fluent aphasia]] * [[Creutzfeldt-Jakob disease]] * [[Dementia pugilistica]] * [[Moyamoya disease]] * [[Posterior cortical atrophy]] or Benson's syndrome. ===Subcortical dementias=== * Dementia due to [[Huntington's disease]] * Dementia due to [[Hypothyroidism]] * Dementia due to [[Parkinson's disease]] * Dementia due to [[Vitamin B1 deficiency]] * Dementia due to [[Vitamin B12 deficiency]] * Dementia due to [[Folate deficiency]] * Dementia due to [[Syphilis]] * Dementia due to [[Subdural hematoma]] * Dementia due to [[Hypercalcaemia]] * Dementia due to [[Hypoglycemia]] * [[AIDS dementia complex]] * Pseudodementia (associated with [[clinical depression]] and [[bipolar disorder]]) * Substance-induced persisting dementia (related to psychoactive use and formerly [[Absinthism]]) * Dementia due to multiple etiologies * Dementia due to other general medical conditions (i.e. [[end stage renal failure]], [[cardiovascular disease]] etc.) * Dementia not otherwise specified (used in cases where no specific criteria is met) Dementia and early onset dementia have been associated with neurovisceral porphyrias. [[Porphyria]] is listed in textbooks in the differential diagnosis of dementia. Because acute intermittent porphyria, hereditary coproporphyria and variegate porphyria are aggravated by environmental toxins and drugs the disorders should be ruled out when these etiologies are raised. ==Treatment== Except for the treatable types listed above, there is no cure to this illness, although scientists are progressing in making a type of medication that will slow down the process. [[Acetylcholinesterase inhibitor|Cholinesterase inhibitor]]s are often used early in the disease course. Cognitive and behavioral interventions may also be appropriate. Educating and providing emotional support to the [[caregiver]] (or carer) is of importance as well (''see also [[elderly care]]''). A [[Canadian]] study found that a lifetime of [[bilingualism]] has a marked influence on delaying the onset of dementia by an average of four years when compared to [[monolingualism|monolingual]] patients. The researchers determined that the onset of dementia symptoms in the monolingual group occurred at the mean age of 71.4, while the bilingual group was 75.5 years. The difference remained even after considering the possible effect of cultural differences, [[immigration]], formal [[education]], employment and even [[gender]] as influences in the results.<ref>{{cite web | url=http://www.medicalnewstoday.com/medicalnews.php?newsid=60646 | title=Bilingualism Has Protective Effect In Delaying Onset Of Dementia By Four Years, Canadian Study Shows | publisher=Medical News Today | date=[[2007-01-11]] | accessdate=2007-01-16}}</ref> ===Medications=== *[[Acetylcholinesterase inhibitor]]s [[Tacrine]] (Cognex), [[donepezil]] (Aricept), [[galantamine]] (Razadyne, Memeron), and [[rivastigmine]] (Exelon) are approved by the United States Food and Drug Administration (FDA) for treatment of dementia induced by Alzheimer disease. They may be useful for other similar diseases causing dementia such as Parkinsons or vascular dementia.<ref>Lleo A, Greenberg SM, Growdon JH. Current pharmacotherapy for Alzheimer's disease. Annu Rev Med. 2006;57:513-33. Review. PMID 16409164</ref> *N-methyl-D-aspartate Blockers. Memantine (Namenda) is a drug representative of this class. It can be used in combination with acetylcholinesterase inhibitors. ====Off label==== *Amyloid deposit inhibitors [[Minocycline]] and [[Clioquinoline]], antibiotics, may help reduce [[amyloid]] deposits in the brains of persons with Alzheimer disease.<ref>Choi, Y., Kim, H.S., Shin, K.Y., Kim, E.M., Kim, M., Kim, H.S., Park, C.H., Jeong, Y.H., Yoo, J., Lee, J.P., Chang K.A., Kim S., & Suh, Y.H. Related Minocycline Attenuates Neuronal Cell Death and Improves Cognitive Impairment in Alzheimer's Disease Models. ''Neuropsychopharmacology''. 