7 There are two sets of diagnostic criteria for vascular dementia and these are summarized in Table I. Table 1. Key features of vascular dementia (VaD) according to the criteria of ADDTC (Alzheimer’s Disease
Diagnostic and Treatment Centers) and NIND-AIREN (National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l’Enseignement … Symptoms of Lewy-body dementia Lewy-body dementia is characterized by a fluctuating course with distressing psychotic symptoms and marked behavioral disturbance interspersed with periods of lucidity when the degree of cognitive impairment seems relatively- minor Inhibitors,research,lifescience,medical in relation to the severity of the behavioral disturbance. Consensus criteria have been agreed that incorporate these elements and are summarized below.8 Assessment of dementia The aim of investigations is to establish a diagnosis and to detect the presence of coexisting disorders. An
accurate diagnosis makes appropriate discussion Inhibitors,research,lifescience,medical of management and prognosis with the patient and their family. A diagnosis of AD will arouse anxieties in families about the genetic implications. Differentiating between AD and vascular dementia allows the clinician to give the family information about the course of the illness. The most important Inhibitors,research,lifescience,medical investigation is obtaining a full history from the patient together with further information from suitable informants such as family members, and will include the family doctor
who is an essential source of information about Inhibitors,research,lifescience,medical the patient’s family history, past medical and personal history, premorbid personality, social circumstances, and dynamics of family relationships. Discussion with a reliable informant will quickly establish the onset and chemical structure duration of the presenting problem. Difficulties with memory and changes in personality are universal. Problems encountered with hobbies, such as following a complicated Inhibitors,research,lifescience,medical knitting pattern or playing bridge, may be the first change noted. Knowledge of the course of the illness is important in distinguishing vascular dementia from AD. Evidence of psychotic symptoms such as hallucinations or delusions can be obtained from family members. Examination of the mental state will not show evidence of any self-neglect, physical illness may be apparent, and disinhibited or inappropriate behavior as might agitation or retardation indicating depression. Guarded or hostile behavior may indicate underlying paranoid ideas. Poor attention span (indicating clouding of consciousness) can be apparent and helpful in differentiating delirium from dementia. The patient’s speech will reveal evidence of aphasia or dysarthria.