Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-26T08:55:49.014Z Has data issue: false hasContentIssue false

Chapter 11 - Evaluation and Management of Dementia

from Section II - Geriatric Syndromes

Published online by Cambridge University Press:  30 June 2022

By
Carol K. Chan  and
Constantine G. Lyketsos
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

Dementia is a clinical syndrome characterized by global cognitive decline, involving deficits in memory and at least one other area of cognition, and affects over 47 million persons worldwide. While Alzheimer’s dementia is the most common cause, it commonly co-occurs with other dementia-related pathologies such as cerebrovascular disease and Lewy body disease. The evaluation and differential diagnosis of dementia involves history taking with outside informants, thorough medication review, examination focused on phenomenology and associated features, and a workup for potential causes. Depression and delirium due to other medical causes may overlap with symptoms of dementia, and should be considered in a dementia evaluation. The four pillars of dementia care are: (1) disease-oriented treatment, (2) symptomatic treatments, (3) supportive care for the patient, and (4) supportive care for the caregiver. Management usually involves psychological, social, and environmental adjustments. Disease-modifying pharmacotherapy for dementia is still under development, and has largely been unsuccessful. Although symptomatic treatments such as cholinesterase inhibitors and memantine are available, they provide a modest and temporary stabilization of cognitive changes associated with the disease, and do not reverse or stop the degenerative process.

