Curriculum · Neurology
Differentiating the dementias in an older adult
What it is
An older adult with memory impairment, inappropriate behavior, disturbance of sleep and impaired activities of daily living including showering, cooking and self care over two years of progressive deficits does not yet have a named dementia. The options set against each other are Alzheimer's dementia, dementia with Lewy bodies, Parkinson's dementia and fronto-temporal dementia, and what separates them is the history each one opens with rather than the memory loss they share.
How it presents
The opening history is what the named forms are told apart by:
- Alzheimer's: short term memory, then long term memory, then social graces, a chronic and insidious course.
- Pick's Disease: personality first, memory later.
- Lewy Body: delirium.
- Multi-Infarct: acute exacerbation with a CVA.
- CJD: myoclonus with rapid decline.
- Normal Pressure Hydrocephalus: ataxic gait, urinary incontinence and dementia.