Clinical features and multidisciplinary approaches to dementia care

Figures & data

Figure 1 Worldwide subtypes of late onset dementia (≥65 years).

Copyright © 2007, Elsevier Inc. Adapted with permission from Brookmeyer et al.⁶

Abbreviations: DLB, dementia with Lewy bodies; FTD, frontotemporal dementias.

Figure 2 Global prevalence of Alzheimer’s disease as a function of age and total number of worldwide cases per year.

Copyright © 2006, Lancet Publishing Group. Adapted with permission from Ferri et al.³

Figure 3 Differential diagnostic considerations for dementia.

Abbreviations: AD, Alzheimer’s disease; DLB, dementia with Lewy bodies; FTD, frontotemporal dementia; MCI, mild cognitive impairment; PDD, Parkinson’s disease dementia; VaD, vascular dementia.

Table 1 Summary of DSM-IV and National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA) criteria for the diagnosis of Alzheimer’s disease (AD)

DSM-IV criteria

NINCDS-ADRDA criteria

Insidious onset with progressive decline of cognitive function resulting in impairment of social or occupational functioning from a previously higher level Impairment of recent memory and at least one of the following cognitive domains: – Aphasia – Apraxia – Agnosia – Executive functioning (planning, organizing, sequencing, abstraction) Cognitive deficits are not due to other neurological, psychiatric, toxic, metabolic, or systemic diseases Cognitive deficits do not occur in the setting of a delirium

Probable AD – Deficits in two or more domains of cognition – Progressive decline of memory and other cognitive functions – Preserved consciousness – Onset between ages 40 and 90 years – Absence of systemic or other brain disease that could account for symptoms Possible AD – Atypical onset, presentation, or clinical course of dementia – Presence of another illness capable of producing dementia Definite AD – Clinical criteria for probable AD – Tissue diagnosis by autopsy or biopsy

Table 2 Common clinical presentations of frontotemporal dementia

Presentation	Clinical features
Behavioral	Impulsive behaviors and disinhibition (eg, inappropriate sexual behaviors) Change in personality (eg, indifference, apathy, mental inflexibility) Poor judgment and poor insight into consequences of behaviors (eg, financial risk taking) Repetitive, compulsive, stereotypic behaviors (eg, hyperorality) Loss of personal hygiene (eg, wearing same clothes for multiple consecutive days Loss of social graces/insight (eg, making jokes during a funeral)
Language	Non-fluent aphasia → with anomia, agrammatism, phoemic paraphrasias, impaired word repetition, alexia, agraphia Fluent-aphasia → with early loss of word meaning (ie, empty speech), poor comprehension, semantic paraphrasias, prosopagnosia, associative agnosia

Copyright © 2010, Lippincott Williams & Wilkins. Modified with permission from Arvanitakis.⁷⁰

Table 3 Pharmacologic treatments for dementia

Drug name	Mechanism	Daily dosage	Side effects
Donepezil	AChE inhibitor	5–10 mg	Nausea, vomiting, diarrhea, vivid dreams, leg cramps
Rivastigmine	AChE inhibitor	3–12 mg	Nausea, vomiting, diarrhea, weight loss, anorexia
Galantamine	AChE inhibitor	8–12 mg	Nausea, vomiting, diarrhea, weight loss, anorexia
Memantine	NMDA receptor antagonist	10–20 mg	Hallucinations, confusion

Abbreviations: AChE, acetylcholinesterase; NMDA, N-methyl-D-aspartic acid.

Table 4 Neuropsychiatric features of behavioral and psychological symptoms of dementia

Presentation	Clinical features
Behavioral and psychological excess	Aggression: aggressive resistance, verbal or physical aggression
	Agitation: aimless walking, pacing, trailing, restlessness, repetitive actions, sleep disturbances
	Psychosis: hallucinations, delusions, misidentification
Behavioral and psychological deficits	Depression: sad, tearful, hopeless, low self-esteem, anxiety, guilt
	Apathy: withdrawal, lack of motivation, loss of interest

BrookmeyerRJohnsonEZiegler-GrahamKArrighiHMForecasting the global burden of Alzheimer’s diseaseAlzheimers Dement720073318619119595937

 PubMed Web of Science ®Google Scholar

FerriCPPrinceMBrayneCGlobal prevalence of dementia: a Delphi consensus studyLancet1217200536695032112211716360788

 PubMed Web of Science ®Google Scholar

ArvanitakisZUpdate on frontotemporal dementiaNeurologist12010161162220065792

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