Clinical Description of Dementia

A clinical description of dementia has to do with the examination and treatment of patients with dementia. In order to understand how to examine and treat people who have dementia, you must have a basic understanding of the group of symptoms that causes a progressive loss of memory and other intellectual operations.

Definition

• The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines dementia as the decline in many intellectual functions of a patient. The difficulties that a patient with dementia may have include problems with language, planning and judgment, simple calculations, muscular movement as well as memory loss. Dementia is not caused by aging; this syndrome has a multitude of causes. It is caused by brain diseases, infections, injuries tumors, consequences of mental illness and other disorders. As you age, your risk for developing dementia increases. Patients may develop dementia for over 40 different reasons. Some of the causes are reversible. Reversible dementia may be seen with depression, decreased levels of thyroid hormone or vitamin B deficiencies.

Types & Causes

• Primary dementias are characterized by damage that causes brain tissue to waste away. These include Alzheimer's disease, frontotemporal lobe dementia and Pick's disease. Multi-infarct dementia is also called vascular dementia. This dementia is caused by blood clots or bleeds in the small blood vessels of the brain. The clots or bleeding cuts off the blood supply to the brain. The brain cells get damaged and may die. Lewy body dementia is caused by the development of Lewy bodies in the brain, which interrupt the transmission of nerve impulses in the brain. Alcoholism or exposure to heavy metals may cause brain damage, leading to dementia. Infectious diseases like HIV and other viruses may destroy brain cells, resulting in dementia. Abnormalities in the structure of the brain, such as hydrocephalus, tumors or subdural hematomas can cause dementia to develop.

Symptoms

• The fourth edition of the DSM talks about certain symptoms that a patient must have to be diagnosed with dementia. One symptom is a moderate decline in a patient's memory. This applies to learning new information and recalling information previously learned. Also the patient must have at least one other mental impairment. It could be problems with expressing or understanding language, an inability to perform movements well known to him like tying his shoes, inability to recognize familiar objects, problems understanding abstract concepts or displaying good judgment. These difficulties must be bad enough to interfere with normal daily life. There may also be personality changes. People with dementia may become paranoid, have delusions, mood swings, anxiety or frequent bouts of anger.

Examination

• The examination to determine if a patient has dementia is long, complicated and has many parts. The first step is for the doctor to take a full history, including a discussion with the family. Next the patient takes a mental status examination (MSE), which evaluates a patient's ability to follow instructions, recall information, communicate in general, perform simple tasks, as well as getting a sense of a patient's emotional state. A neurological examination is also done. This exam includes an evaluation of a patient's reflexes and cranial nerves. Blood and urine samples are tested to rule out treatable causes of dementia.

  A patient, suspected of having dementia may be given a computed tomography (CT) scan, magnetic resonance imaging (MRI) or a positron-emission tomography (PET) scan. These tests allow the doctor to see if different portions of the brain are abnormal.

Treatment

• Multi-infarct dementia is often treated by keeping a patient's blood pressure and other health issues under control. Patients with substance abuse are encouraged to seek treatment for these addictions. Dementias related to tumors, head injuries and hydrocephalus often require surgery. A patient with depression may respond to medications and therapy, which may combat the depression and reverse the dementia.

  If it is determined that the dementia is irreversible, then a number of medications can be tried. There is no cure for these dementias, so the best a patient gets is a slowing in the progression of the disease. At present, the most commonly taken medication for Alzheimer's disease is an anticholinesterase drug. A patient may get medications to help him cope with sleep disturbances, depression, anxiety and other problem behavior symptoms that may accompany his dementia.