Dementia

Aka: Dementia, Alzheimer's Disease, Alzheimer Disease, Alzheimers Disease

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II. Definitions

  1. Dementia
    1. Chronic loss of previously acquired mental function, including impaired memory, judgment, attention span and problem solving
  2. Alzheimer's Disease
    1. Progressive, uniformly fatal, neurodegenerative disease of the brain with gradual development of Dementia
    2. Typical onset after age 60 and associated with severe cortical atrophy, senile Plaques, neurofibrillary tangles

III. Epidemiology

  1. Prevalence (U.S.)
    1. Age 65 to 74 years: 5%
    2. Age 75 to 84 years: 13%
    3. Age >85 years: 33%

IV. Pathophysiology: Alzheimer's Disease

  1. Gradual accumulation of amyloid Plaques and neurofibrillary tangles (hyperphosphorylated Tau Proteins)
  2. Neurofibrillary Tangles lead to Neuron degeneration, cerebral atrophy, Memory Loss, overall functional decline

V. Causes

  1. See Dementia Causes

VI. Risks Factors: Alzheimer's Disease

  1. Age >65 years old (greatest risk factor)
  2. Apo E4 Allele
    1. Confers 8% risk if two Alleles
  3. Family History of Alzheimer's Disease
  4. FAD gene
  5. Female gender
  6. Low education
  7. Head Trauma
  8. Cardiovascular disease (e.g. prior Myocardial Infarction)
  9. Cerebrovascular Disease (e.g. prior Cerebrovascular Accident)
  10. Diabetes Mellitus
  11. Combined CV factors in middle age (Odds Ratio 3.5)
    1. Hyperlipidemia
    2. Hypertension (increased systolic Blood Pressure)
    3. Kivipelto (2001) BMJ 322:1447-51 [PubMed]

VII. Types: Presentations

  1. Cortical (e.g. Alzheimer's Disease): 60-70% of cases
    1. Short Term Memory loss
    2. Aphasia
    3. Apraxia
  2. Subcortical (e.g. Vascular Dementia): 10-20%
    1. Mental slowing
    2. Mood disturbance
  3. Metabolic Dementia (e.g. Vitamin B12 Deficiency)
    1. Similar presentation as subcortical Dementia
  4. Lewy Body Disease (7%)
    1. Parkinsonian symptoms with Dementia
  5. Frontotemporal Dementia
    1. Socially inappropriate and compulsive behaviors
    2. Empathy loss, change in political and religious beliefs
    3. Progressive Aphasia
  6. Mixed Dementia (10-20%)
    1. Combined Cortical and subcortical
    2. Usually Alzheimer's with Multi-infarct Dementia

VIII. Types: Dementia Syndromes

  1. Alzheimer's Disease (60-70%)
  2. Dementia with Lewy Bodies (15-25%)
  3. Frontotemporal Dementia (5-15% overall, but 60% in those 45-60 years old)
  4. Vascular Dementia (5-20%)
  5. Creutzfeldt-Jakaob Disease (<1%)

IX. Criteria

  1. Insidious, gradual onset (months) of deterioration
    1. Mild to severe fluctuations
    2. All higher cortical functions
  2. Long duration of symptoms
  3. Normal Level of Consciousness, but altered content
    1. Impaired memory and
    2. One higher cortical function (e.g. Judgement)
  4. Vital Signs typically normal

X. Presentations: Early

  1. New information is difficult to learn and retain
  2. Complex tasks are difficult to perform
  3. Unable to solve simple problems
  4. Getting lost in familiar surroundings
  5. Difficulty expressing oneself
  6. Irritable or aggressive behavior

XI. History

  1. Family members should accompany patient to appointment, sitting side-by side with patient
  2. First ask questions of patient "why are you here?"
    1. Do not spend much time on this aspect
    2. Establish relationship with patient and establish reliability as historian
  3. Ask family (and patient if mild Dementia)
    1. Baseline functional status (education level, work responsibilities)?
    2. When was the first time their thinking and memory was completely normal?
    3. Timeline of cognitive function loss since onset?
    4. Is there any time you thought they were having a stroke?
    5. Do they repeat? misplace? Forget names? Rely more on notes and calendars?
    6. Who is in charge of medications? Bill Paying? checkbook balancing (IADLs) ?
    7. Word finding difficulty?
    8. Get lost driving?
    9. Do you feel comfortable leaving them alone? Overnight? For a weekend? for a week?
    10. Can they perform Activities of Daily Living (ADLs)?
    11. Are they depressed? anxious? agitated or restless?
    12. Do they have Hallucinations?
    13. How is sleep? Do you sleep in the same bed? Nighttime Incontinence?
    14. Has there been Head Trauma?
  4. References
    1. McCarten (2009) UMN CME Internal Medicine Review, Minneapolis

