Dementia

Key Points

• Dementia is a gradual, progressive impairment of memory and other cognitive functions that is severe enough to impact work, social activities, and relationships.

• Dementia can be divided into four categories: Alzheimer's disease (60% of cases), dementia with Lewy bodies (15%), vascular dementia (15%), and all other causes (10%).

• Comprehensive, longitudinal, well-coordinated care delivered by the family physician for both the patient and the caregiver is the cornerstone of effective management of patients with dementia.

• The cholinesterase inhibitors are effective in slowing the progression of cognitive and functional decline and may be used in conjunction with memantine (NMDA receptor antagonist) to treat moderate to severe dementia.

Dementia is characterized by the development of an acquired impairment in memory associated with impairment in one or more cognitive domains, including executive function, language (expressive or receptive), praxis (learned motor sequences), or gnosis (ability to recognize objects, faces, or other sensory information). The impairments are severe enough to interfere with work, social activities or relationships (American Psychiatric Association, 1994). The course is usually one of gradual, progressive decline and causes impairment in the ability to perform activities of daily living (ADLs). The incidence of dementia increases with age. By 75 years, 10% to 15% of people have dementia, increasing to 35% to 50% for those over 85.

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