Dementia: Difference between revisions
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==Treatment== | ==Treatment== | ||
===Behavior management techniques (BMT)=== | ===Behavior management techniques (BMT)=== | ||
Behavior management techniques (BMT) might help.<ref name="pmid14559955">{{cite journal |author=Teri L, Gibbons LE, McCurry SM, ''et al'' |title=Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial |journal=JAMA |volume=290 |issue=15 |pages=2015–22 |year=2003 |pmid=14559955 |doi=10.1001/jama.290.15.2015}}</ref> | Behavior management techniques (BMT) might help.<ref name="pmid14559955">{{cite journal |author=Teri L, Gibbons LE, McCurry SM, ''et al'' |title=Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial |journal=JAMA |volume=290 |issue=15 |pages=2015–22 |year=2003 |pmid=14559955 |doi=10.1001/jama.290.15.2015}}</ref> More specifically, " interventions that address behavioral issues and unmet needs" may help.<ref name="pmid17101935">{{cite journal |author=Ayalon L, Gum AM, Feliciano L, Areán PA |title=Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review |journal=Arch. Intern. Med. |volume=166 |issue=20 |pages=2182–8 |year=2006 |pmid=17101935 |doi=10.1001/archinte.166.20.2182}}</ref> | ||
===Disease management team / care managers=== | |||
The use of care managers may help.<ref name="pmid17101935"/><ref name="pmid17116916">{{cite journal |author=Vickrey BG, Mittman BS, Connor KI, ''et al'' |title=The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial |journal=Ann. Intern. Med. |volume=145 |issue=10 |pages=713–26 |year=2006 |pmid=17116916 |doi=}}</ref> | |||
==Screening== | ==Screening== | ||
Revision as of 23:58, 7 November 2007
Dementia is "progressive decline in two or more cognitive domains that is severe enough to interfere with the performance of everyday activities."[1]
Deficits in cognitive function contribute to impaired functional status.[2] The deficits in the domains of cognitive function are[3]:
- Agnosia - "Failure to recognize or identify objects despite intact sensory function"[3]
- Aphasia - "Deterioration of language function"[3]
- Apraxia - "Impaired ability to execute motor activities despite intact motor abilities, sensory function, and comprehension of the required task"[3]
- Disturbance in executive functioning - "The ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior"[3]
Classification
Cortical dementias
Among the many causes of cortical dementia, common causes are:
- Alzheimer's disease
- Frontotemporal lobar degeneration (Pick's Disease)
- Dementia with Lewy bodies
Subcortical dementias
Among the many causes of subcortical dementia, common causes are:
- Vitamin B12 deficiency
Diagnosis
A number of systematic reviews, including ones by the U.S. Preventive Services Task Force (USPSTF)[4], Rational Clinical Examination[3], and others[5], have summarized the diagnostic accuracy of screening tests.
Mini-mental state examination
The Mini-mental state examination (MMSE) is the most studied test.[3] A systematic review concluded that the accuracy of the MMSE is:[4]:
- sensitivity 71% to 92%
- specificity 56% to 96%
A copy of the Mini-mental state examination can be found in the appendix of the original publication.[6]
Modified Mini-Mental State examination (3MS)
A meta-analysis concluded that the Modified Mini-Mental State (3MS) examination has:[5]
- sensitivity 83% to 94%
- specificity 85% to 90%
A copy of the 3MS is online.[7]
Abbreviated mental test score
A meta-analysis concluded:[5]
- sensitivity 73% to 100%
- specificity 71% to 100%
Other examinations
Many other tests have been studied [8][9][1] including the clock-drawing test.[10]
Treatment
Behavior management techniques (BMT)
Behavior management techniques (BMT) might help.[11] More specifically, " interventions that address behavioral issues and unmet needs" may help.[12]
Disease management team / care managers
The use of care managers may help.[12][13]
Screening
In 2003, a clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF) gave a grade I recommendation, indicating "the evidence is insufficient to recommend for or against routine screening for dementia in older adults".[14]
References
- ↑ Jump up to: 1.0 1.1 Karlawish, J. & Clark, C. (2003). "Diagnostic evaluation of elderly patients with mild memory problems". Ann Intern Med 138 (5): 411-9. PMID 12614094.
- ↑ Royall DR, Lauterbach EC, Kaufer D, Malloy P, Coburn KL, Black KJ (2007). "The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association". The Journal of neuropsychiatry and clinical neurosciences 19 (3): 249–65. DOI:10.1176/appi.neuropsych.19.3.249. PMID 17827410. Research Blogging.
- ↑ Jump up to: 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Holsinger T, Deveau J, Boustani M, Williams JW (2007). "Does this patient have dementia?". JAMA 297 (21): 2391–404. DOI:10.1001/jama.297.21.2391. PMID 17551132. Research Blogging.
- ↑ Jump up to: 4.0 4.1 Boustani, M.; Peterson, B.; Hanson, L.; Harris, R.; & Lohr, K. (2003). "Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force". Ann Intern Med 138 (11): 927-37. PMID 12779304.
- ↑ Jump up to: 5.0 5.1 5.2 Cullen B, O'Neill B, Evans JJ, Coen RF, Lawlor BA (2007). "A review of screening tests for cognitive impairment". J. Neurol. Neurosurg. Psychiatr. 78 (8): 790–9. DOI:10.1136/jnnp.2006.095414. PMID 17178826. Research Blogging.
- ↑ Folstein MF, Folstein SE, McHugh PR (1975). ""Mini-mental state". A practical method for grading the cognitive state of patients for the clinician". Journal of psychiatric research 12 (3): 189-98. DOI:10.1016/0022-3956(75)90026-6. PMID 1202204. Research Blogging.
- ↑ Hogan DB, Ebly EM (2000). "Predicting who will develop dementia in a cohort of Canadian seniors". The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 27 (1): 18–24. PMID 10676583. [e] [Appendix: The Modified Mini-Mental State (3MS)]
- ↑ Sager, M.; Hermann, B.; La Rue, A.; & Woodard, J. (2006). "Screening for dementia in community-based memory clinics". WMJ 105 (7): 25-9. PMID 17163083.
- ↑ Fleisher, A.; Sowell B.; Taylor C.; Gamst A.; Petersen R.; & Thal L. (2007). "Clinical predictors of progression to Alzheimer disease in amnestic mild cognitive impairment". Neurology 68 (19): 1588-95. PMID 17287448.
- ↑ Royall, D.; Cordes J.; & Polk M. (1998). "CLOX: an executive clock drawing task". J Neurol Neurosurg Psychiatry 64 (5): 588-94. PMID 9598672. Example form
- ↑ Teri L, Gibbons LE, McCurry SM, et al (2003). "Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial". JAMA 290 (15): 2015–22. DOI:10.1001/jama.290.15.2015. PMID 14559955. Research Blogging.
- ↑ Jump up to: 12.0 12.1 Ayalon L, Gum AM, Feliciano L, Areán PA (2006). "Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review". Arch. Intern. Med. 166 (20): 2182–8. DOI:10.1001/archinte.166.20.2182. PMID 17101935. Research Blogging.
- ↑ Vickrey BG, Mittman BS, Connor KI, et al (2006). "The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial". Ann. Intern. Med. 145 (10): 713–26. PMID 17116916. [e]
- ↑ U.S. Preventive Services Task Force (2003). "Screening for dementia: recommendation and rationale". Ann. Intern. Med. 138 (11): 925–6. PMID 12779303. [e]