Overview:
Gradual increase in incidence as you age
50% change after age 85
Annual screening over age 70 (AAN recommendation)
60% of dementia is Alzheimers
Lewy Body Dementia (psychiatric/visual hallucinations with Parkinson’s symptoms) is as prevalent as vascular dementia
5% Parkinson’s
< 5% frontotemporal dementia
Dementia is generally progressive and acquired; increased risk when patients notice symptoms themselves
Workup:
R/o delirium, psychiatric diagnosis
Labs: TSH, RPR, B12, folate, CBC, CMP, other neurologic conditions
Assess for neglect and abuse
*Functional assessment (cooking, cleaning, finances)
*MMSE or SLUMS (if abnormality in this or functional, reassess every 6 months)
If both abnormal functional assessment and MMSE, greatly increased risk and can get neuroimaging at that time (non-con CT if just Alzheimers considered, MRI otherwise) PET scan negative is prognostically reassuring for 3 years for Alzheimers progression, but ridiculously expensive
Treatment:
– Community Resources: Area Agency on Aging (https://humanservices.mesacounty.us/AdultServices/area-agency-on-aging.aspx)
– Books: “The 36 hour day” (https://www.amazon.com/36-Hour-Day-Alzheimer-Disease-Dementias/dp/1455521159); “Can’t we talk about something more pleasant” (https://www.amazon.com/Cant-Talk-about-Something-Pleasant/dp/1632861011)
– Routine assessments: skin and diet; driving OT in GJ (Jill Wohlgemuth) “Shift to Independence”
– Meds: Donepezil; can combo with donepezil + momantine (only for mild-moderate as nothing for severe); Lewy Body (dopamine agonists + antipsychotics (clozapine) + donepezil); Vascular (reduce risk with DM and HTN); Fronto-temporal (nothing)
