Neurology Search
Neurology Neurology
alzheimer's%20disease%20-and-%20dementia
ALZHEIMER'S DISEASE AND DEMENTIA
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.

Alzheimer's%20disease%20-and-%20dementia Diagnosis

Diagnosis

  • In order for a diagnosis of dementia to be made, cognitive impairment should be severe enough to represent a significant decline from previous level of occupational and social functioning

Diagnostic Guidelines

  • Diagnosis of subtype of dementia is done by using international standard criteria
  • Clinical assessment is the basis of diagnosis
    • Neuropsychological testing is used when dementia is not clinically obvious

Alzheimer’s Disease

  • Diagnosis of Alzheimer’s disease should be made when typical degenerative syndrome is present
    • Definitive diagnosis is only confirmed on microscopic exam of the brain (usually at autopsy)
    • MRI findings of hippocampal atrophy may help in the diagnosis of Alzheimer’s disease in a patient with typical clinical presentation
    • Amyloid positron emission tomography (PET) scan and cerebrospinal fluid amyloid and tau levels may help in the diagnosis of Alzheimer's disease

Vascular Dementia

  • Diagnosed by history, focal neurological signs and symptoms and/or imaging studies

Dementia with Lewy Bodies

  • Histopathologically, Lewy inclusion bodies are present in the cerebral cortex
  • May be diagnosed based on history, physical, neurological examination and functional neuroimaging studies usually MRI

Assessment

Clinical Assessment

Should include, but is not limited to, the following:

  • Careful evaluation of medical, psychiatric, neurological, medication and social history
  • Detailed review of cognitive and behavioral symptoms from patient and caregiver

Physical Examination

  • Exclude treatable causes which may be contributing to dementia

Laboratory Tests

Diagnostic Tests

  • Complete blood count (CBC), serum electrolytes, liver function test, renal function tests, glucose, thyroid function, vitamin B12 and folate levels, and syphilis serology (if syphilis is suspected)
  • Neuroimaging (MRI, CT scan)
  • Neuropsychological testing

Cognitive and Mental State Examination

  • Montreal Cognitive Asssessment, 7-Minute Screen, Memory Impairment Screen, Mini-Mental State Exam, or Abbreviated Mental Test
  • Score interpretations should also consider other factors that may affect the performance (eg educational level, social class, cultural background, literacy, language or other communication difficulties)
Editor's Recommendations
Most Read Articles
Product Highlight - ADACEL
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Spotlight on multidrug-resistant gram-negative infections: New developments for an old problem
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Standing good for heart health
Jairia Dela Cruz, Yesterday
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.
Early life exposure helps ward off later allergies to cow’s milk formula
6 days ago
Daily intake of cow’s milk formula in early life helps prevent the development of cow’s milk allergy later on without competing with breastfeeding, a recent study has found.