Keywords

dementianeuropsychiatric symptomsdiagnosistherapyAlzheimer’s diseasecholinesterase inhibitorsmemantineneuroimagingneuropsychological test
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 112 - 128
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aarsland, D, Zaccai, J, Brayne, C. A systematic review of prevalence studies of dementia in Parkinson’s disease. Mov. Disord. Off. J. Mov. Disord. Soc. 2005; 20:1255–1263. https://doi.org/10.1002/mds.20527.Google Scholar
Alzheimer’s Association. 2019 Alzheimer’s disease facts and figures. Alzheimers Dement. 2019; 15:321–387.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). Washington, DC: American Psychiatric Association, 2013.Google Scholar
Appleby, BS, Lyketsos, CG. Rapidly progressive dementias and the treatment of human prion diseases. Expert Opin. Pharmacother. 2011; 12:1–12.Google Scholar
Bang, J, Spina, S, Miller, BL. Frontotemporal dementia. Lancet Lond. Engl. 2015; 386:1672–1682. https://doi.org/10.1016/S0140-6736(15)00461-4.Google Scholar
Baumgart, M, Snyder, HM, Carrillo, MC, Fazio, S, Kim, H, Johns, H. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimers Dement. 2015; 11:718–726. https://doi.org/10.1016/j.jalz.2015.05.016.Google Scholar
Bennett, JM, Chekaluk, E, Batchelor, J. Cognitive tests and determining fitness to drive in dementia: A systematic review. J. Am. Geriatr. Soc. 2016; 64:1904–1917. https://doi.org/10.1111/jgs.14180.CrossRefGoogle ScholarPubMed
Bertoux, M, Delavest, M, de Souza, LC, Funkiewiez, A, Lépine, J-P, Fossati, P, Dubois, B, Sarazin, M. Social cognition and emotional assessment differentiates frontotemporal dementia from depression. J. Neurol. Neurosurg. Psychiatry. 2012; 83:411–416. https://doi.org/10.1136/jnnp-2011-301849.Google Scholar
Burckhardt, M, Herke, M, Wustmann, T, Watzke, S, Langer, G, Fink, A. Omega-3 fatty acids for the treatment of dementia. Cochrane Database Syst. Rev. 2016; 4:CD009002. https://doi.org/10.1002/14651858.CD009002.pub3.Google ScholarPubMed
Chêne, G, Beiser, A, Au, R, Preis, SR, Wolf, PA, Dufouil, C, Seshadri, S. Gender and incidence of dementia in the Framingham Heart Study from mid-adult life. Alzheimers Dement. J. Alzheimers Assoc. 2015; 11:310–320. https://doi.org/10.1016/j.jalz.2013.10.005.Google Scholar
Chung, S-D, Liu, S-P, Sheu, J-J, Lin, C-C, Lin, H-C, Chen, C-H. Increased healthcare service utilizations for patients with dementia: A population-based study. PLOS ONE. 2014; 9:e105789. https://doi.org/10.1371/journal.pone.0105789.Google Scholar
Clarfield, AM. The decreasing prevalence of reversible dementias: An updated meta-analysis. Arch. Intern. Med. 2003; 163:2219–2229. https://doi.org/10.1001/archinte.163.18.2219.Google Scholar
Cummings, J, Ritter, A, Zhong, K. Clinical trials for disease-modifying therapies in Alzheimer’s disease: A primer, lessons learned, and a blueprint for the future. J. Alzheimers Dis. JAD. 2018; 64:S3–S22. https://doi.org/10.3233/JAD-179901.CrossRefGoogle Scholar
Cummings, JL, Isaacson, RS, Schmitt, FA, Velting, DM. A practical algorithm for managing Alzheimer’s disease: What, when, and why? Ann. Clin. Transl. Neurol. 2015; 2:307–323. https://doi.org/10.1002/acn3.166.Google Scholar
Dawson, JD, Anderson, SW, Uc, EY, Dastrup, E, Rizzo, M. Predictors of driving safety in early Alzheimer disease. Neurology. 2009; 72:521–527.Google Scholar
Doraiswamy, PM, Leon, J, Cummings, JL, Marin, D, Neumann, PJ. Prevalence and impact of medical comorbidity in Alzheimer’s disease. J. Gerontol. A. Biol. Sci. Med. Sci. 2002; 57:M173–177. https://doi.org/10.1093/gerona/57.3.m173.Google Scholar
Dubinsky, RM, Stein, AC, Lyons, K. Practice parameter: risk of driving and Alzheimer’s disease (an evidence-based review): Report of the quality standards subcommittee of the American Academy of Neurology. Neurology. 2000; 54:2205–2211.Google Scholar
Duthie, A, Chew, D, Soiza, RL. Non-psychiatric comorbidity associated with Alzheimer’s disease. QJM Mon. J. Assoc. Physicians. 2011; 104:913–920. https://doi.org/10.1093/qjmed/hcr118.CrossRefGoogle ScholarPubMed
Eggenberger, E, Heimerl, K, Bennett, MI. Communication skills training in dementia care: A systematic review of effectiveness, training content, and didactic methods in different care settings. Int. Psychogeriatr. 2013; 25:345–358. https://doi.org/10.1017/S1041610212001664.Google Scholar
Emre, M, Aarsland, D, Brown, R, et al. Clinical diagnostic criteria for dementia associated with Parkinson’s disease. Mov. Disord. Off. J. Mov. Disord. Soc. 2007; 22:1689–1707; quiz 1837. https://doi.org/10.1002/mds.21507.CrossRefGoogle ScholarPubMed
Etters, L, Goodall, D, Harrison, BE. Caregiver burden among dementia patient caregivers: A review of the literature. J. Am. Acad. Nurse Pract. 2008; 20:423–428. https://doi.org/10.1111/j.1745-7599.2008.00342.x.Google Scholar