2007 Apr 4; PMID 17406652</ref> *Antipsychotic drugs [[Haloperidol]] (Haldol), [[risperidone]] (Risperdal), [[olanzapine]] (Zyprexa), and [[quetiapine]] (Seroquel) are frequently prescribed to help manage [[psychosis]] and [[agitation]]. Treatment of dementia-associated psychosis or agitation is intended to decrease psychotic symptoms (for example, paranoia, delusions, hallucinations), screaming, combativeness, and/or violence.<ref>Wei, Z., Mousseau, D.D., Dai, Y., Cao, X., Li, X.M. (2006). Haloperidol induces apoptosis via the sigma2 receptor system and Bcl-XS. ''Pharmacogenomics J. 6''(4):279-88. Epub 2006 Feb 7. PMID 16462815</ref><ref>Wang, H., Xu, H., Dyck, L.E., & Li, X.M. (2005). Olanzapine and quetiapine protect PC12 cells from beta-amyloid peptide(25-35)-induced oxidative stress and the ensuing apoptosis. ''Journal Neuroscience Res, 81''(4):572-80. PMID 15948179</ref> *[[Antidepressant]] drugs [[Clinical depression|Depression]] is frequently associated with dementia and generally worsens the degree of [[cognitive]] and [[behavioral]] impairment. [[Antidepressant]]s may be helpful in alleviating cognitive and behavior symptoms by reuptaking [[neurotransmitter]] regulation through reuptake of [[serotonin]], [[noradrenaline]] and [[dopamine]]. *Antianxiety drugs Many patients with dementia experience [[anxiety]] symptoms. Although [[benzodiazepines]] like [[diazepam]] (Valium) have been used for treating anxiety in other situations, they are often avoided because they may increase agitation in persons with dementia or are too sedating. [[Buspirone]] (Buspar) is often initially tried for mild-to-moderate anxiety. [[Selegiline]], a drug used primarily in the treatment of Parkinson's disease, appears to slow the development of dementia. Selegiline is thought to act as an [[antioxidant]], preventing [[free radical]] damage. However, it also acts as a stimulant, making it difficult to determine whether the delay in onset of dementia symptoms is due to protection from free radicals or to the general elevation of brain activity from the stimulant effect. ==Prevention== {{Main|Prevention of dementia}} Since there is no cure for dementia, the best an individual can do is to prevent it from developing in the first place. The main method to prevent dementia is to live an active life, both mentally and physically. It appears that the regular moderate consumption of alcohol (beer, wine, or distilled spirits) may reduce risk.<ref> Mulkamal, K.J., ''et al''. Prospective study of alcohol consumption and risk of dementia in older adults. ''Journal of the American Medical Association'', 2003 (March 19), ''289'', 1405-1413; Ganguli, M., ''et al''. Alcohol consumption and cognitive function in late life: A longitudinal community study. ''Neurology'', 2005, ''65'', 1210-12-17; Huang, W., ''et al''. Alcohol consumption and incidence of dementia in a community sample aged 75 years and older. ''Journal of Clinical Epidemiology'', 2002, ''55(10)'', 959-964; Rodgers, B., ''et al''. Non-linear relationships between cognitive function and alcohol consumption in young, middle-aged and older adults: The PATH Through Life Project. ''Addiction'', 2005, ''100(9)'', 1280-1290; Anstey, K. J., ''et al''. Lower cognitive test scores observed in alcohol are associated with demographic, personality, and biological factors: The PATH Through Life Project. ''Addiction'', 2005, ''100(9)'', 1291-1301; Espeland, M., ''et al''. Association between alcohol intake and domain-specific cognitive function in older women. ''Neuroepidemiology'', 2006, ''1(27)'', 1-12; Stampfer, M.J., ''et al'. Effects of moderate alcohol consumption on cognitive function in women. ''New England Journal of Medicine'', 2005, ''352'', 245-253; Ruitenberg, A., ''et al''. Alcohol consumption and risk of dementia: the Rotterdam Study. ''Lancet'', 2002, ''359(9303)'', 281-286; Scarmeas, N., ''et al''. Mediterranean diet and risk for Alzheimer’s disease. ''Annals of Neurology'', 2006 (published online [[April 18]], [[2006]]). </ref> Furthermore, there are medications which might contribute to prevent the onset of dementia, including hypertension medications, anti-diabetic drugs, and [[NSAID]]s.