Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Dementia is a progressive and largely irreversible clinical syndrome that is characterised by a widespread impairment of mental function.
Although many people with dementia retain positive personality traits and personal attributes, as their condition progresses they can experience some or all of the following: memory loss, language impairment, disorientation, changes in personality, difficulties with activities of daily living, self-neglect, psychiatric symptoms (for example, apathy, depression or psychosis) and out-of-character behaviour (for example, aggression, sleep disturbance or disinhibited sexual behaviour, although the latter is not typically the presenting feature of dementia).
Making a diagnosis of dementia in the early stages can be a clinical challenge.
The insidious and variable emergence of dementia symptoms makes recognition of the syndrome problematic, particularly in the primary care setting, with the often limited time available for consultation (Iliffe S, 2009)
In addition, physicians need to be wary of patients' ability to hide their symptoms. In the early stages of dementia, accommodation to or denial of changes in cognition, functional ability, mood, or behavior are common coping strategies (Woods RT, 2003).
As the person's denial strengthens, the concerns of the family become more pressing, with the physician often caught in between and faced with apparently irreconcilable needs.
The proposed diagnostic criteria move away from the traditional 2-step approach of first identifying dementia according to degree of functional disability and then specifying its cause (Dubois D, 2007).
Instead, they aim to define the clinical, biochemical, structural, and metabolic presence of AD at the earliest stages before full-blown dementia.
These new criteria are centered on a clinical core of early and significant episodic memory impairment.
They stipulate that there also must be at least one or more abnormal biomarkers among structural neuroimaging with magnetic resonance imaging, molecular neuroimaging with PET, and CSF analysis of β-amyloid or τ proteins (Dubois D, 2007).
For example, a decrease in the β-amyloid (1–42) peptide and an increase in the τ and phospho-τ proteins may be the earliest signs of AD (Dubois B, 2009).
These criteria represent a cultural shift requiring a more biologically focused workup than previous approaches, and their timeliness is highlighted by the development of drugs that are directed at altering pathogenesis, particularly at the production and clearance of β-amyloid.
Behavioural Pathology in Alzheimer's Disease
To measure behavioural and psychological symptoms of dementia in persons with Alzheimer’s disease
Neuro-Psychiatric Inventory Questions
To assess psychopathology in the person with dementia and to help distinguish between the different causes of dementia
Dementia is one of 4 sub-domains of the
The Psychological Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
Back To : Comprehensive Geriatric Assessment
Back To : Psychological Assessment
Neuro-Psychiatric Inventory Questions - Instruction Manual
Instruction Manual for the NPI
Neuroimaging for Psychiatric Disorders
Go To : Neuroimaging for Psychiatric Disorders