XII. Findings: Signs and symptoms

  1. Normal alertness, awareness, attentiveness
  2. No Hallucinations or Delusions
  3. Disorientation
  4. Memory Impairment (short much more than long term)
    1. New forgetfulness
    2. Difficult word finding
  5. Impaired Executive, Social, or cognitive function
    1. Driving difficulties or getting lost
    2. Neglect of self care and household chores
    3. Difficult money handling
    4. Work mistakes
    5. Judgement and Language impaired
  6. Behavior changes
    1. See Behavior Problems in Dementia
  7. Personality change
    1. Inappropriately friendly or even flirtatious
    2. Affect shallow or blunted or social withdrwal
    3. Frustration to explosive spells
  8. Psychiatric symptoms
    1. Suspiciousness or paranoia
    2. Withdrawal or apathy
    3. Abnormal beliefs or Hallucinations
  9. Provocative Factors
    1. Acute illness
    2. Hospitalization
    3. Minor surgery
    4. Bereavement

XIII. Evaluation: Dementia Screening Tools

  1. See Mental Status Consolidated Screening
  2. Mini-Cognitive Assessment Instrument
    1. Patient repeats and recalls 3 unrelated words, and draws a clock face with a given time
  3. General Practitioner Assessment of Cognition (GPCOG)
    1. https://www.alz.org/documents_custom/gpcog(english).pdf
  4. Ascertain Dementia 8-Item Informant Questionnaire
    1. https://www.alz.org/documents_custom/ad8.pdf
  5. Early Detection and Screen for Dementia (NTG-EDSD)
    1. https://www.the-ntg.org/ntg-edsd
    2. Indicated in adults with Down Syndrome or other congenital intellectual disabilities

XIV. Evaluation: Dementia Diagnosis Tools

  1. See Mental Status Exam (lists all tests, history, exam)
  2. St. Louis University Mental Status (SLUMS)
    1. http://medschool.slu.edu/agingsuccessfully/pdfsurveys/slumsexam_05.pdf
  3. Addenbrooke's Cognitive Examination (ACE)
    1. Differentiates Alzheimer's from other Dementias
    2. Detect early Dementia
  4. Mini-Mental Status Exam (requires payment for use)
    1. Standard decline 3 points per 6 months
    2. Error is +/- 3 points
  5. Montreal Cognitive Assessment
    1. http://dementia.ie/images/uploads/site-images/MoCA-Test-English_7_1.pdf
  6. Psychometric Testing
    1. Test of higher cognitive functioning
      1. Logical, abstract, conceptual and verbal reasoning
      2. Identifies more subtle changes in cognition
    2. Indications
      1. Early Dementia
      2. Depression
      3. Alcohol Abuse versus Alzheimer's Disease
      4. Unusual Dementias
      5. Non-english speaker or patient with less education

XV. Evaluation: Depression Screening Tools

  1. Patient Health Questionaire 9 (PHQ-9)
  2. Zung Depression Rating Scale
  3. Cornell Scale for Depression in Dementia
  4. Geriatric Depression Scale (GDS, also in short version)

XVI. Diagnosis

  1. See Dementia Diagnosis

XVII. Associated Conditions

  1. Gait Apraxia
  2. Disinhibited behavior
  3. Slurred speech if Vascular
  4. Anxiety, mood, and sleep disturbance
  5. Delusions and Visual Hallucinations
  6. Speech rambling, irrelevant, and incoherent
  7. Personality change

