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Chapter 13. Dementia and Milder Cognitive Syndromes

Constantine G. Lyketsos, M.D., M.H.S.
DOI: 10.1176/appi.books.9781585623754.391126

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Dementia is a clinical syndrome that can be caused by a range of diseases or injuries to the brain. Although it can affect young people, it is most commonly seen in older individuals because dementia prevalence increases with age. Given the aging of the population worldwide, dementia is already epidemic and one of the top 10 causes of disability in developed countries (Murray and Lopez 1997). As shown in Figure 13–1, by 2040 an estimated 81 million new cases of dementia will occur worldwide, mostly in the developing world (Ferri et al. 2005). In the United States, as many as 15 million new cases of dementia are expected in the next several decades (Hebert et al. 2003). Given that dementia is a chronic disease, with estimates of its duration ranging from 3–4 years in community settings (Graham et al. 1997) to 10–12 years in clinical settings (Rabins et al. 2006), it poses a unique public health problem with serious effects on its victims, their families, and society at large. In the United States alone, it is estimated that by 2050, the annual cost of dementia will be close to $400 billion in direct and indirect expenses (Murman 2001; Murman et al. 2007).

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FIGURE 13–1. Projected prevalence of dementia worldwide.Source. Adapted from Ferri CP, Prince M, Brayne C, et al.: "Global Prevalence of Dementia: A Delphi Consensus Study." Lancet 366:2112–2117, 2005.

FIGURE 13–2. Flowchart in the diagnosis of dementia.CIND = cognitive impairment not dementia; MCI = mild cognitive impairment; NPS = neuropsychiatric symptoms; VCI = vascular cognitive impairment.
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Table 13–1. Definitions related to dementia
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Table 13–2. The four key elements of the dementia syndrome
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Table 13–3. Cortical versus subcortical subsyndromes of dementia
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Table 13–4. Contributing causes of neuropsychiatric symptoms
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Table 13–5. Evidence-based nonpharmacological treatments for neuropsychiatric symptoms
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Table 13–6. Guidelines for use of medications to treat neuropsychiatric symptoms
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Table 13–7. Supportive care for patients
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Table 13–8. Supportive care for the caregiver

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You have a 65-year-old patient who presents with a clinical syndrome consisting of a measurable decline in memory with little effect on day-to-day functioning. Which of the following best describes this syndrome?
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For the dementia syndrome to be present, key elements must be exhibited by the patient. Which of the following is not one of these key elements?
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Traditionally, dementia is differentiated into cortical and subcortical subsyndromes. Which of the following areas of impairment is indicative of subcortical dementia?
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