Dementia is a topic covered in the 5-Minute Emergency Consult.

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  • Progressive deterioration in cognition, behavior, or both without impaired consciousness that is severe enough to interfere with activities of daily living due to alteration in cortical brain function. A chronic and progressive form of organic brain syndrome.
  • Over 50 different causes, but >60% caused by Alzheimer disease
    • Involves increased neurofibrillary tangles and elevated beta amyloid plaques
  • Prevalence 1% at age 60 yr to 30–50% by age 85 yr
  • Characterized by gradual decline in cognitive functioning:
    • Generally evolves over period of years
    • Course is highly variable, months to years in duration
    • Rapid decline indicative of other causes, or rare rapid onset causes of dementia (prion diseases, progressive supranuclear palsy)
  • Variable hereditary
    • Increased risk of Alzheimer disease in 1st-degree relatives of patients with Alzheimer
    • Apolipoprotein ε4 is the only well-established mutation with late-onset Alzheimer


  • Primary dementia:
    • Cortical (Alzheimer disease, frontotemporal dementia)
    • Subcortical (Huntington disease, Parkinson disease, progressive supranuclear palsy)
  • Secondary dementia:
    • Cerebrovascular disease (multi-infarct dementia)
    • Toxic, metabolic, nutritional derangements
    • Prion disorders (Creutzfelt-Jakob or bovine spongiform encephalopathy and variants)
    • Infectious agents (HIV, syphilis, encephalitis)
    • Vasculitis (systemic lupus erythematosus, thrombotic thrombocytopenic purpura)
    • Traumatic (chronic subdural hematomas, pugilistic dementia)
    • Structural (normal pressure hydrocephalus, brain masses)
    • Binswanger disease
  • Reversible (∼15%) causes include normal pressure hydrocephalus, medications, intracranial masses, and alcohol abuse syndromes
  • Pseudodementia:
    • Depression in elderly can present with dementia-like symptoms
    • Common in mildly demented patients, look for pin-point event with short duration of symptoms
    • Generally with history of psychiatric conditions, emphasis on failures and disabilities

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