XVIII. Labs: Secondary Cause Evaluation

  1. Goals: Rule out reversible cause (Delirium Causes)
  2. Guidelines vary based on organization
    1. American Academy of Neurology (AAN)
    2. Canadian Consensus Conference on Dementia (CCCD)
  3. Standard Evaluation
    1. Thyroid Stimulating Hormone (AAN, CCCD)
    2. Serum Vitamin B12 Level (AAN)
    3. Complete Blood Count (CCCD)
    4. Comprehensive Metabolic Panel
      1. Serum Electrolytes
      2. Serum Calcium
      3. Serum Glucose
      4. Liver Function Tests
      5. Renal Function Tests
  4. Evaluation only as indicated
    1. Syphilis Serology (VDRL or RPR)
    2. Urinalysis
    3. Serum Magnesium
    4. Arterial Blood Gas (ABG) or Venous Blood Gas (VBG)
    5. Medication Levels
    6. Chest XRay
    7. Electrocardiogram (EKG)
    8. Electroencephalogram (EEG)
      1. Seizure Disorder
      2. Creutzfeldt-Jakob Disease (or other Prion Disease)
    9. Lyme Titer
    10. Lumbar Puncture for rapidly progressive Dementia
      1. Systemic signs and symptoms
      2. Atypical presentation
      3. Cancer
      4. Hydrocephalus
      5. Infectious disease
        1. Neurosyphilis
        2. HIV Infection
        3. Cerebral Lyme Disease
        4. Creutzfeldt-Jakob Disease (or Prion Disease)
          1. Positive CSF for 14-3-3 Protein
    11. Heavy Metal screening
    12. Ceruplasmin for Wilson' Disease
    13. Arylsulfatase for metachromatic leukodystrophy
    14. Serum Protein Electrophoresis for Multiple Myeloma
    15. Human Immunodeficiency Virus (HIV)
    16. Connective Tissue Disease
      1. Erythrocyte Sedimentation Rate (ESR)
      2. C-Reactive Protein (C-RP)
      3. Antinuclear Antibody (ANA)
      4. C3 Complement
      5. C4 Complement
      6. Anti-DS DNA
    17. Urine Toxicologic screen
    18. Urine porphobilinogens

XIX. Labs: Alzheimer Disease Specific Testing

  1. Apolipoprotein E (not recommended)
  2. PrecivityAD
    1. Marketed for age 60 years old and older with Cognitive Impairment
    2. Combines 2 tests
      1. Apolipoprotein E (apoE) Genotype
      2. Amyloid-Beta (Abeta) Peptides: Abeta 42 to Abeta 20 ratio
    3. Generates a proprietary Amyloid Probability Score
      1. Low Likelihood <36
      2. Intermediate Likelihood 36 to 57 (consider Amyloid PET)
      3. High Likelihood >57
    4. References
      1. Anderson (2022) Am Fam Physician 105(1): 79-81 [PubMed]
  3. Lumipulse G
    1. Marketed for age 55 years old and older with Cognitive Impairment
    2. Measures multiple biomarkers for Alzheimer Disease in cerebrospinal fluid (CSF)
      1. Total and Phosphorylated Tau
      2. Amyloid-Beta (Abeta) Peptides: Abeta 42 to Abeta 40 ratio
        1. Low ratio <0.072 supports Alzheimer Disease diagnosis
    3. References
      1. Lau (2023) Am Fam Physician 107(5): 550-1 [PubMed]

XX. Imaging

  1. Imaging modalities
    1. Brain MRI (preferred): Especially coronal views
      1. Hippocampal atrophy is hallmark
    2. CT Head
      1. Poor Test Sensitivity in Dementia
      2. Evaluates for Intracranial Mass, Intracranial Hemorrhage, large CVA
    3. Amyloid Positron Emission Tomography (PET) Scan
      1. Indicated if definitive diagnosis will impact management
      2. Cost is $5000 in 2022 (may be covered by Medicare)
      3. Good efficacy in comparison with autopsy confirmed Alzheimer Disease
        1. Test Sensitivity: 91%
        2. Test Specificity: 92%
  2. Imaging Indications (indicated in most cases of Dementia)
    1. Age under 60 years old
    2. Dementia with duration under 1 month
    3. Rapid progression over months
    4. Recent Head Trauma
    5. History of Cerebrovascular Accidents
    6. History of cancer
    7. History of Anticoagulant use
    8. Seizure Disorder
    9. Urinary Incontinence of new onset
    10. Headaches
    11. Focal neurologic findings
    12. Visual Field Defects
    13. Papilledema
    14. Gait Abnormality or Ataxia
  3. References
    1. Chertkow (2001) Can J Neurol Sci 28:S28-41 [PubMed]
    2. Dietch (1983) West J Med 138:835 [PubMed]