Farrimond, LE, Roberts, E, McShane, R. Memantine and cholinesterase inhibitor combination therapy for Alzheimer’s disease: A systematic review. BMJ Open. 2012; 2. https://doi.org/10.1136/bmjopen-2012-000917.Google Scholar
Filippi, M, Agosta, F, Barkhof, F, et al. European Federation of the Neurologic Societies, EFNS task force: The use of neuroimaging in the diagnosis of dementia. Eur. J. Neurol. 2012; 19:e131–140, 1487–1501. https://doi.org/10.1111/j.1468-1331.2012.03859.x.Google Scholar
Folstein, MF, Folstein, SE, McHugh, PR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975; 12:189–198. https://doi.org/10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Gatz, M, Reynolds, CA, Fratiglioni, L, et al. Role of genes and environments for explaining Alzheimer disease. Arch. Gen. Psychiatry. 2006; 63:168–174. https://doi.org/10.1001/archpsyc.63.2.168.CrossRefGoogle ScholarPubMed
Geda, YE, Schneider, LS, Gitlin, LN, et al. Neuropsychiatric Syndromes Professional Interest Area of ISTAART. Neuropsychiatric symptoms in Alzheimer’s disease: Past progress and anticipation of the future. Alzheimers Dement. J. Alzheimers Assoc. 2013; 9:602–608. https://doi.org/10.1016/j.jalz.2012.12.001.Google Scholar
Geschwind, MD, Haman, A, Miller, BL. Rapidly progressive dementia. Neurol. Clin. Dementia. 2007; 25:783–807. https://doi.org/10.1016/j.ncl.2007.04.001.Google Scholar
Glinz, D, Gloy, VL, Monsch, AU, et al. Acetylcholinesterase inhibitors combined with memantine for moderate to severe Alzheimer’s disease: A meta-analysis. Swiss Med. Wkly. 2019; 149:w20093. https://doi.org/10.4414/smw.2019.20093.Google Scholar
Gorno-Tempini, ML, Hillis, AE, Weintraub, S, et al. Classification of primary progressive aphasia and its variants. Neurology. 2011; 76:1006–1014.Google Scholar
Gower, LEJ, Gatewood, MO, Kang, CS. Emergency department management of delirium in the elderly. West. J. Emerg. Med. 2012; 13:194–201. https://doi.org/10.5811/westjem.2011.10.6654.Google Scholar
Groves, WC, Brandt, J, Steinberg, M, et al. Vascular dementia and Alzheimer’s disease: Is there a difference? A comparison of symptoms by disease duration. J. Neuropsychiatry Clin. Neurosci. 2000; 12(3):305–315.CrossRefGoogle Scholar
Hamilton, JM, Landy, KM, Salmon, DP, et al. Early visuospatial deficits predict the occurrence of visual hallucinations in autopsy-confirmed dementia with Lewy bodies. Am. J. Geriatr. Psychiatry Off. J. Am. Assoc. Geriatr. Psychiatry. 2012; 20:773–781. https://doi.org/10.1097/JGP.0b013e31823033bc.CrossRefGoogle ScholarPubMed
Harrison Dening, K, Sampson, EL, De Vries, K. Advance care planning in dementia: Recommendations for healthcare professionals. Palliat. Care Res. Treat. 2019; 12:1178224219826579.Google Scholar
Inouye, SK, Westendorp, RGJ, Saczynski, JS. Delirium in elderly people. Lancet Lond. Engl. 2014; 383:911–922. https://doi.org/10.1016/S0140-6736(13)60688-1.CrossRefGoogle ScholarPubMed
Joe, E, Ringman, JM, Cognitive symptoms of Alzheimer’s disease: Clinical management and prevention. BMJ. 2019; 367:l6217. https://doi.org/10.1136/bmj.l6217.Google Scholar
Kales, HC, Gitlin, LN, Lyketsos, CG. Management of neuropsychiatric symptoms of dementia in clinical settings: Recommendations from a multidisciplinary expert panel. J. Am. Geriatr. Soc. 2014; 62:762–769.Google Scholar
Kukull, WA, Larson, EB, Teri, L, et al. The mini-mental state examination score and the clinical diagnosis of dementia. J. Clin. Epidemiol. 1994; 47:1061–1067. https://doi.org/10.1016/0895-4356(94)90122-8.Google Scholar
Liu, CC, Liu, CC, Kanekiyo, T, et al. Apolipoprotein E and Alzheimer disease: Risk, mechanisms and therapy. Nat. Rev. Neurol. 2013; 9:106–118. https://doi.org/10.1038/nrneurol.2012.263.Google Scholar
Livingston, G, Sommerlad, A, Orgeta, V, et al. Dementia prevention, intervention, and care. The Lancet. 2017; 390:2673–2734. https://doi.org/10.1016/S0140-6736(17)31363-6.Google Scholar
Lyketsos, CG, Colenda, CC, Beck, C, et al. Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease. Am. J. Geriatr. Psychiatry. 2006; 14:561–573.Google Scholar
Marioni, RE, Proust-Lima, C, Amieva, H, et al. Social activity, cognitive decline and dementia risk: A 20-year prospective cohort study. BMC Public Health. 2015; 15:1089. https://doi.org/10.1186/s12889-015-2426-6.Google Scholar
Matsunaga, S, Kishi, T, Iwata, N. Combination therapy with cholinesterase inhibitors and memantine for Alzheimer’s disease: A systematic review and meta-analysis. Int. J. Neuropsychopharmacol. 2015; 18. https://doi.org/10.1093/ijnp/pyu115.Google Scholar
McKeith, IG, Boeve, BF, Dickson, DW, et al. Diagnosis and management of dementia with Lewy bodies. Neurology. 2017; 89:88–100. https://doi.org/10.1212/WNL.0000000000004058.Google Scholar
McKhann, GM, Knopman, DS, Chertkow, H, et al. The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011; 7:263–269.Google Scholar
