OVERVIEW
OVERVIEW
Dementia is a syndrome centered on acquired cognitive impairment that results in significant decreases in daily living, social interaction, and work ability. Dementia is described as a neurocognitive disorder in the American Psychiatric Association’s “Manual of Mental Disorders and Statistics,” 5th edition (DSM-V).
Are you covered by Medicare?
Yes
Department
Neurology, Psychiatry, Geriatrics
Synonyms
Chronic encephalopathy syndrome, Neurocognitive disorders
Clinical Symptoms
The patient has cognitive impairment involving memory, learning, orientation, comprehension, judgment, calculation, language, visuospatial function, analysis and problem solving, and is often accompanied by mental, behavioral and personality abnormalities at some point in the course of the disease.
Harms
It leads to a serious decline in the quality of life of patients and caregivers, and increases the medical and economic burden.
Screening
Laboratory tests, dementia scale tests, cerebral blood flow tests, electroencephalography, CT, magnetic resonance imaging, molecular imaging, genetic testing, etc.
Diagnosis
A comprehensive analysis based on medical history, general and neurological physical examination, neuropsychological assessment, laboratory and imaging tests. The diagnosis of dementia is divided into three main steps: firstly, to clarify whether it is dementia, secondly, to clarify the cause of dementia, and finally, to determine the severity of dementia.
Treatment Principles
Through etiological treatment and symptomatic treatment, we can slow down or stop the progress of dementia, improve cognitive function, maximize the maintenance of the patient’s functional status, enhance the patient’s ability to perform daily life and improve the quality of life, reduce complications, prolong the survival period, and reduce the burden of caregivers.
Curability
Current therapies can only improve symptoms in the short term, cannot slow down the progression of the disease, let alone cure it.
Dietary recommendations
Low-salt diet, abstain from smoking and alcohol.
Causes
Causes
The etiology covers almost all central nervous system diseases, including infection, poisoning, trauma, vascular disease, genetic metabolic disease, neurodegeneration, tumor, neuropsychology, etc. The main causes are neurodegenerative disease and non-degenerative disease dementia. The main causes are categorized into neurodegenerative diseases and non-degenerative diseases dementia, the former mainly includes Alzheimer’s disease, dementia with Lewy bodies, Parkinson’s disease dementia, frontotemporal lobe dementia, etc., and the latter includes vascular dementia, normal-pressure hydrocephalus, and dementia caused by other secondary diseases.
Symptoms and Diagnosis
Typical Symptoms
Early manifestations of the patient are memory and concentration loss, decreased work ability, easy to be depressed and anxious. With the progress of the disease, the ability of thinking, understanding, calculation, reasoning and logical judgment gradually diminishes; on this basis, there may be temporary and fragmentary delusional concepts, such as stolen and jealousy delusions; personality changes appear earlier, becoming lazy, unkempt, selfish and suspicious, and even loss of moral concepts, stealing, aggressive behavior, and so on. In the late stage, patients have poor thinking, slow reaction, fragmented or aphasic speech, emotional indifference, childishness, and in severe cases, urinary incontinence, and complete inability to take care of their own lives.
Other symptoms
Movement disorder or even a state of wooden stiffness.
Diagnostic basis
1. Clinical manifestations
(1) Intellectual deficits, with evidence of short-range memory deficits and frequent forgetfulness of recent events.
(2) At least one of the following symptoms is present: (1) Significantly reduced ability to make abstract generalizations, such as difficulty in interpreting idioms and proverbs, reduced vocabulary, inability to comprehend words with abstract meanings, and difficulty in generalizing the common features of things of the same kind. (ii) Significantly impaired judgment, inability to make correct judgments about the differences between similar things. (iii) Other disorders of higher cortical functions, such as aphasia, dysarthria, dyscognition, difficulty in calculation and composition.
2. Auxiliary examination
(1) Dementia scale: to determine the degree of dementia.
(2) Cerebral blood flow examination: cerebral blood flow measurement can be significantly reduced.
(3) Electroencephalography: In dementia, there is brain dysfunction, organic damage to the central nervous system, neuronal degeneration, necrosis and loss, and therefore abnormal changes in the bioelectric activity of brain cells. (4) CT: It shows atrophic changes of the brain, including diffuse atrophy of the cerebral cortex, flattening and thinning of the cerebral gyrus, widening of the sulcus, enlargement of the cerebral pools and ventricles, and it is directly proportional to the severity of dementia.
(5) Magnetic resonance imaging: similar to CT, it shows brain atrophy and enlarged ventricles, and is one of the most meaningful imaging manifestations.
(6) Biochemical tests and a variety of independent tests can detect causative factors.
(7) Molecular imaging: PET-CT can detect Aß and T-AU proteins, glucose uptake is reduced in the relevant areas, etc.
(8) Genetic examination: relevant causative genes such as PSEN1, PSEN2 or APP may be found.
The DSM-V categorizes neurocognitive disorders as severe and mild, and its criteria for neurocognitive impairment do not require memory to be one of the domains that must be impaired, but rather extends to six domains: complex attention, executive functioning, learning memory, language functioning, perceptual use, and social cognition. In addition to history and observation, this needs to be confirmed by quantitative clinical assessment.
Treatment
Treatment Approach
A combination of etiologic, symptomatic, biological, psychological, and rehabilitative treatments are mostly used.
Drug therapy
Treatment can be actively directed at the cause of the disease. Symptomatic treatment can be based on the use of haloperidol and phenazopyridine in case of excitability and agitation; haloperidol can be used in case of greater excitability; phenazopyridine can be used in case of delusion and hallucination; oral doxepin or amitriptyline can be used in case of depression and anxiety. Benzodiazepines are also often used, which are helpful for agitation and insomnia.
Other treatments
Etiologic treatment, biological treatment, psychotherapy, rehabilitation.
Prognosis
Early diagnosis and treatment can improve the prognosis.
Nursing care
Daily care
1. Open windows for patients in the morning to ventilate the room and keep the air fresh. In the evening, create sleeping conditions for the patient, close the curtains and keep the surrounding environment quiet.
2. Keep the floor dry, non-slip and free of obstacles.
3. The patient should always be in the line of sight of family members to ensure patient safety.
4. Follow the doctor’s instructions for medication to ensure that the patient will take all the medication at the same time, and keep records in a timely manner.
Diet regulation
Give low-salt diet, quit smoking and alcohol.