XXI. Diagnostics: Special Tests (Research use only currently)

  1. Cerebrospinal Fluid for Alzheimer's specific Proteins
    1. High tau
    2. Low Beta-Amyloid
  2. Functional imaging
    1. SPECT scan
    2. Positron Emission Tomography (PET Scan)
    3. Functional Head MRI

XXII. Differential Diagnosis

  1. See Dementia Differential Diagnosis
  2. See Altered Level of Consciousness
  3. Delirium
    1. Especially if recent hospitalization or illness
  4. Psychosis
  5. Major Depression
  6. Medications are a very common cause
    1. See Drug Induced Altered Level of Consciousness Causes
    2. See Polypharmacy
    3. See Medication Use in the Elderly (Beers List, STOPP)
    4. Anticholinergic Medications (e.g. Elavil, Benadryl)
    5. Drug Toxicity (e.g. Digoxin, Phenytoin)

XXIII. Course

  1. Cases due to reversible cause: 10-20%
  2. High index of suspicion for reversibility in elderly

XXIV. Management

  1. See Dementia Management

XXV. Management: Neurology Consultation Indications

  1. Rapidly progressive Dementia (weeks to months)
  2. Dementia in a young patient
  3. Severe behavior psychiatric abnormalities
  4. Red Flags for uncommon Dementia
    1. Significant personality change
    2. Extrapyramidal signs
    3. Rapid progression
    4. Gaze Palsy
    5. Urinary Incontinence
    6. Gait Abnormality

XXVI. Management: Evaluate the Caregivers - Family journey phases

  1. Prediagnostic: Is there a real issue?
  2. Diagnosis: Tramua of the diagnosis
  3. Role changes: Taking away rights
  4. Chronic caregiving: Engulfment and exhaustion
  5. Shared care: Obtaining respites
  6. Long term care: Patient is moved to long-term care
  7. End of life: Prolonging life versus a good death
  8. Reference
    1. Caron (2000) Alzheimer's Disease - The Family Journey, North Ridge Press, Plymouth, MN

XXVII. Resources

  1. See Dementia Resources

XXVIII. References

  1. (1994) Neurology 44:2203-6 [PubMed]
  2. Adelman (2005) Am Fam Physician 71:1745-50 [PubMed]
  3. Daly (1999) J Am Board Fam Pract 12:375-85 [PubMed]
  4. Falk (2018) Am Fam Physician 97(6): 398-405 [PubMed]
  5. Santacruz (2001) Am Fam Physician 63:703-18 [PubMed]
  6. Jaqua (2024) Am Fam Physician 110(3): 281-93 [PubMed]

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Related Studies

Ontology: Alzheimer's Disease (C0002395)

Definition (MEDLINEPLUS)

Alzheimer's disease (AD) is the most common form of dementia among older people. Dementia is a brain disorder that seriously affects a person's ability to carry out daily activities.

AD begins slowly. It first involves the parts of the brain that control thought, memory and language. People with AD may have trouble remembering things that happened recently or names of people they know. A related problem, mild cognitive impairment (MCI), causes more memory problems than normal for people of the same age. Many, but not all, people with MCI will develop AD.

In AD, over time, symptoms get worse. People may not recognize family members or have trouble speaking, reading or writing. They may forget how to brush their teeth or comb their hair. Later on, they may become anxious or aggressive, or wander away from home. Eventually, they need total care. This can cause great stress for family members who must care for them.

AD usually begins after age 60. The risk goes up as you get older. Your risk is also higher if a family member has had the disease.

No treatment can stop the disease. However, some drugs may help keep symptoms from getting worse for a limited time.

