Dementia
Dementia is a clinical syndrome characterized by various symptoms, such as memory and concentration difficulties, behavioral abnormalities, language and perception difficulties, as well as problems with the ability of comprehension and judgment.
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Relevance for Elderly Patients, Epidemiology Dementia is a clinical syndrome characterized by various symptoms, such as memory and concentration difficulties, behavioral abnormalities, language and perception difficulties, as well as problems with the ability of comprehension and judgment. The clinical diagnosis of dementia can be established when the following three criteria apply: 1. Newly incurred cognitive deficits 2. Duration over at least half a year 3. Impairment in the activities of the daily life due to cognitive deficits. The diagnosis of dementia cannot be established in the absence of impairments in the activities of daily living. Mild cognitive impairment (MCI) has to be delimited from dementia. This syndrome, like clinically defined dementia, also includes cognitive deficits; these deficits, however, are less marked and therefore do not lead to relevant impairments of the daily routine activities. People with mild cognitive disorders carry a high risk of developing dementia in the foreseeable future and
S. Schwarz (*) L. Fr€ olich Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Square J 5, 68159 Mannheim, Germany e-mail: [email protected]; [email protected]
should therefore be observed closely not to miss the right time for an intervention. Dementia is a clinical syndrome with a heterogeneous etiology. The most frequent cause for a dementia is Alzheimer’s disease (approximately 60% of all dementia disorders). The terms Alzheimer’s disease and dementia are often used synonymously, but this is incorrect. In fact, a large number of other disorders can cause dementia. Primary dementia, most commonly resulting from neurodegenerative disorders, can be roughly partitioned from secondary dementia as a complication of other diseases. The most frequent neurodegenerative dementia disorders are – Alzheimer’s disease – Group of frontotemporal dementias – Lewy-body dementia – Dementia associated with Parkinson’s disease. The most frequent dementia diseases that cannot be traced back to neurodegenerative processes are – Vascular dementia – Dementia after stroke, including multi-infarct dementia. In addition, a large number of dementia syndromes result from infectious, inflammatory, toxic, endocrine, and metabolic causes, with significant regional differences. For example, in Southern Africa, HIV infection is one of the most frequent causes for dementia, whereas in industrialized countries, HIV-associated dementia only plays a minor role. Dementia is a clinical syndrome with a heterogeneous etiology.
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_15, # Springer-Verlag Wien 2013
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S. Schwarz and L. Fr€ olich
Healthy 77 y
Alzheimer‘s 73 y
MIX-type 85 y
Fig. 1 Typical MRT findings for Alzheimer’s and mixed dementia (neurodegenerative plus vascular components). MRT magnetic resonance tomography (From F. Hentschel, Central Institute of Mental Health, Mannheim, Germany)
Pathological studies demonstrated that the majo
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