Mielke, MM, Rosenberg, PB, Tschanz, J, et al. Vascular factors predict rate of progression in Alzheimer disease. Neurology. 2007; 69:1850–1858. https://doi.org/10.1212/01.wnl.0000279520.59792.fe.Google Scholar
Muangpaisan, W, Petcharat, C, Srinonprasert, V. Prevalence of potentially reversible conditions in dementia and mild cognitive impairment in a geriatric clinic. Geriatr. Gerontol. Int. 2012; 12:59–64. https://doi.org/10.1111/j.1447-0594.2011.00728.x.Google Scholar
Nasreddine, ZS, Phillips, NA, Bédirian, V, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 2005; 53:695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x.Google Scholar
Norton, S, Matthews, FE, Barnes, DE, et al. Potential for primary prevention of Alzheimer’s disease: An analysis of population-based data. Lancet Neurol.2014; 13:788–794. https://doi.org/10.1016/S1474-4422(14)70136-X.Google Scholar
O’Brien, JT, Thomas, A. Vascular dementia. The Lancet. 2015; 386:1698–1706. https://doi.org/10.1016/S0140-6736(15)00463-8.Google Scholar
Okamura, N, Harada, R, Furukawa, K, et al. Advances in the development of tau PET radiotracers and their clinical applications. Ageing Res. Rev. 2016; 30:107–113. https://doi.org/10.1016/j.arr.2015.12.010.Google Scholar
Paterson, RW, Takada, LT, Geschwind, MD. Diagnosis and treatment of rapidly progressive dementias. Neurol. Clin. Pract. 2012; 2:187–200. https://doi.org/10.1212/CPJ.0b013e31826b2ae8.Google Scholar
Phan, SV, Osae, S, Morgan, JC, et al. Neuropsychiatric symptoms in dementia: Considerations for pharmacotherapy in the USA. Drugs RD. 2019; 19:93–115. https://doi.org/10.1007/s40268-019-0272-1.Google Scholar
Rodda, J, Carter, J. Cholinesterase inhibitors and memantine for symptomatic treatment of dementia. BMJ. 2012; 344. https://doi.org/10.1136/bmj.e2986.Google Scholar
Rosen, T, Connors, S, Clark, S, et al. Assessment and management of delirium in older adults in the emergency department: Literature review to inform development of a novel clinical protocol. Adv. Emerg. Nurs. J. 2015; 37:183–E3. https://doi.org/10.1097/TME.0000000000000066.Google Scholar
Sorbi, S, Hort, J, Erkinjuntti, T, et al. EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur. J. Neurol. 2012; 19:1159–1179. https://doi.org/10.1111/j.1468-1331.2012.03784.x.Google Scholar
Steinman, MA, Hanlon, JT. Managing medications in clinically complex elders: “There’s got to be a happy medium.” JAMA. 2010; 304:1592–1601. https://doi.org/10.1001/jama.2010.1482.CrossRefGoogle ScholarPubMed
Tiraboschi, P, Salmon, DP, Hansen, LA, et al. What best differentiates Lewy body from Alzheimer’s disease in early-stage dementia? Brain J. Neurol. 2006; 129:729–735. https://doi.org/10.1093/brain/awh725.Google Scholar
Vandervoort, A, Houttekier, D, Vander Stichele, R, et al. Quality of dying in nursing home residents dying with dementia: Does advanced care planning matter? A nationwide postmortem study. PloS One. 2014; 9:e91130.Google Scholar
Vann Jones, SA, O’Brien, JT. The prevalence and incidence of dementia with Lewy bodies: A systematic review of population and clinical studies. Psychol. Med. 2014; 44:673–683. https://doi.org/10.1017/S0033291713000494.Google Scholar
Vieira, RT, Caixeta, L, Machado, S, et al. Epidemiology of early-onset dementia: A review of the literature. Clin. Pract. Epidemiol. Ment. Health CP EMH. 2013; 9:88–95. https://doi.org/10.2174/1745017901309010088.Google Scholar
Walker, Z, Possin, KL, Boeve, BF, Aarsland, D. Non-Alzheimer’s dementia 2. Lancet Lond. Engl. 2015; 386:1683–1697. https://doi.org/10.1016/S0140-6736(15)00462-6.Google Scholar
Weiner, M, Khachaturian, Z. The use of MRI and PET for clinical diagnosis of dementia and investigation of cognitive impairment: A consensus report. Alzheimer’s Assoc. Chic. IL. 2005; 1:1–15.Google Scholar
Williams-Gray, CH, Mason, SL, Evans, JR, et al. The CamPaIGN study of Parkinson’s disease: 10-year outlook in an incident population-based cohort. J. Neurol. Neurosurg. Psychiatry. 2013; 84:1258–1264. https://doi.org/10.1136/jnnp-2013-305277.Google Scholar
Xu, W, Tan, L, Wang, H-F, et al. Education and risk of dementia: Dose-response meta-analysis of prospective cohort studies. Mol. Neurobiol. 2016; 53:3113–3123. https://doi.org/10.1007/s12035-015-9211-5.Google Scholar
Zhao, Q-F, Tan, L, Wang, H-F, et al. The prevalence of neuropsychiatric symptoms in Alzheimer’s disease: Systematic review and meta-analysis. J. Affect. Disord. 2016; 190:264–271. https://doi.org/10.1016/j.jad.2015.09.069.Google Scholar
Blennow, K, Dubois, B, Fagan, AM, Lewczuk, P, de Leon, MJ, Hampel, H. Clinical utility of cerebrospinal fluid biomarkers in the diagnosis of early Alzheimer’s disease. Alzheimers Dement. 2015; 11(1):58–69.Google Scholar
Olsson, B, Lautner, R, Andreasson, U, Ohrfelt, A, Portelius, E, Bjerke, M, et al. CFS and blood biomarkers for the diagnosis of Alzheimer’s disease: A systematic review and meta-analysis. Lancet Neurol. 2016; 15:673–684.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×