NIH: National Institute on Aging
Definition (NCI) A progressive, neurodegenerative disease characterized by loss of function and death of nerve cells in several areas of the brain leading to loss of cognitive function such as memory and language.
Definition (NCI_NCI-GLOSS) A brain disorder that usually starts in late middle age or old age and gets worse over time. Symptoms include loss of memory, confusion, difficulty thinking, and changes in language, behavior, and personality.
Definition (MSH) A degenerative disease of the BRAIN characterized by the insidious onset of DEMENTIA. Impairment of MEMORY, judgment, attention span, and problem solving skills are followed by severe APRAXIAS and a global loss of cognitive abilities. The condition primarily occurs after age 60, and is marked pathologically by severe cortical atrophy and the triad of SENILE PLAQUES; NEUROFIBRILLARY TANGLES; and NEUROPIL THREADS. (From Adams et al., Principles of Neurology, 6th ed, pp1049-57)
Definition (CSP) neurodegenerative disorder of the CNS resulting in progressive loss of memory and intellectual functions; begins in the middle or later years; characterized by brain lesions such as neurofibrillary tangles and neuritic plaques.
Concepts Disease or Syndrome (T047)
MSH D000544
ICD9 331.0
ICD10 G30 , G30.9
SnomedCT 73768007, 26929004, 267688001, 154998003
LNC MTHU020798
English Alzheimer Disease, Alzheimer's Disease, Dementia, Senile, Disease, Alzheimer, Disease, Alzheimer's, ALZHEIMER'S DISEASE, Senile Dementia, DAT - Dementia Alzheimer type, DAT - Dementia Alzheimer's type, Dementia in Alzheimer's dis, Dementia in Alzheimer's disease, Alzheimer's disease, unspecified, Alzheimer's Dementia, AD, ALZHEIMER DISEASE, ALZHEIMER DIS, ALZHEIMERS DIS, Alzheimer's disease, NOS, simple senile dementia, Dementia of the Alzheimer's type NOS, Alzheimer Type Senile Dementia, Senile Dementia, Alzheimer Type, Alzheimer Type Dementia, Dementia, Alzheimer Type, Alzheimer disease, Alzheimer Disease [Disease/Finding], alzheimers disease, dats, senile dementia, Alzheimers dementia, Disease;Alzheimers, alzheimers dementia, alzheimer diseases, alzheimer's diseases, dementia alzheimers, Dementia, Primary Senile Degenerative, Alzheimers disease, Syndrome, Alzheimer, Dementia, Alzheimer (AD), Alzheimer Syndrome, Dementia, Alzheimer-Type (ATD), Alzheimer Sclerosis, Alzheimer-Type Dementia (ATD), Alzheimer Type Dementia (ATD), Alzheimer Dementia (AD), Sclerosis, Alzheimer, Alzheimer's disease (diagnosis), Alzheimer dementia, Dementia Alzheimer's type, Alzheimer's disease, AD - Alzheimer's disease, Alzheimer's disease (disorder), Alzheimer; dementia (etiology), Alzheimer; dementia (manifestation), Alzheimer; sclerosis, Alzheimer, dementia; Alzheimer (etiology), dementia; Alzheimer (manifestation), sclerosis; Alzheimer, Alzheimers Disease, Dementia of Alzheimers Type, Dementia of the Alzheimer's type, Primary Senile Degenerative Dementia
