Dementia is a progressive disease that starts with memory loss affecting a person's recent memory. Patients with dementia will often be able to remember things that happened years ago, but cannot recall recent events. Alzheimer's disease is the most common form of dementia. As the disease progresses, it will affect other cognitive abilities until the patient is no longer able to function.
Identification
The "Merck Manual "describes dementia as a slow progressive disease that affects a patient's memory, thinking, judgment and ability to function. Family members and friends may start to notice changes in the patient's personality, the ability to follow through on activities, difficulty following directions and the inability to remember what he or she was doing. In some instances, the patient will appear confused, become disruptive and have inappropriate behaviors.
Considerations
Most cases of dementia are not reversible because they occur from a primary brain disorder that has no other cause. In some cases, dementia can be caused from an infection, head injury or a brain tumor; if the underlying cause can be treated, the dementia can often be reversed.
Cognitive Testing
The diagnosis of dementia is made based on the family's history of the patient's symptoms, memory testing of the patient and other diagnostic tests, such as computerized tomography (CT) scans and laboratory studies. The memory testing can consist of various types of tests. Common tests used include the Mini Mental State Examination, Clock Drawing Test and the Mini-Cog test. The Mini Mental State Examination tests five cognitive domains: orientation, registration, calculation and attention, recall and language. The clock drawing test will require that the patient put the numbers on the face of a clock. They are then asked to put the hands of the clock on a specific time. With this test, as the dementia worsens, the clock drawing performance decreases. The Mini-Cog test is a combination of three recall items and the clock drawing test. There are other tests that can be used in helping to diagnose dementia, but regardless of what test is used, the underlying objective for all of them is to assess the patient's memory.
Other Studies
Physicians will need to rule out any other disease process that could present with memory loss for the patient. A CT scan is performed to make sure there is not a head injury and also as a baseline for future comparison. Laboratory studies will be done to rule out any type of infections or electrolyte imbalances that could cause similar symptoms.
Prognosis
Patients with dementia are at risk for injury due to their memory loss, and as the disease progresses, they will no longer be able to care for themselves. Patients will eventually require around-the-clock care and cannot be left unattended.
References
- "Current Diagnosis & Treatment Emergency Medicine"; McGraw Hill; 2010
- Merck Manual: Dementia
- "Journal of the American Academy of Nurse Practitioners"; An Evaluation of Dementia Screening in the Primary Care Setting; Harvan & Cotter; 2006
