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. 1981 Dec;135(6):469–481.

Diagnosis and Treatment of Dementia in the Aged

Gary W Small 1,2,3,4, Lissy F Jarvik 1,2,3,4, Edward H Liston 1,2,3,4
PMCID: PMC1273321  PMID: 6121426

Abstract

Dementia affects an estimated 5 percent of the population 65 years of age and older, with 20 percent being affected at 75 years or older. Although the most common forms, primary degenerative and multi-infarct dementia, currently lack specific treatments, it is estimated that a thorough diagnostic evaluation will uncover a treatable cause in 10 percent to 20 percent. The differential diagnosis includes benign senescent forgetfulness, depression, adjustment disorder, paranoid states, amnestic syndrome, delirium, drug effects, systemic illnesses and intracranial conditions. The approach to each patient involves a history, physical examination, mental status evaluation and laboratory tests that focus on identifying treatable conditions. When no specific treatments are available, however, symptomatic treatments, including pharmacotherapy, environmental management, family supports and psychotherapy, can offer relief for both patients and their families and improve the daily functioning of the elderly patient with dementia.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ADAMS R. D., FISHER C. M., HAKIM S., OJEMANN R. G., SWEET W. H. SYMPTOMATIC OCCULT HYDROCEPHALUS WITH "NORMAL" CEREBROSPINAL-FLUID PRESSURE.A TREATABLE SYNDROME. N Engl J Med. 1965 Jul 15;273:117–126. doi: 10.1056/NEJM196507152730301. [DOI] [PubMed] [Google Scholar]
  2. Albert M. L., Feldman R. G., Willis A. L. The 'subcortical dementia' of progressive supranuclear palsy. J Neurol Neurosurg Psychiatry. 1974 Feb;37(2):121–130. doi: 10.1136/jnnp.37.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Ashford J. W., Soldinger S., Schaeffer J., Cochran L., Jarvik L. F. Physostigmine and its effect on six patients with dementia. Am J Psychiatry. 1981 Jun;138(6):829–830. doi: 10.1176/ajp.138.6.829. [DOI] [PubMed] [Google Scholar]
  4. BEDFORD P. D. General medical aspects of confusional states in elderly people. Br Med J. 1959 Aug 15;2(5145):185–188. doi: 10.1136/bmj.2.5145.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Blessed G., Tomlinson B. E., Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry. 1968 Jul;114(512):797–811. doi: 10.1192/bjp.114.512.797. [DOI] [PubMed] [Google Scholar]
  6. Bondareff W., Mountjoy C. Q., Roth M. Selective loss of neurones of origin of adrenergic projection to cerebral cortex (nucleus locus coeruleus) in senile dementia. Lancet. 1981 Apr 4;1(8223):783–784. doi: 10.1016/s0140-6736(81)92657-x. [DOI] [PubMed] [Google Scholar]
  7. Burrows G. D., Vohra J., Hunt D., Sloman J. G., Scoggins B. A., Davies B. Cardiac effects of different tricyclic antidepressant drugs. Br J Psychiatry. 1976 Oct;129:335–341. doi: 10.1192/bjp.129.4.335. [DOI] [PubMed] [Google Scholar]
  8. Celesia G. G., Wanamaker W. M. Psychiatric disturbances in Parkinson's disease. Dis Nerv Syst. 1972 Sep;33(9):577–583. [PubMed] [Google Scholar]
  9. Davies P., Maloney A. J. Selective loss of central cholinergic neurons in Alzheimer's disease. Lancet. 1976 Dec 25;2(8000):1403–1403. doi: 10.1016/s0140-6736(76)91936-x. [DOI] [PubMed] [Google Scholar]
  10. Davis K. L., Mohs R. C., Tinklenberg J. R. Enhancement of memory by physostigmine. N Engl J Med. 1979 Oct 25;301(17):946–946. doi: 10.1056/NEJM197910253011722. [DOI] [PubMed] [Google Scholar]
