Dementia has been traditionally seen as a gener alised impairment of intellect and memory. Differential diagnosis of dementia differential diagnosis. It is commonly defined as acquired diffuse intellectual impairment with no disturbance of consciousness. Differential diagnosis of dementia factsheet diagnosing dementia is a two stage process. Diagnosis may be complicated by other forms of dementia that have symptoms and pathologies similar to alzheimers disease. It should be kept in mind that many people with downs syndrome have abnormal scans.
In addition, an estimated 3050% of ad patients have comorbid depression. Assessment of dementia differential diagnosis of symptoms. Jul 27, 2016 dementia with lewy bodies dlb is one of the most common types of degenerative dementia, affecting an estimated 1. Rf coen, d omahony, i bruce, ba lawlor, jb walsh, d coakley. Differential diagnosis of dementia syndromes clinics in geriatric. Dementia to meet the diagnostic criteria for dementia the patient must not only have significant memory problems, they must also have impairment in at least one of four cognitive domains. A diagnosis of alzheimers disease or another type of dementia is never by itselfanother type of dementia is never by itself a sufficient reason to revoke ones driving privilege discussions should take place early in the diseaseearly in the disease involve the patient and caregiver safety. Evaluation of dementia differential diagnosis of symptoms bmj. Age of onset can help in the differential diagnosis of dementia.
To reduce all the clinical data, collected from an unselected group of subjects, to a small set of factors and to see how these factors correspond to standard clinical diagnosis of dementing disorders. Mar 26, 2018 vascular dementia is the second most common form of dementia after alzheimer disease ad. Dementia differential diagnosis and treatment final. Timely diagnosis is when the patient wants it or when the carers need it. Accurate prediction of histologically confirmed alzheimers disease and the differential diagnosis of dementia. Senile depression is often accompanied by cog nitive dysfunction. The diagnosis and differential diagnosis of dementia and pseudodementia in the elderly. The accurate diagnosis of dementia is a challenge for both gps and specialists. Differential diagnosis of alzheimers dementia and vascular dementia. Delirium occurs suddenly over a matter of hours or days and the symptoms tend to fluctuate throughout the day. Get a printable copy pdf file of the complete article 927k. Clinical presentation and differential diagnosis of.
Differential diagnosis between dementia and psychiatric. Depression is an important consideration in the differential diagnosis of alzheimer disease ad. Differential diagnosis of alzheimers disease neurology. As for causes of dementia other than ad, important points for differential diagnosis, particularly with regard to ad, are also mentioned. The alzheimers association and the national institute on aging nia jointly issued four criteria and guidelines to diagnose alzheimers disease, including recommendations for clinical office settings. Assessment of dementia differentials bmj best practice. This collection features the best content from afp, as identified by the afp editors, on dementia and related issues, including alzheimers, binswangers type dementia, and dementia with lewy. Differential diagnosis the 3ds semphn dementia pathways tool. Request pdf differential diagnosis of dementia syndromes dementia includes a spectrum of clinical features centered on cognitive and behavioral disturbances. Accurate prediction of histologically confirmed alzheimer. Subtyping dementia is important in guiding prescribing decisions. Diagnosis and management in general practice 3 2014 70whi0qual the time between symptom development and diagnosis is characterized by uncertainty for people with dementia and their families. A summary of fdgpet and amyloid pet findings for each neurodegenerative dementia is shown in table 2. Feb 15, 2001 the early diagnosis of dementia requires careful questioning to elicit clues to the presence of functional and cognitive impairment.
Distinguishing the differential diagnosis find, read and cite all. Heston exhibits cognitive or behavioral symptoms that interfere with the ability to function at usual activities, a decline in previous functioning levels not explained by delirium or a major psychiatric disorder, impaired ability to. Iv,2 cid103, other psychiatric disorders must be ruled out as the primary cause of cognitive or functional. Vascular dementia is the second most common form of dementia after alzheimer disease ad. This collection features the best content from afp, as identified by the afp editors, on dementia and related issues, including alzheimers, binswangers type. Get a printable copy pdf file of the complete article 927k, or click on a page image below to browse page by page. Pet approaches for diagnosis of dementia american journal. Some tumors and infections in the brain vitamin b12 deficiency.
At first presentation, the three ds should be considered when taking into account differential diagnosis in a patient with cognitive impairment. Delirium is an acute disturbance of brain function which is nearly always associated with physical illness. Clinical approach to the differential diagnosis between. Differential diagnosis between dementia and other neuropsychiatric disorders should always include assessments for depression, delirium, and use of psychoactive substances, as well as investigate the use of benzodiazepines, antiepileptics and pattern of alcohol consumption. Personcentered thinking is a philosophy behind service provision that supports positive control and selfdirection of peoples own lives. Definitions and diagnostic criteria diagnostic criteria for bvftd were last revised in 2011 1 and are included in dsm5 major frontotemporal neurocognitive disorder. Some abilities remain stable vocabulary fund of information verbal intelligence chronological age 10. The term pseudodementia refers to the appearence of cognitive dysfunction dementia due to depression. Because large gaps still exist in current knowledge on the diagnosis of dementia, the panel has made specific recommendations for further research that will result in improving the differential diagnosis of dementing diseases. However, differential diagnosis between dementia with lewy bodies, alzheimers disease, and parkinsons disease with dementia can still be very dif. A case study, archives of clinical neuropsychology, volume 11, issue 5, 1 january 1996, pages 41 we use cookies to enhance your experience on our website. We outline an approach to the general diagnostic workup in this chapter, with detailed recommendations for specific situations e. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail.
