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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
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| Static dementia:
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TIT (Traumatic,
Inflammatory, Tumor)
Ischemia, Haemorrhage
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Brain injury (Trauma)
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Meningitis
& encephalitis (Inflammation)
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Intracranial neoplasms (Tumour)
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Global ischemia
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Cardiac arrest
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Intracranial hemorrhage
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Progressive
dementia: |
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Senile dementia ? Alzheimer
type
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Multi-infarct (arteriosclerotic)
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Communicating hydrocephalus
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Trauma, Tumor, Huntington?s
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Rare: CJD, AIDS, parkinsonism,
MS etc
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Pseudodementia: |
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- Drug intoxication /
depression / fugue
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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.
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(adapted from Goldman: Cecil Textbook of Medicine, 21st Ed., Copyright
? 2000 W. B. Saunders Company)
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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: |
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| 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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