  11. Davis K. L., Mohs R. C., Tinklenberg J. R., Pfefferbaum A., Hollister L. E., Kopell B. S. Physostigmine: improvement of long-term memory processes in normal humans. Science. 1978 Jul 21;201(4352):272–274. doi: 10.1126/science.351807. [DOI] [PubMed] [Google Scholar]
  12. Drachman D. A., Sahakian B. J. Memory and cognitive function in the elderly. A preliminary trial of physostigmine. Arch Neurol. 1980 Oct;37(10):674–675. doi: 10.1001/archneur.1980.00500590098022. [DOI] [PubMed] [Google Scholar]
  13. ENGEL G. L., ROMANO J. Delirium, a syndrome of cerebral insufficiency. J Chronic Dis. 1959 Mar;9(3):260–277. doi: 10.1016/0021-9681(59)90165-1. [DOI] [PubMed] [Google Scholar]
  14. Etienne P., Gauthier S., Dastoor D., Collier B., Ratner J. Lecithin in Alzheimer's disease. Lancet. 1978 Dec 2;2(8101):1206–1206. doi: 10.1016/s0140-6736(78)92191-8. [DOI] [PubMed] [Google Scholar]
  15. Feinberg I., Koresko R. L., Heller N. EEG sleep patterns as a function of normal and pathological aging in man. J Psychiatr Res. 1967 Jun;5(2):107–144. doi: 10.1016/0022-3956(67)90027-1. [DOI] [PubMed] [Google Scholar]
  16. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  17. Ford C. V., Winter J. Computerized axial tomograms and dementia in elderly patients. J Gerontol. 1981 Mar;36(2):164–169. doi: 10.1093/geronj/36.2.164. [DOI] [PubMed] [Google Scholar]
  18. Fox J. H., Kaszniak A. W., Huckman M. Computerized tomographic scanning not very helpful in dementia--nor in craniopharyngioma. N Engl J Med. 1979 Feb 22;300(8):437–437. doi: 10.1056/NEJM197902223000819. [DOI] [PubMed] [Google Scholar]
  19. Fox J. H., Topel J. L., Huckman M. S. Dementia in the elderly--a search for treatable illnesses. J Gerontol. 1975 Sep;30(5):557–564. doi: 10.1093/geronj/30.5.557. [DOI] [PubMed] [Google Scholar]
  20. Gaitz C. M., Varner R. V., Overall J. E. Pharmacotherapy for organic brain syndrome in late life. Evaluation of an ergot derivative vs placebo. Arch Gen Psychiatry. 1977 Jul;34(7):839–845. doi: 10.1001/archpsyc.1977.01770190101010. [DOI] [PubMed] [Google Scholar]
  21. Gordon E. B., Sim M. The E.E.G. in presenile dementia. J Neurol Neurosurg Psychiatry. 1967 Jun;30(3):285–291. doi: 10.1136/jnnp.30.3.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Gustafson L., Risberg J., Hagberg B., Hougaard K., Nilsson L., Ingvar D. H. Cerebral blood flow, EEG and psychometric variables related to clinical findings in presenile dementia. Acta Neurol Scand Suppl. 1972;51:439–440. [PubMed] [Google Scholar]
  23. Hachinski V. C., Iliff L. D., Zilhka E., Du Boulay G. H., McAllister V. L., Marshall J., Russell R. W., Symon L. Cerebral blood flow in dementia. Arch Neurol. 1975 Sep;32(9):632–637. doi: 10.1001/archneur.1975.00490510088009. [DOI] [PubMed] [Google Scholar]
  24. Hughes C. P., Gado M. Computed tomography and aging of the brain. Radiology. 1981 May;139(2):391–396. doi: 10.1148/radiology.139.2.6971454. [DOI] [PubMed] [Google Scholar]
  25. Isaacs B., Kennie A. T. The Set test as an aid to the detection of dementia in old people. Br J Psychiatry. 1973 Oct;123(575):467–470. doi: 10.1192/bjp.123.4.467. [DOI] [PubMed] [Google Scholar]
  26. Jacobs J. W., Bernhard M. R., Delgado A., Strain J. J. Screening for organic mental syndromes in the medically ill. Ann Intern Med. 1977 Jan;86(1):40–46. doi: 10.7326/0003-4819-86-1-40. [DOI] [PubMed] [Google Scholar]
