Dementia syndromes: evaluation and treatment

Abstract

As our population ages, diseases affecting memory and daily functioning will affect an increasing number of individuals, their families and the healthcare system. The social, financial and economic impacts will be profound. This article provides an overview of current dementia syndromes to assist clinicians in evaluating, educating and treating these patients. KeywordsAlzheimer's disease; cognition; dementia; donepezil; galantamine; memory; rivastigmine; vascular dementia Dementia is a progressive disorder of memory loss and impaired cognitive ability. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV defines dementia as a decline in memory with impairment of at least one other cognitive function, such as skilled movements (limb apraxia), language (aphasia) or executive function (e.g., planning, attention and abstract reasoning). This decline should represent a change from previous behavior; it should impair social and/or occupational functioning; and cannot be accounted for by other psychiatric conditions such as depression, other mood disorders or psychosis [1,2].Dementia comes in many forms, with the Alzheimer's and vascular subtypes being most common [3]. Dementia (neurodegenerative) is age related, with prevalence estimated at 20% in individuals older than 85 years [201]. The decline in cognition and memory function not only affects test performance, but often manifests as behavioral and mood changes, as well as the inability to perform activities of daily living (ADLs). With our aging population, the number of patients with dementia will rise and place an increasing burden on families and our healthcare system. Accurate diagnosis of dementia is important for prognosis and to guide therapy. The number of potentially reversible dementias, perhaps upwards of 11%, is small, but these disorders may †

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