Dementia is a clinical syndrome characterized by impairment of multiple higher cortical functions that include memory, orientation, thinking, comprehension, calculation, capacity for learning, language, judgment,  executive function and visuo-spatial function. It is usually accompanied or preceded by deterioration in emotional control, social behavior or motivation.
Alzheimer's disease is the most common cause of dementia. Sporadic cases usually present after >60 year while familial types are rare and present in <60 year of age (early-onset dementia).
Short-term memory loss is the most common early symptom. Other spheres of cognitive impairment manifest after several years.

Differential Diagnosis

  • Amnestic disorder
  • Age-related memory impairment
  • Delirium
  • Major depressive disorder
  • Schizophrenia
  • Mild cognitive impairment
    • Condition demonstrating focal or multifocal cognitive impairment not normal for age with minimal instrumental activities of daily living (IADLs) impairment which does not cross the diagnosis of dementia
    • Can be the primary manifestation of Alzheimer’s disease (AD) and secondary in other forms of dementia, neurologic disease processes, psychiatric disorder or systemic disease
    • Amnestic MCI (aMCI) is syndrome where memory dysfunction predominates
    • Nonamnestic MCI presents as more prominent impairment in other cognitive features (eg executive, language,visuo-spatial)
    • Patients assessed with MCI has greater risk of progressing to dementia
    • Encourage these patients to return for re-evaluation in 6-12 months
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Christina Lau, 21 Nov 2018

Pharmacological management of vascular cognitive impairment (VCI) is a balancing act when it comes to the use of antihypertensives, statins and oral anticoagulants (OACs), according to Professor Majon Muller of the Department of Internal Medicine, Amsterdam University Medical Center, the Netherlands, who spoke at VasCog 2018 held in Hong Kong.