Dementia
Dementia is "progressive decline in two or more cognitive domains that is severe enough to interfere with the performance of everyday activities."[1]
Deficits in cognitive function contribute to impaired functional status.[2] The deficits in the domains of cognitive function are[3]:
- Agnosia - "Failure to recognize or identify objects despite intact sensory function"[3]
- Aphasia - "Deterioration of language function"[3]
- Apraxia - "Impaired ability to execute motor activities despite intact motor abilities, sensory function, and comprehension of the required task"[3]
- Disturbance in executive functioning - "The ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior"[3]
Classification
Cortical dementias
Among the many causes of cortical dementia, common causes are:
- Alzheimer's disease
- Frontotemporal lobar degeneration (Pick's Disease)
- Dementia with Lewy bodies
Subcortical dementias
Among the many causes of subcortical dementia, common causes are:
- Vitamin B12 deficiency
Diagnosis
A number of systematic reviews, including ones by the U.S. Preventive Services Task Force (USPSTF)[4], Rational Clinical Examination[3], and others[5], have summarized the diagnostic accuracy of screening tests.
Mini-mental state examination
The Mini-mental state examination (MMSE) is the most studied test.[3] A systematic review concluded that the accuracy of the MMSE is:[4]:
- sensitivity 71% to 92%
- specificity 56% to 96%
A copy of the Mini-mental state examination can be found in the appendix of the original publication.[6]
Modified Mini-Mental State examination (3MS)
A meta-analysis concluded that the Modified Mini-Mental State (3MS) examination has:[5]
- sensitivity 83% to 94%
- specificity 85% to 90%
A copy of the 3MS is online.[7]
Abbreviated mental test score
A meta-analysis concluded:[5]
- sensitivity 73% to 100%
- specificity 71% to 100%
Other examinations
Many other tests have been studied [8][9][1] including the clock-drawing test.[10]
Treatment
Behavior management techniques (BMT)
Behavior management techniques (BMT) might help.[11] More specifically, " interventions that address behavioral issues and unmet needs" may help.[12]
Disease management team / care managers
The use of care managers may help.[12][13]
Medications
Anti-psychotics
The newer, atypical anti-psychotics (olanzapine, quetiapine, risperidone), were found to have "adverse effects offset advantages in the efficacy of atypical antipsychotic drugs for the treatment of psychosis, aggression, or agitation in patients with Alzheimer's disease."[14]
Screening
In 2003, a clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF) gave a grade I recommendation, indicating "the evidence is insufficient to recommend for or against routine screening for dementia in older adults".[15]
References
- ↑ 1.0 1.1 Karlawish, J. & Clark, C. (2003). "Diagnostic evaluation of elderly patients with mild memory problems". Ann Intern Med 138 (5): 411-9. PMID 12614094.
- ↑ Royall DR, Lauterbach EC, Kaufer D, Malloy P, Coburn KL, Black KJ (2007). "The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association". The Journal of neuropsychiatry and clinical neurosciences 19 (3): 249–65. DOI:10.1176/appi.neuropsych.19.3.249. PMID 17827410. Research Blogging.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Holsinger T, Deveau J, Boustani M, Williams JW (2007). "Does this patient have dementia?". JAMA 297 (21): 2391–404. DOI:10.1001/jama.297.21.2391. PMID 17551132. Research Blogging.
- ↑ 4.0 4.1 Boustani, M.; Peterson, B.; Hanson, L.; Harris, R.; & Lohr, K. (2003). "Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force". Ann Intern Med 138 (11): 927-37. PMID 12779304.
- ↑ 5.0 5.1 5.2 Cullen B, O'Neill B, Evans JJ, Coen RF, Lawlor BA (2007). "A review of screening tests for cognitive impairment". J. Neurol. Neurosurg. Psychiatr. 78 (8): 790–9. DOI:10.1136/jnnp.2006.095414. PMID 17178826. Research Blogging.
- ↑ Folstein MF, Folstein SE, McHugh PR (1975). ""Mini-mental state". A practical method for grading the cognitive state of patients for the clinician". Journal of psychiatric research 12 (3): 189-98. DOI:10.1016/0022-3956(75)90026-6. PMID 1202204. Research Blogging.
- ↑ Hogan DB, Ebly EM (2000). "Predicting who will develop dementia in a cohort of Canadian seniors". The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 27 (1): 18–24. PMID 10676583. [e] [Appendix: The Modified Mini-Mental State (3MS)]
- ↑ Sager, M.; Hermann, B.; La Rue, A.; & Woodard, J. (2006). "Screening for dementia in community-based memory clinics". WMJ 105 (7): 25-9. PMID 17163083.
- ↑ Fleisher, A.; Sowell B.; Taylor C.; Gamst A.; Petersen R.; & Thal L. (2007). "Clinical predictors of progression to Alzheimer disease in amnestic mild cognitive impairment". Neurology 68 (19): 1588-95. PMID 17287448.
- ↑ Royall, D.; Cordes J.; & Polk M. (1998). "CLOX: an executive clock drawing task". J Neurol Neurosurg Psychiatry 64 (5): 588-94. PMID 9598672. Example form
- ↑ Teri L, Gibbons LE, McCurry SM, et al (2003). "Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial". JAMA 290 (15): 2015–22. DOI:10.1001/jama.290.15.2015. PMID 14559955. Research Blogging.
- ↑ 12.0 12.1 Ayalon L, Gum AM, Feliciano L, Areán PA (2006). "Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review". Arch. Intern. Med. 166 (20): 2182–8. DOI:10.1001/archinte.166.20.2182. PMID 17101935. Research Blogging.
- ↑ Vickrey BG, Mittman BS, Connor KI, et al (2006). "The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial". Ann. Intern. Med. 145 (10): 713–26. PMID 17116916. [e]
- ↑ Schneider LS, Tariot PN, Dagerman KS, et al (2006). "Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease". N. Engl. J. Med. 355 (15): 1525–38. DOI:10.1056/NEJMoa061240. PMID 17035647. Research Blogging.
- ↑ U.S. Preventive Services Task Force (2003). "Screening for dementia: recommendation and rationale". Ann. Intern. Med. 138 (11): 925–6. PMID 12779303. [e]