Which clinical history findings are characteristic of dementia?

Updated: Sep 19, 2018
  • Author: Richard D Shin, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Answer

Dementia presents with a history of chronic, steady decline in short and, later, long-term memory and is associated with difficulties in social relationships, work, and activities of daily life. In contrast to delirium, the sensorium is usually clear. However, acute confusional states can be superimposed on an underlying dementing process. The diagnosis is usually known previously in a patient who presents to the ED with moderate-to-severe symptoms.

Earlier stages of dementia may present subtly, and patients may minimize or attempt to hide their impairments. Patients at this stage often have an associated depression. In addition, major depression alone can present as a dementia-like condition in elderly patients but is treatable and reversible. Dementia of relatively recent onset has a higher likelihood of a potentially reversible etiology. Take a careful history, looking for past or present drug or alcohol abuse, current medications, chronic or acute medical illnesses and psychiatric disorders to uncover a treatable or modifiable cause for the cognitive impairment.

Elderly patients with depressed mood, hopelessness, and suicidality may be suffering from "pseudodementia" (false dementia). When the depression is alleviated with treatment, the dementia-like condition resolves.

A history of a stuttering course of chronic memory loss may point to multi-infarct dementia, which is caused by repeated lacunar strokes. Treatment aimed at preventing future strokes may arrest further progression of the dementia. However, small strokes in specific areas of the brain may trigger the onset of progressive Alzheimer-type dementia


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