Dementia: Its Definition, Differential Diagnosis, and Subtypes

Excerpt

Dementia, not unlike heart failure or renal insufficiency, is a generic term that makes little assumption about etiology. Because there are no specific laboratory tests, however, its diagnosis relies exclusively on clinical criteria. The presence of dementia should be suspected whenever mental changes of insidious onset emerge without sufficient situational stress and gradually interfere with the daily living activities that are appropriate for age and background. Dementia can be reversible or irreversible, precipitously progressive or indolent, bristling with multiple cognitive deficits, or characterized almost exclusively by disturbances of affect, motivation, and personality. When the behavioral changes are dramatic and interfere with active careers in younger individuals, early diagnosis poses little difficulty. The real challenge arises among the elderly, in whom dementia is also far more common. This is because the elderly tend to have less demanding daily activities, the disruption of which may take longer to detect, and also because