DEMENTIA

  Dementia, A Growing Concern.

 

As we advance in the knowledge of controlling and curing diseases and medical conditions more people achieve longer lives. Thus prevalence of diseases and conditions "related" to aging rises dramatically. One of this rising problems is Dementia.

Dementia is a syndrome (a disease or condition that has many etiologies) that courses with progressive and "disabling" cognitive impairment. The keyword that describes best this condition is disabling, because it is usual that the elderly will lose some of their cognitive abilities but never to the point of not being able to conduct their social and occupational activities and care for themselves. Once a person reaches the stage that their normal daily activities are impaired, then he or she becomes a burden to his or her family, and also a social and economic burden.

Diagnostic criteria for dementia (DSM-IV):

Short- and long-term memory impairment

Impairment in abstract thinking, judgment, other higher cortical function or personality change

Cognitive disturbance interferes with significantly with work, social activities or relationships with others

These cognitive changes do not occur exclusively in the setting of delirium

 

By using this criteria we can classify people in three groups:

Cognitively normal

Demented

Mild cognitive impairment

Mild cognitive impairment is best explained as any cognitive impairment of a single domain (usually memory impairment below 1.5 standard deviations) that does not affect their daily social and occupational activities. Since dementia requires at least two domains (memory and a second domain) of cognitive impairment, these people cannot be classified as demented.

Alzheimer's disease:

It is a form of late onset dementia and one of the most common causes of dementia. Diagnostic criteria for Alzheimer's disease (NINCDS/ADRDA):

A. Alzheimer's disease is characterized by progressive decline and ultimately loss of multiple cognitive functions, including both:

Memory impairment--impaired ability to learn new information or to recall previously learned information.

 

And at least one of the following:

Loss of word comprehension ability, for example, inability to respond to "Your daughter is on the phone." (aphasia);

Loss of ability to perform complex tasks involving muscle coordination, for example, bathing or dressing (apraxia);

Loss of ability to recognize and use familiar objects, for example, clothing (agnosia);

Loss of ability to plan, organize, and execute normal activities, for example, going shopping.

B. The problems in "A" represent a substantial decline from previous abilities and cause significant problems in everyday functioning.

C. The problems in "A" begin slowly and gradually become more severe.

D. The problems in "A" are not due to:

Other conditions that cause progressive cognitive decline, among them: stroke, Parkinson's disease, Huntington's chorea, brain tumor, etc.

Other conditions that cause dementia, among them: hypothyroidism, HIV infection, syphilis, and deficiencies in niacin, vitamin B12, and folic acid.

E. The problems in "A" are not caused by episodes of delirium.

F. The problems in "A" are not caused by another mental illness: depression, schizophrenia, etc.

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