Portuguese DOENCA DE ALZHEIMER, Demência tipo Alzheimer NE, Demência de tipo Alzheimer, Demência Senil, Demência Senil Tipo Alzheimer, Demência Tipo Alzheimer, Doença de Alzheimer
Spanish ENFERMEDAD DE ALZHEIMER, Demencia de tipo Alzheimer NEOM, enfermedad de Alzheimer (trastorno), enfermedad de Alzheimer, Demencia de tipo Alzheimer, Enfermedad de Alzheimer, Demencia Senil, Demencia Senil Tipo Alzheimer, Demencia Tipo Alzheimer
Dutch dementie van Alzheimer type NAO, ziekte van Alzheimer, Alzheimer; dementie, Alzheimer; sclerose, dementie; Alzheimer, sclerose; Alzheimer, Ziekte van Alzheimer, niet gespecificeerd, dementie type Alzheimer, Dementie, Alzheimer-type, Dementie, seniele, Seniele dementie, Alzheimer-type, Ziekte van Alzheimer
French Démence de type Alzheimer SAI, MALADIE D'ALZHEIMER, Démence de type Alzheimer, Démence d'Alzheimer, Maladie d'Alzheimer, Démence dégénérative primaire de type Alzheimer, Démence sénile primitive de type Alzheimer, Démence sénile primitive dégénérative
German Demenz vom Alzheimer Typ NNB, ALZHEIMERSCHE ERKRANKUNG, Alzheimer-Krankheit, nicht naeher bezeichnet, Demenz vom Alzheimertyp, Alzheimer-Krankheit, Dementia senilis, Demenz, senile, Demenz, Alzheimer-Typ, Senile Demenz, Alzheimer-Typ, Demenz, primär degenerative senile, Primär degenerative senile Demenz
Italian Demenza tipo Alzheimer NAS, Demenza tipo Alzheimer, Demenza senile tipo Alzheimer, Demenza senile, Demenza degenerativa primaria senile, Malattia di Alzheimer
Japanese アルツハイマー型認知症ＮＯＳ, ｱﾙﾂﾊｲﾏｰｶﾞﾀﾆﾝﾁｼｮｳ, ｱﾙﾂﾊｲﾏｰｶﾞﾀﾆﾝﾁｼｮｳNOS, ｱﾙﾂﾊｲﾏｰﾋﾞｮｳ, Alzheimer型認知症, 初老期認知症-Alzheimer型, アルツハイマー型認知症, アルツハイマー型老年痴呆, 痴呆-アルツハイマー型, アルツハイマー型痴呆-初老期, 老年期認知症-Alzheimer型, Alzheimer型痴呆, 初老期アルツハイマー型痴呆, アルツハイマー病, 認知症-Alzheimer型, アルツハイマー型初老期痴呆, 老年一次性変性痴呆, アルツハイマー型痴呆, 初老期痴呆-Alzheimer型, 老年期痴呆-アルツハイマー型, 一次痴呆, 急性錯乱性老年性痴呆, 初老期痴呆-アルツハイマー型, 痴呆-一次性変性-老年, 老年期痴呆-Alzheimer型, Alzheimer型老年期痴呆, アルツハイマー型老年期痴呆, 痴呆-Alzheimer型, Alzheimer病, Alzheimer型初老期痴呆
Swedish Alzheimers sjukdom
Czech Alzheimerova nemoc, Demence Alzheimerova typu, Demence Alzheimerova typu NOS, Fischerova nemoc, Alzheimerova choroba, senilní demence Alzheimerova typu, Alzheimerova demence, senilní demence
Finnish Alzheimerin tauti
Russian DEMENTSIIA SENIL'NAIA, SENIL'NAIA DEMENTSIIA SO SPUTANNOST'IU SOZNANIIA, AL'TSGEIMERA BOLEZN', DEMENTSIIA PRESENIL'NAIA AL'TSGEIMERA, DEMENTSIIA TIPA AL'TSGEIMERA, АЛЬЦГЕЙМЕРА БОЛЕЗНЬ, ДЕМЕНЦИЯ ПРЕСЕНИЛЬНАЯ АЛЬЦГЕЙМЕРА, ДЕМЕНЦИЯ СЕНИЛЬНАЯ, ДЕМЕНЦИЯ ТИПА АЛЬЦГЕЙМЕРА, СЕНИЛЬНАЯ ДЕМЕНЦИЯ СО СПУТАННОСТЬЮ СОЗНАНИЯ
Korean 알쯔하이머병, 상세불명의 알쯔하이머병
Croatian ALZHEIMEROVA BOLEST
Polish Choroba Alzheimera
Hungarian Alzheimer típusú dementia k.m.n., Alzheimer-kór, Alzheimer-típusú dementia
Norwegian Alzheimers sykdom, Alzheimers lidelse
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Dementia (C0497327)