  27. Jarvik L. F., Ruth V., Matsuyama S. S. Organic brain syndrome and aging. A six-year follow-up of surviving twins. Arch Gen Psychiatry. 1980 Mar;37(3):280–286. doi: 10.1001/archpsyc.1980.01780160050005. [DOI] [PubMed] [Google Scholar]
  28. KAHN R. L., GOLDFARB A. I., POLLACK M., PECK A. Brief objective measures for the determination of mental status in the aged. Am J Psychiatry. 1960 Oct;117:326–328. doi: 10.1176/ajp.117.4.326. [DOI] [PubMed] [Google Scholar]
  29. KILOH L. G. Pseudo-dementia. Acta Psychiatr Scand. 1961;37:336–351. doi: 10.1111/j.1600-0447.1961.tb07367.x. [DOI] [PubMed] [Google Scholar]
  30. KRAL V. A. Senescent forgetfulness: benign and malignant. Can Med Assoc J. 1962 Feb 10;86:257–260. [PMC free article] [PubMed] [Google Scholar]
  31. Kahn R. L., Zarit S. H., Hilbert N. M., Niederehe G. Memory complaint and impairment in the aged. The effect of depression and altered brain function. Arch Gen Psychiatry. 1975 Dec;32(12):1569–1573. doi: 10.1001/archpsyc.1975.01760300107009. [DOI] [PubMed] [Google Scholar]
  32. Kaplitz S. E. Withdrawn, apathetic geriatric patients responsive to methylphenidate. J Am Geriatr Soc. 1975 Jun;23(6):271–276. doi: 10.1111/j.1532-5415.1975.tb00317.x. [DOI] [PubMed] [Google Scholar]
  33. Katon W., Raskind M. Treatment of depression in the medically ill elderly with methylphenidate. Am J Psychiatry. 1980 Aug;137(8):963–965. doi: 10.1176/ajp.137.8.963. [DOI] [PubMed] [Google Scholar]
  34. Katzman R. Editorial: The prevalence and malignancy of Alzheimer disease. A major killer. Arch Neurol. 1976 Apr;33(4):217–218. doi: 10.1001/archneur.1976.00500040001001. [DOI] [PubMed] [Google Scholar]
  35. Libow L. S. Pseudo-senility: acute and reversible organic brain syndromes. J Am Geriatr Soc. 1973 Mar;21(3):112–120. doi: 10.1111/j.1532-5415.1973.tb00855.x. [DOI] [PubMed] [Google Scholar]
  36. Liston E. H. Clinical findings in presenile dementia. A report of 50 cases. J Nerv Ment Dis. 1979 Jun;167(6):337–342. doi: 10.1097/00005053-197906000-00002. [DOI] [PubMed] [Google Scholar]
  37. Marsden C. D., Harrison M. J. Outcome of investigation of patients with presenile dementia. Br Med J. 1972 Apr 29;2(5808):249–252. doi: 10.1136/bmj.2.5808.249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Myrianthopoulos N. C. Huntington's chorea. J Med Genet. 1966 Dec;3(4):298–314. doi: 10.1136/jmg.3.4.298. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Nott P. N., Fleminger J. J. Presenile dementia: the difficulties of early diagnosis. Acta Psychiatr Scand. 1975 Mar;51(3):210–217. doi: 10.1111/j.1600-0447.1975.tb00006.x. [DOI] [PubMed] [Google Scholar]
  40. Pathy M. S. Clinical presentation of myocardial infarction in the elderly. Br Heart J. 1967 Mar;29(2):190–199. doi: 10.1136/hrt.29.2.190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Paulson G. W. The neurological examination in dementia. Contemp Neurol Ser. 1977;15:169–188. [PubMed] [Google Scholar]
  42. Perry E. K., Tomlinson B. E., Blessed G., Bergmann K., Gibson P. H., Perry R. H. Correlation of cholinergic abnormalities with senile plaques and mental test scores in senile dementia. Br Med J. 1978 Nov 25;2(6150):1457–1459. doi: 10.1136/bmj.2.6150.1457. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975 Oct;23(10):433–441. doi: 10.1111/j.1532-5415.1975.tb00927.x. [DOI] [PubMed] [Google Scholar]
  44. Poliquin N., Straker M. A clinical psychogeriatric unit: organization and function. J Am Geriatr Soc. 1977 Mar;25(3):132–137. doi: 10.1111/j.1532-5415.1977.tb00275.x. [DOI] [PubMed] [Google Scholar]