By continuing to use our website, you are agreeing to our use of cookies. The use of pet enables the early detection of pathophysiologic changes in patients with dementia and allows differential diagnosis among neurodegenerative dementias. Role of neuropsychological assessment in the differential. The first stage is to establish a diagnosis of dementia whilst the second is to elucidate the cause of the dementia. Differential diagnosis of dementia syndromes request pdf. It may be difficult to differentiate dementia from delirium. The current study identifies specific neuropsychological patterns of. Dementia is the loss of cognitive functioningthinking, remembering, and reasoningand behavioral abilities to such an extent that it interferes with a persons daily life and activities. Assessment in the diagnosis of dementia onset before age 65 mild or atypical pattern of cognitive problems discrepancy between clinical findings and history combined mood and cognitive problems helpful in establishing a baseline for future comparison always required for researchlevel diagnosis. Diagnosis and differential diagnosis of dementia dementia. Dementia differential diagnosis and treatment final handout. Links to pubmed are also available for selected references. Visioalgorithm guiding the differential dx of dementia.
Dementia plus any combination of symptoms on this chart is adequate reason to suspect lewy body dementia and pursue a differential diagnosis. Differential diagnosis 1 alzheimers disease ad rationale. Though depressive illness may result in cognitive impairment and may occasionally mimic true dementia, that impairment more commonly occurs in the early stages of a dementing illness. Each disease has characteristic regional metabolic reduction patterns on fdgpet. After defining dementia, in the following chapter we discuss the diagnosis and differential diagnosis. Differential diagnosis between dementia and psychiatric disorders. In addition, several features distinguish dementia from depression, but the two can coexist and the distinction may be uncertain. Department of neurology, university of virginia health system, p. Alzheimers disease is also the most common form of dementia. Differential diagnosis depression, delirium and dementia.
Depression, dementia and delirium have some features in common. Several autopsy series from the united states indicate that most cases of dementia are caused by alzheimers disease, with vascular disease next. Thank you for your interest in spreading the word about the bmj. Pdf on may 20, 2019, lilian e massihi and others published dementia facts. Knowing the key features and pathology of each type of dementia can help in the accurate diagnosis of patients, so they will receive the treatment and support services appropriate for their condition and maintain the highest possible quality of life. Dds is working to implement this through training sessions and other agency wide initiatives. Symptomarea of deficit dementia with lewy bodies dlb parkinsons disease dementia pdd dementia 1. Here, dr shaik and dr varma describe the clinical and imaging characteristics of each of these types of dementia. It is particularly useful for establishing the presence of vascular lesions, which aid in the differential diagnosis process. Full text full text is available as a scanned copy of the original print version. Jan 09, 2020 dementia differential diagnosis checklist.
Even in the hands of experienced dementia experts, clinical diagnosis of ad reaches only the unsettling sensitivity of 70. Most subtyping can be arrived at by taking a careful history. Decline in cognition is extensive, often affecting multiple domains of intellectual functioning. These functions include memory, language skills, visual perception, problem solving, selfmanagement, and the ability to focus and pay attention. When assessing someone who has memory problems it is important for the clinician to remember that not all people with memory problems have. Some tumors and infections in the brain vitamin b12. The differential diagnosis must, firstly, identify potentially treatable causes of cognitive impairment, addressing the different etiologies of reversible dementia such as metabolic alterations. The clinical manifestations of depression overlap with those of ad.
Get a printable copy pdf file of the complete article 644k, or click on a page image below to browse page by page. The diagnosis and differential diagnosis of dementia and. It is hoped that these various methods may facilitate earlier diagnosis of dementia and its subtypes, and provide differential diagnosis of. Heston exhibits cognitive or behavioral symptoms that interfere with the ability to function at usual activities, a decline in previous functioning levels not explained by delirium or a major psychiatric disorder, impaired ability to acquire and remember new. Like dementia, there is disturbance of memory, language. Depression occurring in an elderly patient calls for evaluation. Dementia is a syndrome characterised by an appreciable deterioration in cognition resulting in behavioural problems and impairment in the activities of daily living. Article abstractaccurate diagnosis of dementia is essential to provide appropriate treatment as well as patient and family counseling. The majority of cases of dementia have degenerative and vascular causes. Of the 340 patients treated between 1999 and 2009, 19. Brain imaging in differential diagnosis of dementia. The process of the differential diagnosis of dementia varies with geographic location, as it is affected by the prior probability or prevalence of any condition at a particular site.
An accurate diagnosis is critical for the proper management and treatment of these disorders. Depression and delirium, particularly hypoactive delirium, may present with apathy, withdrawal and tearfulness. A case study analysis christopher koeppl, md ministry medical group wisconsin alzheimers institute. Studies using computed tomography ct scanning show cerebral atrophy in people with downs syndrome and dementia. Dementia with lewy bodies is one of the most prevalent dementia diagnoses. Early diagnosis of dementia american family physician. The prevalence of dementia is approximately 1% at the age of 60 years, and doubles every 5 years, to reach 30% to 50% by the age of 85 years. Keywords cognition, dementia, differential diagnosis, neuropsychological tests clinical overlap in the presentation of dementia of the alzheimers type, vascular dementia, frontotemporal dementia, and major depressive disorder, poses signi. In a study, huntingtons disease hd was the most prevalent cause of dementia in people aged 45 to 65 years, with 18 cases per 100,000, followed by ad and ftd which both had a prevalence of 15 cases per 100,000. Pdf neurocognitive differential diagnosis of dementing. It is important to distinguish dementia from other conditionsa few temporary andor treatablethat may cause loss of cognitive functioning. A prospective evaluation of the dat inventory, age and ageing we use cookies to enhance your experience on our website. Dementia with lewy bodies dlb is one of the most common types of degenerative dementia, affecting an estimated 1. Brain imaging in differential diagnosis of dementia imaging biomarkers hold the promise of earlier diagnosis that may lead to more effective treatment.
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