0071643192.pdf

■ Waxing and waningsymptoms

■ Hallucinations, if present, are visual and/or auditory.

DIFFERENTIAL

Dementia, psychosis

DIAGNOSIS

■ History of acuity of change in behavior.

■ Mini–mental status examination: Tests orientation, memory, attention,

calculation, recall, and language.

■ Score <23 is abnormal.

■ General PE and ancillary tests to search for underlying cause

■ Include head CT and LP, if necessary.

TREATMENT

■ Treat underlying cause.

■ Sedate with haloperidol or benzodiazepines if severe agitation.

Dementia

Dementia results from a gradualloss of mental capacity with relatively pre-

served attention function.

CAUSES

Causes include

■ Alzheimer disease (most common)

■ Reduction of neurons in the cerebral cortex and increased amyloid

deposition→neurofibrillary tangles and plaques.

■ Vascular (multi-infarct)

■ Parkinson disease

■ Viral infection: HIV, Creutzfeldt-Jakob disease

■ Possible treatable causes:

■ Depression (most common treatable cause)

■ Vitamin B 12 deficiency

■ Neurosyphilis

■ Hypothyroidism

■ Normal pressure hydrocephalus

■ Intracranial mass (eg, brain tumor)

■ Chronic drug use

SYMPTOMS/EXAM

■ Gradual onsetconfusional state

■ Usually presents in the elderly

■ Disordered cognition with normal attention

■ Loss of mental capacity especially memory

■ Remote memories often preserved

DIFFERENTIAL

■ Delirium, psychosis

NEUROLOGY

A score of <23 on the

mini–mental status

examination is abnormal.

Keep in mind reversible

causes when evaluating the

patient with dementia.