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Chapter 11 - Evaluation and Management of Dementia

from Section II - Geriatric Syndromes

Published online by Cambridge University Press:  30 June 2022

By
Carol K. Chan  and
Constantine G. Lyketsos
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
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Summary

Dementia is a clinical syndrome characterized by global cognitive decline, involving deficits in memory and at least one other area of cognition, and affects over 47 million persons worldwide. While Alzheimer’s dementia is the most common cause, it commonly co-occurs with other dementia-related pathologies such as cerebrovascular disease and Lewy body disease. The evaluation and differential diagnosis of dementia involves history taking with outside informants, thorough medication review, examination focused on phenomenology and associated features, and a workup for potential causes. Depression and delirium due to other medical causes may overlap with symptoms of dementia, and should be considered in a dementia evaluation. The four pillars of dementia care are: (1) disease-oriented treatment, (2) symptomatic treatments, (3) supportive care for the patient, and (4) supportive care for the caregiver. Management usually involves psychological, social, and environmental adjustments. Disease-modifying pharmacotherapy for dementia is still under development, and has largely been unsuccessful. Although symptomatic treatments such as cholinesterase inhibitors and memantine are available, they provide a modest and temporary stabilization of cognitive changes associated with the disease, and do not reverse or stop the degenerative process.

Keywords

dementianeuropsychiatric symptomsdiagnosistherapyAlzheimer’s diseasecholinesterase inhibitorsmemantineneuroimagingneuropsychological test
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 112 - 128
Publisher: Cambridge University Press
Print publication year: 2022

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