<ref name=wvdhhr>[http://www.wvdhhr.org/bph/oehp/hsc/dementia/prevent.htm West Virginia Department of Health and Human Resources (with further links to experiments respectively)]</ref> Studies published in US journals suggested that a [[Mediterranean diet]] or long-term beta-carotene supplements could ward off dementia.<ref>[http://news.bbc.co.uk/2/hi/health/7092292.stm BBC NEWS | Health | Healthy diet 'cuts dementia risk'<!-- Bot generated title -->]</ref> ==Risk to self and others== [[Driving]] with dementia could lead to severe injury or even death to self and others. Doctors should advise appropriate testing on when to quit driving.<ref>[http://www.cbc.ca/health/story/2007/09/19/drivers-dementia.html?ref=rss Drivers with dementia a growing problem, MDs warn, CBC News, Canada], [[September 19]], [[2007]]</ref> Florida's [[Baker Act]] allows law enforcement and the judiciary to force [[mental evaluation]] for those suspected of suffering from dementia or other mental [[Incapacity|incapacities]].{{fact|date=March 2008}} ==Services== [[Adult daycare]] centers as well as special care units in nursing homes often provide specialized care for dementia patients. Adult daycare centers offer supervision, recreation, meals, and limited health care to participants, as well as providing respite for caregivers. ==See also== * [[Caregiving and dementia]] ==References== ===Notes=== {{reflist}} ===Bibliography=== ===External links=== * [http://www.knowledgenetwork.ca/beyondmemory/index.html An Documentary About Dementia Produced by Knowledge Network] * [http://www.ahaf.org/alzdis/about/adabout.htm Alzheimer's Disease Research] * [http://www.sciencedaily.com/news/mind_brain/dementia/ Dementia Research News from ScienceDaily] * [http://www.dementia.stir.ac.uk The Dementia Services Development Centre, University of Stirling] * [http://www.ehr.chime.ucl.ac.uk/display/demcare/Home Dementia tutorial for U.K. practitioners by the Alzheimer's Society] * {{PDFlink|[http://changeagentteam.org.uk/_library/docs/Housing/Telecare/Telecare_gettingstarted.pdf Getting Started in Telecare for Patients with Dementia]|897&nbsp;[[Kibibyte|KiB]]<!-- application/pdf, 918906 bytes -->}} * [http://www.alzheimersdementiainfo.com AlzheimersDementiaInfo] - Articles and information regarding Alzheimer's disease and other elder care issues. * [http://www.dementiaguide.ca/aboutdementia/understanding/ Understanding Dementia: a primer of diagnosis and management] *[http://alzonline.phhp.ufl.edu AlzOnline] - AlzOnline provides education, information, and support to persons caring for someone with Alzheimer's disease or a related memory problem. * [http://www.olderpeoplesmentalhealth.csip.org.uk CSIP National Older Persons Mental Health Programme] Includes an involvement toolkit with tips on how people with dementia can get involved in the planning, development and evaluation of services * [http://www.dasninternational.org Dementia Advocacy and Support Network] * [http://www.bradford.ac.uk/health/dementia/dcm/index.php Dementia Care Mapping] Bradford Dementia Group * {{GPnotebook|-1650851840|Dementia}} * {{EMedicineConsumer|38533-1}} * {{MedlinePlusOverview|Dementia}} * {{MerckGeriatrics|5|40|a}} {{Mental and behavioural disorders}} [[Category:Aging-associated diseases]] [[Category:Cognitive disorders]] [[Category:Neurology]] [[Category:Neurobiological brain disorder]] [[Category:Pathology]] [[Category:Psychiatry]] [[gn:Tarova]] [[bg:Деменция]] [[cs:Demence]] [[da:Demens]] [[de:Demenz]] [[et:Dementsus]] [[es:Demencia]] [[eu:Dementzia]] [[fr:Démence]] [[ga:Néaltrú]] [[hr:Demencija]] [[it:Demenza]] [[he:שיטיון]] [[mk:Деменција]] [[mt:Demenzja]] [[ms:Penyakit Dementia]] [[nl:Dementie]] [[ja:認知症]] [[no:Demens]] [[pl:Demencja]] [[pt:Demência]] [[ru:Деменция]] [[scn:Demenza]] [[simple:Dementia]] [[sk:Demencia]] [[sr:Деменција]] [[fi:Dementia]] [[sv:Demens]] [[th:ภาวะสมองเสื่อม]] [[vi:Chứng mất trí]] [[tr:Demans]] [[zh:失智症]]