DementiaCauses
- 50% Alzheimers disease (AD)
- 20% multi-infarct dementia (MID), secondary to hypertension and atherosclerosis
- 15-20% MID and AD
- Alcohol-related dementia
- Normal pressure hydrocephalus
- Hypothyroidism
- Vitamin B12 deficiency
- Neurosyphilis
Recognition
Differentiate from
- Delerium: acute, fluctuating level of consciousness, hallucinations, intense fearfulness.
- Depression
Assessment/screening for dementia via mental test score .
Prognosis
Alzheimers disease: 6-8yrs
MID: 5yrs
If over age 80, little reduction in life expectancy.
Assessment
-
History
- Incontinence
- Dressing
- Feeding
- Financial affairs
- Current level of support
- mental test score
-
Examination
- Focal neurological signs
- Carotid bruits
- Gait
- BP
-
Investigation
- FBC (B12/folate if macrocytosis)
- TFT
- Glucose
- MSU
- Consider Calcium, gammaGTP, syphilis serology.
- CT scan: if suspicion of normal pressure hydrocephalus or chronic subdural haemorrhage. Usually not useful over age 75.
Management
- MID: control risk factors (hypertension, smoking, obesity, diabetes). Consider aspirin.
- Keep drugs to a minimum: avoid polypharmacy. Thioridazine 25mg or haloperidol 1.5mg may be useful to reduce disinhibition or wandering.
- Consider psychogeriatric day hospital.
- Identify specific problems and define strategies to improve them
- Preserve existing functioning.
- Ensure adequate overall care. Consider social services input.
- Combined protocol and shared care drug information sheets
Information for carers
- Attendance allowance
- Exemption from community charge
-
Alzheimer's disease Society
158-160 Balham High Road
London SW12 9BN
Tel: 0181 675 6557