Clinical features

Dementia may generally be described as referring to a widespread deterioration in mental function, without impairment of consciousness.

Suspect dementia when

• family members report to the physician about memory impairment but the patient denies it (1)
• the patient is questioned, he/she looks at the carer for an answer - the ‘head-turning sign’ (2)

widespread deterioration in mental function. This refers to the loss of a variety of abilities in the spheres of:

• decline in memory – mostly impairment of learning new material or retaining new information (1), repetitive questioning, difficulty recalling time or date (2)
• failure of other areas of higher cognitive functioning which will affect normal daytime activities and executive functions (1,3) –
  • difficulty in performing complex tasks
  • difficulties in judgement and planning, analytic thought
  • problems in finding one’s way around familiar places (spatial awareness) -
  • impairment in language – problems with expressing themselves or getting “lost” in conversations (1)
• challenging behaviour (behavioural and psychological symptoms of dementia (BPSD)
  • depression
  • apathy
  • agitation
  • disinhibition
  • psychosis (delusions or hallucinations)
  • wandering
  • aggression
  • incontinence (4)
  • challenging behaviour is frequently associated with high levels of strain and distress for the family carers and has been a common cause of admissions to institutional care (4)
• the basic tasks of self-care

If impairment of consciousness is present together with general intellectual impairment, then the condition is defined as delirium or confusional state - acute or sub-acute.

The clinical picture at any one time is determined by:

• the patient's previous personality and intellectual endowment
• the nature of the pathological process and the stage that it has reached

Reference:

• (1) Adelman AM, Daly MP. Initial evaluation of the patient with suspected dementia. Am Fam Physician. 2005;71(9):1745-50
• (2) Royal Australian College of General Practitioners 2003. Care of patients with dementia in general practice
• (3) Royal College of Psychiatrists 2009. Dementia and people with learning disabilities: Guidance on the assessment , diagnosis, treatment and support of people with learning disabilities who develop dementia
• (4) National Collaborating center for mental health 2007: Dementia: A NICE-SCIE guideline on supporting people with dementia and their carers in health and social care