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Dementia

Definition

Dementia is an acquired persistent impairment in intellectual function with compromise in at least three of the following spheres of mental activity: (1) language, (2) memory, (3) visuospatial skills, (4) emotion or personality, and (5) cognition (abstraction, calculation, judgment).

Dementia is acquired and must therefore be distinguished from congenital mental retardation syndromes.

Main causes of dementia

 
Static dementia:

TIT (Traumatic, Inflammatory, Tumor) Ischemia, Haemorrhage

 
  1. Brain injury (Trauma)

  2. Meningitis  & encephalitis (Inflammation)

  3. Intracranial neoplasms (Tumour)

  4. Global ischemia

  5. Cardiac arrest

  6. Intracranial hemorrhage

  Progressive dementia:
 
  1. Senile dementia ? Alzheimer type

  2. Multi-infarct (arteriosclerotic)

  3. Communicating hydrocephalus

  4. Trauma, Tumor, Huntington?s

  5. Rare: CJD, AIDS, parkinsonism, MS etc

  Pseudodementia:
 
  1. Drug intoxication / depression / fugue

Diagnosis

Mini-mental status examination. If the mini-mental status examination scores normal in patients presenting with intellectual deficits a formal neuropsychological evaluation conducted by a neuropsychologist should be performed.

(adapted from Goldman: Cecil Textbook of Medicine, 21st Ed., Copyright ? 2000 W. B. Saunders Company)


SCORE
Orientation: What is the month, day, date, year, season? Where are you, what floor, city, county and state? (score 1 point for each item correct) 10
Registration: state three items (ball, flag, tree) (score 1 point for each item that the patient registers without you having to repeat the words. You may repeat the words until the patient is able to register the words but do not give them credit. You must also tell the patient that he/she should memorize those words and that you will ask him/her to recall those words later). 3
Attention: Can you spell the word WORLD forwards, then backwards? Can you subtract 7 from 100, and keep subtracting 7? (100-93-86-79-72) (Do both items but give credit for best of the two performances). 5
Memory: Can you remember those three words I asked you to memorize? (Do not give clues or multiple choice). 3
Languages:
   Naming: Can you name (show) a pen and a watch? 2
   Repetition: Can you repeat "No if's, and's, or but's"? 1
   Comprehension: Can you take this piece of paper in your right hand, fold it in half, then put it on the floor? (score 1 point for each item done correctly) 3
   Reading: Read and obey, "CLOSE YOUR EYES" 1
   Writing: Can you write a sentence? 1
Visuospatial: Have patient copy intersecting pentagons 1
TOTAL 30
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