Signs and Symptoms

• Cognitive: memory loss, problems with language, disorientation to time and place, poor or decreased judgment, problems with learning and abstract thinking, misplacing things

• Noncognitive: changes in mood or behavior, changes in personality, or loss of initiative

• Functional: difficulty performing familiar tasks Laboratory Tests

• MRI or CT is used to measure changes in brain size and volume and rule out stroke, brain tumor, or cerebral edema.

• Tests to exclude possible causes of dementia include a depression screen, vitamin

B12 deficiency, thyroid function tests (thyroid-stimulating hormone and free triiod-

othyronine and thyroxine), CBC, and chemistry panel.

• Other diagnostic tests to consider for differential diagnosis: erythrocyte sedimentation rate, urinalysis, toxicology, chest x-ray, heavy metal screen, HIV testing, CSF examination, electroencephalography, and neuropsychological tests such as the Folstein Mini Mental Status Examination.

Table 35-2 Diagnostic Criteria for AD Based on DSM-IV-TR

Dementia of the Alzheimer's type

A. The development of multiple cognitive deficits manifested by both

1. Memory impairment (impaired ability to learn new information or to recall previously learned information)

2. One or more of the following cognitive disturbances:

(a) Aphasia (language disturbance)

(b) Apraxia (impaired ability to carry out motor activities despite intact motor function)

(c) Agnosia (failure to recognize or identify objects despite intact sensory function)

(d) Disturbance in executive funning (e.g., planning, organizing, sequencing, abstracting)

B. The cognitive deficits in criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning

C. The course is characterized by gradual onset and continuing cognitive decline

D. The cognitive deficits in criteria A1 and A2 are not due to any of the following:

1. Other CNS conditions that cause progressive deficits in memory and cognition

2. Systemic conditions that are known to cause dementia

3. Substance-induced conditions

E. The deficits do not occur exclusively during the course of delirium

F. The disturbance is not better accounted for by another Axis I disorder

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