Dementia is progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Particularly affected areas may be memory, attention, language and problem solving, although particularly in the later stages of the condition, affected persons may be disoriented in time (not knowing what day, week, month or year it is), place (not knowing where they are) and person (not knowing who they are). Symptoms of dementia can be classified as either reversible or irreversible depending upon the etiology of the disease, although dementia, by definition, is irreversible and will eventually result in death. Dementia is a non-specific term that encompasses many disease processes just as fever is attributable to many etiologies.
Affected persons may also show signs of psychosis, depression and delirium. Early symptoms often consist in changes in personality, or in behavior. Often dementia can be first evident during an episode of delirium. There is a higher prevalance of eventually developing dementia in individuals who experience an acute episode of confusion while hospitilized.
Dementia can affect language, comprehesion, motor skills, short term memory, ability to identify commonly used items, reaction time, personality traits, and executive functioning.
Proper differential diagnosis between the types of dementia will require, at the least, referral to a specialist, e.g. a geriatric internist, geriatric psychiatrist or neurologist. However, there are some brief (5-15 minutes) tests that have good reliability and can be used in the office or other setting to evaluate cognitive status. Examples of such tests include the abbreviated mental test score (AMTS) and the mini mental state examination (MMSE).
An AMTS score of less than six and an MMSE score under 24 suggests a need for further evaluation. Of course, this must be interpreted in the context of the person's educational and other background, and particular circumstances. Routine blood tests are usually performed to rule out treatable causes. These tests include vitamin B12, folic acid, thyroid-stimulating hormone (TSH), C-reactive protein, full blood count, electrolytes, calcium, renal function and liver enzymes. Abnormalities may suggest vitamin deficiency, infection or other problems that commonly cause confusion or disorientation in the elderly. Chronic use of substances such as alcohol can also predispose the patient to cognitive changes suggestive of dementia.
A CT scan or magnetic resonance imaging (MR scan) is commonly performed. This may suggest normal pressure hydrocephalus, a potentially reversible cause of dementia, and can yield information relevant to other types of dementia, such as infarction (stroke) that would point at a vascular type of dementia. Sometimes neuropsychological testing is helpful as well.
The final diagnosis of dementia is made on the basis of the clinical picture. For research purposes, the diagnosis depends on both a clinical diagnosis and a pathological diagnosis (ie, based on the examination of brain tissue, usually from autopsy).
Lisa Angelettie, M.S.W., is a psychotherapist, author, and an online advice expert. She has been helping people make smarter life choices since 1998. Visit her for Advice & Counseling, or take a free Depression Screening today.
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