Dementias

exp date isn't null, but text field is

Clinical Features

SIGNS AND SYMPTOMS

  • Deterioration of activities of daily living e.g., hygiene, social interaction
  • Forgetfulness including wondering and getting lost
  • Language deficits e.g., word finding difficulties
  • Disturbances of orientation
  • Personality changes such as irritability, and suspiciousness (sometimes persecutory delusion)

INVESTIGATIONS

  • Formal memory tests should be used; e.g., MMSE and MOCA
  • HIV, syphilis, FBC, LFTS, U & Es, urinalysis
  • If impairment is due to HIV, use International HIV Dementia Scale (IHDS). Any impairment symbolizes possibility of dementia.

Treatment 

Do physical examination to look for possible causes such HIV, high BP, alcohol dependence, vitamin deficiencies etc. Assess for depression which can mimic dementia

  • The aim of treatment is supportive
  • Correct any sensory impairment such as visual or hearing deficits
  • Treat any physical comorbidities e.g., vascular, and optimize patient's physical health - good diet, exercise, hygiene
  • Treat any physical illness promptly
  • Encourage patient to use remaining abilities as much as possible
  • Use reminders and prompts to help memory
  • Manage pertinent risks such as unintentional fire setting, getting lost, suicide and falls
  • Discuss end of life planning e.g., wills and power of attorney
  • If depressed, refer to depression section for treatment details
  • Antipsychotics should be avoided as they are associated with a high risk of mortality
  • Antipsychotics should be avoided if presentation with features of parkinsonism or prominent visual hallucinations
  • If the psychotic symptoms are prominent, use low dose antipsychotic medications
    • 1st line: Haloperidol 1.25-2.5mg PO 24 hourly until the symptoms resolve or  
    • 2nd line: Risperidone 0.5 - 1mg PO 24 hourly until the symptoms resolve
    • If possible, avoid use of medication especially sleeping tablets {e.g., Diazepam) as they make confusion worse. Aspirin in low doses may slow down vascular dementia

REFERENCE CRITERIA

Admission

If there is sudden increase in confusion in known cases of dementia which

  • may be due to acute infection, toxic reaction to medication, acute psychosis, misuse of alcohol or drugs
  • {rule out Delirium or Acute Psychosis)
  • If the possible cause is treatable or manageable diseases such as HIV, High blood pressure
  • Assess for normal pressure hydrocephalus if presenting with prominent gait abnormalities and incontinence
  • Always do a physical check up to rule out comorbid illnesses which can complicate the dementia
  • Assess risk for committing suicide
  • Assess for and treat moderate - severe depression in the care givers {guardians)