Chapter 1 Clinical approach to dementia

Publisher Summary Dementia has devastating effects on patients and their relatives. Memory, intellect, and personality are progressively impaired in this disorder. This process is irreversible in most cases and often necessitates admission to an institution for chronic care. Moreover, dementia often leads to death from secondary complications and its main cause, Alzheimer's disease, has been called “a major killer.” While treating a patient diagnosed with dementia, the emphasis should be on detecting treatable causes. Clinical history and examination, involving mental status examination, are all-important in the differential diagnosis, including normal aging, depression, delirium, amnesic syndromes, and focal neurological dysfunction. The concept of “subcortical” dementia appears useful in the analysis of patients with dementia because most treatable forms of dementia belong to this group. Ancillary investigations should not be used indiscriminately; neither minimax nor purely probabilistic strategies are permissible or feasible in dementia. The principle of decision analysis should be applied—that is, the maximization of expected utility. Both the diagnosis of the dementia syndrome and of its causes is rather unreliable. Alzheimer's disease is diagnosed by exclusion, with no positive test being available yet.