  45. Prien R. F., Caffey E. M., Jr Pharmacologic treatment of elderly patients with organic brain syndrome: a survey of twelve Veterans Administration Hospitals. Compr Psychiatry. 1977 Nov-Dec;18(6):551–560. doi: 10.1016/s0010-440x(97)90005-5. [DOI] [PubMed] [Google Scholar]
  46. ROTH M., MORRISSEY J. D. Problems in the diagnosis and classification of mental disorder in old age; with a study of case material. J Ment Sci. 1952 Jan;98(410):66–80. doi: 10.1192/bjp.98.410.66. [DOI] [PubMed] [Google Scholar]
  47. Rosen W. G., Terry R. D., Fuld P. A., Katzman R., Peck A. Pathological verification of ischemic score in differentiation of dementias. Ann Neurol. 1980 May;7(5):486–488. doi: 10.1002/ana.410070516. [DOI] [PubMed] [Google Scholar]
  48. Signoret J. L., Whiteley A., Lhermitte F. Influence of choline on amnesia in early Alzheimer's disease. Lancet. 1978 Oct 14;2(8094):837–837. doi: 10.1016/s0140-6736(78)92612-0. [DOI] [PubMed] [Google Scholar]
  49. Sitaram N., Weingartner H., Gillin J. C. Human serial learning: enhancement with arecholine and choline impairment with scopolamine. Science. 1978 Jul 21;201(4352):274–276. doi: 10.1126/science.351808. [DOI] [PubMed] [Google Scholar]
  50. Small G., Mandel M. R. The medically ill elderly, tricyclic response, and ECT. Am J Psychiatry. 1981 May;138(5):703–704. doi: 10.1176/ajp.138.5.aj1385703. [DOI] [PubMed] [Google Scholar]
  51. Smith J. S., Kiloh L. G. The investigation of dementia: results in 200 consecutive admissions. Lancet. 1981 Apr 11;1(8224):824–827. doi: 10.1016/s0140-6736(81)92692-1. [DOI] [PubMed] [Google Scholar]
  52. Sroka H., Elizan T. S., Yahr M. D., Burger A., Mendoza M. R. Organic mental syndrome and confusional states in Parkinson's disease. Relationship to computerized tomographic signs of cerebral atrophy. Arch Neurol. 1981 Jun;38(6):339–342. doi: 10.1001/archneur.1981.00510060041004. [DOI] [PubMed] [Google Scholar]
  53. Tomlinson B. E., Blessed G., Roth M. Observations on the brains of demented old people. J Neurol Sci. 1970 Sep;11(3):205–242. doi: 10.1016/0022-510x(70)90063-8. [DOI] [PubMed] [Google Scholar]
  54. WILLIAMSON J., STOKOE I. H., GRAY S., FISHER M., SMITH A., MCGHEE A., STEPHENSON E. OLD PEOPLE AT HOME. THEIR UNREPORTED NEEDS. Lancet. 1964 May 23;1(7343):1117–1120. doi: 10.1016/s0140-6736(64)91803-3. [DOI] [PubMed] [Google Scholar]
  55. Wells C. E., Buchanan D. C. The clinical use of psychological testing in evaluation for dementia. Contemp Neurol Ser. 1977;15:189–204. [PubMed] [Google Scholar]
  56. Wells C. E. Chronic brain disease: an overview. Am J Psychiatry. 1978 Jan;135(1):1–12. doi: 10.1176/ajp.135.1.1. [DOI] [PubMed] [Google Scholar]
  57. Wells C. E. Pseudodementia. Am J Psychiatry. 1979 Jul;136(7):895–900. doi: 10.1176/ajp.136.7.895. [DOI] [PubMed] [Google Scholar]
  58. Williamson J. Prescribing problems in the elderly. Practitioner. 1978 May;220(1319):749–755. [PubMed] [Google Scholar]
  59. Wilson W. P., Musella L., Short M. J. The electroencephalogram in dementia. Contemp Neurol Ser. 1977;15:205–221. [PubMed] [Google Scholar]
  60. Wiśniewski H. M., Coblentz J. M., Terry R. D. Pick's disease. A clinical and ultrastructural study. Arch Neurol. 1972 Feb;26(2):97–108. doi: 10.1001/archneur.1972.00490080015001. [DOI] [PubMed] [Google Scholar]

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