Definition (MEDLINEPLUS)

Dementia is the name for a group of symptoms caused by disorders that affect the brain. It is not a specific disease. People with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose their ability to solve problems or control their emotions. Their personalities may change. They may become agitated or see things that are not there.

Memory loss is a common symptom of dementia. However, memory loss by itself does not mean you have dementia. People with dementia have serious problems with two or more brain functions, such as memory and language. Although dementia is common in very elderly people, it is not part of normal aging.

Many different diseases can cause dementia, including Alzheimer's disease and stroke. Drugs are available to treat some of these diseases. While these drugs cannot cure dementia or repair brain damage, they may improve symptoms or slow down the disease.

NIH: National Institute of Neurological Disorders and Stroke
Definition (MSHCZE) Chronický, trvalý úbytek duševních funkcí a schopností. Za vznik d. zodpovídají tři skupiny onemocnění mozku. Jde o důsledky aterosklerózy s poruchami prokrvení mozku (skupina ischemicko-vaskulárních d.), důsledky jiných chorobných stavů (symptomatické d., např. v důsledku otrav, alkoholismu, d. při AIDS). Nejč. příčinou d. je Alzheimerova nemoc (s některými vzácnějšími chorobami patří do skupiny atroficko-degenerativních onemocnění mozku). D. postihuje inteligenci, kognitivní funkce, vyšší city. Z kognitivního deficitu jsou patrné zhoršení paměti, afázie, apraxie, agnozie, narušení výkonných funkcí. Mizí schopnost soustředění, otupují se zájmy, člověk se nevyzná v čase, je zmatený, bloudí i v nejbližším okolí (dezorientace). Kortikální d. je způsobena postižením kůry (klasicky u Alzheimerovy nemoci), vyznačuje se normální řečí se značně narušenou sémantikou až afázií, amnézií, poruchami zrakové a prostorové orientace. U subkortikální d. (u Parkinsonovy nebo Huntingtonovy nemoci) bývá výrazněji narušena řeč v důsledku motorických poruch, jazykové schopnosti jsou však postiženy málo. Bývá porucha motivace, snížená aktivita, zpomalení duševních pochodů. V případě d. smíšené (např. vaskulární, multiinfarktová d.) lze pozorovat různé kombinace postižení. Průběh je různý – závisí na příčině a ev. včasné léčbě a různý bývá i u jednotlivých typů. Příznaky se vyvíjejí postupně, u některých forem naučené dovednosti a staré vzpomínky dlouho přetrvávají, mizí však schopnost naučit se novému. Léčba d. je farmakologická a důležité jsou rovněž nefarmakologické postupy z oblasti psychoterapie. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI_NCI-GLOSS) A condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems. Symptoms may also include personality changes and emotional problems. There are many causes of dementia, including Alzheimer disease, brain cancer, and brain injury. Dementia usually gets worse over time.
Definition (NCI) Loss of intellectual abilities interfering with an individual's social and occupational functions. Causes include Alzheimer's disease, brain injuries, brain tumors, and vascular disorders.
Definition (MSH) An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D003704
ICD9 294.2, 290
ICD10 F03 , F03.90, F03.9
SnomedCT 192180006, 268675002, 52448006, 88339003
DSM4 294.8
LNC LA10586-8
English Dementia, Amentia, Dementia NOS, Unspecified dementia, [X]Unspecified dementia, dementia (diagnosis), dementia, Amentias, Dementia [Disease/Finding], dementia disorder, dementia disorders, dementias, Dementia, unspecified, [X] Senile dementia, depressed or paranoid type, [X]Senile psychosis NOS, [X]Senile dementia NOS, [X]Primary degenerative dementia NOS, [X] Senile dementia NOS, [X] Senile psychosis NOS, [X] Unspecified dementia, [X] Primary degenerative dementia NOS, [X]Unspecified dementia (disorder), Organic dementia, DEMENTIA, -- Dementia, Dementia (disorder), amentia, Dementia, NOS, Dementias
French DEMENCE, Démence SAI, Amentie, Démence
Portuguese DEMENCIA, Demência NE, Amência, Demência
Spanish DEMENCIA, Amencia, Demencia NEOM, [X]demencia no especificada, [X]demencia no especificada (trastorno), demencia (trastorno), demencia, Demencia
German DEMENZ, Amentia, Demenz NNB, Nicht naeher bezeichnete Demenz, Demenz
Dutch amentie, dementie NAO, Niet gespecificeerde dementie, dementie, Dementia, Dementie
Italian Demenza NAS, Amenzia, Amenza, Demenza
Japanese 認知症ＮＯＳ, アメンチア, ｱﾒﾝﾁｱ, ﾆﾝﾁｼｮｳNOS, ﾆﾝﾁｼｮｳ, 痴呆状態, 癡呆, 痴呆, 認知症
Swedish Demens
Czech demence, Amence, Demence NOS, Demence
Finnish Dementia
Russian DEMENTSIIA, DEMENTSIIA SENIL'NAIA PARANOIDNAIA, PARANOIDNAIA SENIL'NAIA DEMENTSIIA, SLABOUMIE, ДЕМЕНЦИЯ, ДЕМЕНЦИЯ СЕНИЛЬНАЯ ПАРАНОИДНАЯ, ПАРАНОИДНАЯ СЕНИЛЬНАЯ ДЕМЕНЦИЯ, СЛАБОУМИЕ
Korean 상세불명의 치매
Croatian DEMENCIJA
Polish Demencja, Otępienie, Otępienie przedstarcze, Otępienie starcze
Hungarian Dementia, Amentia, Dementia k.m.n.
Norwegian Demens
Derived from the NIH UMLS (Unified Medical Language System)

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