Dementia
Is an acquired syndrome of decline in memory and at least one other cognitive domain such as language, visuo-spatial, or executive function sufficient to interfere with social or occupational functioning in an alert person.
- Commonest causes are:
- Alzheimer's disease (70%)
- Cerebrovascular ischaemia (vascular dementia) (20-30%)
- Dementia causes a high burden of suffering for patients and their families
- Age is the strongest risk factor for dementia:
- 3% - 11% >65yo have dementia, (rising to 25% - 47 % in those >85yo)
- 1st degree relatives have x2 the risk of developing dementia compared with general population
- CVS risk factors (e.g. ↑BP) risk of both Alzheimer's disease and vascular dementia
Mini-Cog test
Print version on HSE Dementia tools, local copy.
- Instruct the patient to listen carefully and repeat the following:
APPLE WATCH PENNY - Administer the Clock Drawing Test (CDT)
- Ask the patient to repeat the three words given previously
Example of short mental status exam
- Age
- Time (to 1 hour)
- Address for recall at end of test
- Year
- Name of institution
- Recognition 2 persons
- Date of birth
- Date St. Patrick's day
- Present Taoiseach
- Count backwards 20 - 1
Mental State Examination
- The Mini-Mental Status Exam (MMSE) is a well studied instrument for screening for cognitive impairment
- Its accuracy depends upon a person's age and educational level
- MMSE is copyright so please use the mini-Cog
- Early detection of dementia is important for both the patient and care givers
Potential treatment options
Cholinesterase inhibitors: moderate supporting RCT evidence (they slow progression of symptoms if used early)
Ginkgo biloba, selegeline, vitamin E, and oestrogen: No real evidence in favour of their use.
Management of ↑BP in vascular dementia: No strong evidence supporting pharmacotherapy
Non-pharmacological Interventions: (e.g. behaviour training) Some weak supporting evidence for caregiver burden