dementia - Etiology, Symptoms, Diagnosis, Types, Treatment

A decline in intellectual capacity as a result of an alteration of brain functioning which leads to impaired social or occupational abilities. It is commonly due to cerebrovascular disease and the ageing process, in which brain cells are destroyed and brain size is markedly reduced. Features include loss of memory, alteration of personality, impaired judgment, and poor impulse control. There is disorientation in time and place, and a failure to recognize friends and relatives. The term is one of many used previously as synonymous with madness.

ICD-9	290-294
DiseasesDB	29283
MedlinePlus	000739

Dementia (from Latin de- "apart, away" + mens (genitive mentis) "mind") is the progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Symptoms of dementia can be classified as either reversible or irreversible depending upon the etiology of the disease. Dementia is a non-specific term that encompasses many disease processes, just as fever is attributable to many etiologies.

Etiology

The prevalence of dementia in the global community is rising as the global life expectancy is rising. Particularly in Western countries, there is increasing concern about the economic impact that dementia will have in future, older populaces.

Symptoms

Early symptoms of dementia often consist of changes in personality, or in behavior.

Dementia can affect language, comprehension, motor skills, short-term memory, ability to identify commonly used items, reaction time, personality traits, and executive functioning. Even without signs of general intellectual decline, delusions are common in dementia (15-56% incidence rate in Alzheimer's type, and 27-60% incidence rate in multi-infarct dementia). This is called delirium, and many if not most dementia patients also have a delirium on top of the physiologial dementia, adding to the symptoms.

Diagnosis

Proper differential diagnosis between the types of dementia (see below) will require, at the least, referral to a specialist, e.g. Chronic use of substances such as alcohol can also predispose the patient to cognitive changes suggestive of dementia. 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.

The final diagnosis of dementia is made on the basis of the clinical picture.

Types

The most common types of dementia are as follows and vary according to the history and the presentation of the disease: (Where available the ICD-10 codes are provided. The first code refers to the dementia, and the second to the underlying condition.)

Most common causes

(F00/G30) Alzheimer's disease (F01) Vascular dementia (also known as multi-infarct dementia), including Binswanger's disease (F02.3/G20) Dementia with Lewy bodies (DLB) Alcohol Induced Persisting Dementia (F02.0/G31.0) Frontotemporal lobar degeneration (FTLD), including Pick's disease Frontotemporal dementia (or frontal variant FTLD) Semantic dementia (or temporal variant FTLD) Progressive non-fluent aphasia

Less common causes

It can also be a consequence of:

(F02.1/A81.0) Creutzfeldt-Jakob disease (F02.2/G10) Huntington's disease (F02.3/G20) Parkinson's disease (F02.4/B22.0) HIV infection (leading to AIDS dementia complex) (F07.2) Head trauma (Q90) People with Down's syndrome have an increased risk of developing dementia of the Alzheimer's type.

Treatable causes

Less than 5% of a sample of dementia cases have a potentially treatable cause. These include:

(F02.8/E01-E03) Hypothyroidism (F02.8/E51) Vitamin B1 (thiamine) deficiency (F02.8/E53.8) Vitamin B12, Vitamin A deficiency (F03/F32-F33) Depressive pseudodementia (note: dementia and depression can coexist in many patients and can be difficult to differentiate.) (G91.2) Normal pressure hydrocephalus Tumor

Treatment

Except for the treatable types listed above, there is no cure to this illness, although scientists are progressing in making a type of medication that will slow down the process.

Snoezelen rooms that provide patients with a soothing and stimulating environment of light, color, music and scent have been used in the therapy of dementia patients.