Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

Deep Venous Thrombosis Dementia 467

➣Ulceration occurs in 10% of these patients

➣Treat with graduated pressure stockings, elevation

Prognosis

■Most patients will avoid PE with anticoagulation treatment; some

get chronic venous insufficiency despite adequate treatment

Dementia..........................................

CHAD CHRISTINE, MD

history & physical

■Acquired, generalized impairment of cognitive function

■Slowly progressive disorder (typically over years)

■Rare hereditary forms

■Not assoc w/ alteration of level of consciousness

■May be personality changes

■Immediate recall intact, but delayed recall & recent memory

impaired

■Parietal lobe dysfunction (pictorial construction, calculations, right

left discrimination, performance of complex motor tasks)

■Frontal lobe dysfunction (judgment, social skills, grasp reflexes)

tests

Lab Tests

■Diagnosis made clinically

■Serum & CSF studies normal

■Apoliprotein E e4 allele is a risk factor for Alzheimer’s disease

■Brain imaging may show atrophy

differential diagnosis

■Degenerative disorders: Pick’s disease, Creutzfeldt-Jacob disease,

normal-pressure hydrocephalus, dementia w/ Lewy bodies, cor-

ticobasal ganglionic degeration, progressive supranuclear palsy

excluded clinically

■Systemic disorders

➣Cancer: primary or metastatic excluded by neuroimaging & CSF

cytology

➣Infection: serology studies differentiate AIDS dementia & neu-

rosyphilis