Dementia is a syndrome characterized by multiple impairments in general intelligence, learning and memory, language. problem solving, orientation, perception, attention and concentration, judgment, and social abilities without impairment in consciousness.
The patient's personality is also affected. If the patient has an impairment of consciousness, then the patient probably fits the diagnosis of delirium. The disorder may be progressive or static, permanent or reversible. An underlying cause is always assumed, although in rare cases it is impossible to determine a specific cause.
The potential reversibility of dementia is related to the underlying pathology and to the availability and the application of effective treatment. An, estimated 15 percent of persons with dementia have illnesses that are reversible if the physician initiates timely treatment, before irreversible damage has taken place.
Dementia is essentially a disease of the aged. About 5 percent of all persons who reach age 65 have dementia of the Alzheimer's type, compared with 15 to 25 percent of all persons age 85 or older.
Patients with dementia of the Alzheimer's type occupy more than 50 percent of nursing home beds. The risk factors for the development of dementia of the Alzheimer's type include being female, having a first-degree relative with the disorder, and having a history of head injury.
The second most common type of dementia is vascular dementia that is, dementia related to cerebrovascular diseases. Vascular dementias account for 15 to 30 percent of all dementia cases. Vascular dementia is most common in persons between the ages of 60 and 70 and is more common in men than in women. Hypertension predisposes a person to the disease.
Dementia has many causes; however, dementia of the Alzheimer's type and vascular dementia together represent as much as 75 percent of all cases. Other causes of dementia are Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, human immunodeficiency virus (HIV), and head trauma.
Diagnostic Criteria for Dementia of the Alzheimer's Type
The development of multiple cognitive deficits manifested by both memory impairment (impaired ability to learn new information or to recall previously learned information) AND one (or more) of the following disturbances:
(a) aphasia (language disturbance)
(b) apraxia (impaired ability to carry out motor activities despite intact motor function)
(c) agnosia (failure to recognize or identify objects despite intact sensory function)
(d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
Diagnostic Criteria for Vascular Dementia
The general symptoms of vascular dementia are the same as those for dementia of the Alzheimer's type, but the diagnosis of vascular dementia requires evidence supportive of a vascular cause of the dementia.
Course and Prognosis:
The classic course of dementia is an onset in the patient's 50s or 60s, with gradual deterioration over 5 to 10 years, leading eventually to death. The age of onset and the rapidity of deterioration vary among different types of dementia. For example, the mean survival for patients with dementia of the Alzheimer's type is about 8 years, with a range of 1 to 20 years. Data suggest that patients with an early onset of dementia or with a family history of dementia are likely to have a rapid course. The course of the dementia varies from a steady progression (commonly seen with dementia of the Alzheimer's type) to an incrementally worsening dementia (commonly seen with vascular dementia) to a stable dementia (as may be seen in dementia related to head trauma).
The general treatment approach to demented patients is to provide supportive medical care, emotional support for the patients and their families, and pharmacological treatment for specific symptoms.
The clinician may prescribe benzodiazepines for insomnia and anxiety, antidepressants for depression, and antipsychotic drugs for delusions and hallucinations.
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