Dementia

Alternative Names

Symptoms

Problems may involve language, memory, perception, emotional behavior or personality, and cognitive skills (such as calculation, abstract thinking, or judgment). Dementia usually first appears as forgetfulness.

Symptoms include:

• Changed feeling (sensation) or perception
• Changed sleep patterns
  • Change in sleep-wake cycle
  • Insomnia
  • Need for increased sleep
• Decrease in problem-solving skills and judgment
• Disorientation
  • Confused about people, places, or times
  • Unable to pick up cues from the environment
• Disorders of problem-solving or learning
  • Trouble making calculations
  • Unable to learn
  • Unable to think abstractly
  • Unable to think in general terms
• Impaired recognition (agnosia)
  • Trouble recognizing familiar objects or people
  • Trouble recognizing things through the senses
• Lack of or poor language ability (aphasia)
  • Unable to form words
  • Unable to name objects
  • Unable to read or write
  • Unable to repeat a phrase
  • Unable to speak (without muscle paralysis)
  • Unable to understand speech
  • Have impaired language skills
  • Repeat phrases
  • Speak poorly (enunciation)
  • Use slang or the wrong words
• Memory problems
  • Unable to remember new things (short-term memory problems)
  • Unable to remember the past (long-term memory problems)
• Motor system problems
  • Gait changes
  • Impaired skilled motor function (apraxia)
    • Unable to copy geometric figures
    • Unable to copy hand positions
    • Unable to dress self
  • Inappropriate movements
  • Other motor system problems
• Seeing or hearing things that aren't there (hallucinations) and having false ideas (delusions)
• Severe confusion
• Personality changes
  • Anxiety
  • Decreased ability to care for oneself
  • Decreased interest in daily living activities
  • Depression
  • Inappropriate mood or behavior
  • Irritability
  • No mood (flat affect)
  • Not flexible
  • Only concerned with self (self-centered)
  • Poor temper control
  • Unable to function or interact in social or personal situations
  • Unable to keep a job
  • Unable to make decisions
  • Withdrawal from social interaction
• Unable to be spontaneous
• Unable to concentrate

Other symptoms that may occur with dementia:

• Incontinence
• Swallowing problems

Exams and Tests

The following tests and procedures may be done:

• B12 level
• Blood ammonia levels
• Blood chemistry (chem-20)
• Blood gas analysis
• Cerebrospinal fluid (CSF) analysis
• Drug or alcohol levels (toxicology screen)
• Electroencephalograph (EEG)
• Glucose test
• Head CT
• Liver function tests
• Mental status test
• MRI of head
• Serum calcium
• Serum electrolytes
• Thyroid function tests
• Thyroid stimulating hormone level
• Urinalysis

References

Alva G. Alzheimer disease and other dementias. Clin Geriatr Med. 2003; 19(4): 763-76.

American Academy of Neurology. About Dementia. Neurology. 2004; 63(10); E20.

Moore DP, Jefferson JW. Handbook of Medical Psychiatry. 2nd ed. St. Louis, Mo: Mosby; 2004:283-286.

Goetz, CG. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders; 2007.

Farlow MR, Cummings JL. Effective pharmacologic management of Alzheimer's disease. Am J Med, 2007;120:388-397.