DEMENTIA

DEMENTIA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the following questions:

1. Is there a history of drug or alcohol ingestion? Chronic barbiturate intoxication, ergotism, and other psychotropic or antidepressant drugs may cause dementia. Alcoholism may cause dementia in the form of Korsakoff's psychosis or Wernicke's encephalopathy.
2. Is there headache, papilledema, or focal neurologic signs? The most important condition to rule out in this category would be a space-occupying lesion, but normal pressure hydrocephalus, cerebral arteriosclerosis, acute cerebrovascular accident, and general paresis may present with focal neurologic signs.
3. Is there a response to niacin, thiamine, vitamin B ₁₂ , or thyroid? Response to these drugs would indicate that the patient has pellagra, Korsakoff's psychosis, pernicious anemia, or myxedema. However, laboratory tests should be done before administering the medications. Laboratory tests include serum B ₁₂ and folic acid, and a thyroid profile. Unfortunately, most laboratories do not have a test for niacin or thiamine.
4. Is there insight? In patients with cerebral arteriosclerosis, the patient notices that his memory is slipping. This is also true of acquired immunodeficiency syndrome (AIDS).
5. Are there extrapyramidal tract signs? Extrapyramidal tract signs should suggest Huntington's chorea or Parkinson's disease.
6. Are there pyramidal tract signs or myoclonus? Pyramidal tract signs are seen in general paresis and Jakob-Creutzfeldt syndrome, but also myoclonus is seen in Jakob-Creutzfeldt syndrome.

DIAGNOSTIC WORKUP

Routine laboratory tests include a CBC, sedimentation rate, chemistry panel, VDRL test, HIV antibody titer, ANA, blood alcohol level, urine drug screens, thyroid profile, serum B ₁₂ , and folic acid. A CT scan should probably be done in all cases. An EEG may be helpful in demonstrating drug intoxication. A spinal tap may need to be done to diagnose central nervous system lues. The best test for that is the fluorescent treponema antibody absorption test (FTA-ABS). MRI may be useful in distinguishing Alzheimer's disease from cerebral arteriosclerosis, as in cerebral arteriosclerosis small infarcts may be demonstrated. A radioiodinated serum albumin (RISA) cisternography study is useful to diagnose normal pressure hydrocephalus. Arterial blood gases should be drawn. Psychiatric testing will help differentiate organic brain syndrome from other psychiatric disorders and malingering. A neurologist or psychiatrist should be consulted before ordering expensive diagnostic tests.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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