DEMENTIA

Etiologies

Dementia is an impairment of the mental capacities of an individual.† Itís incidence is age related, and therefore as the population lives longer itís prevalence is expected to increase.† Associated characteristics include cognitive impairment of memory, orientation, and language along with progressive loss of daily living skills, and the development of neuropsychiatric symptoms such as apathy, agitation, delusions, and aggression.

†††† There are many potential etiologies for dementia.† The most common are Alzheimerís disease, vascular dementia, drug induced dementia, depression, Lewy body dementia, Pickís disease, and Parkinsonís disease.† Medication side effect and depression are the two most common forms of reversible dementia. Elderly patients who also manifest urinary incontinence and ataxia should be screened for normopressure hydrocephalus (the wet, wacky and wobbly patient).

†††† The initial work up and evaluation should include a full physical exam with special attention directed towards the neurologic exam and specifically the Mini-Mental Status Examination (MMSE).† It is prudent to use laboratory screening tests in an attempt to identify potentially reversible causes of dementia.† Therefore, a CBC, TSH, vitamin B12 level, urinalysis, serum electrolytes with calcium and glucose should be used to screen all patients.† Other tests to consider include an ESR, syphilis serologies, and HIV testing.† Often times neuroimaging may be included in the initial work up.

†††† Discontinuation of any medications (sleeping pills, anticholinergics, H2 blockers, etc) thought to cause or exacerbate underlying dementia is prudent.† Alzheimerís patients may benefit from therapy with cholinesterase inhibitors.† If symptoms of Parkinsonís disease are present, a trial of appropriate medication may prove beneficial.† If patients with Parkinsonís symptoms fail to respond, consider Lewy body dementia.† Anxiety may respond to short-acting benzodiazepines or low doses of trazodone.† Associated depression may respond to treatment with  serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors.