Dementia

E51.2/E52/E63.9 + (F02.8*)

DESCRIPTION

Progressive loss of cognitive function, usually of insidious onset. Initial presentation may be with mild personality or memory changes, before more pronounced defects become evident. Investigate patients for potentially reversible causes:

  • Metabolic
    • Hypothyroidism
    • Vitamin B[12] deficiency
    • Pellagra
    • Thiamine deficiency (Wernicke’s syndrome)
  • Medications and drugs
    • Alcohol abuse
    • Many medicines with CNS side-effects
  • Infections
    • Syphilis
    • HIV
  • Surgical
    • Chronic subdural haematoma
    • Normal pressure hydrocephalus
  • Severe depression (may mimic dementia)

Conditions which may worsen already existing dementia include:

  • electrolyte disturbances and dehydration
  • infections
  • medicine toxicity

GENERAL MEASURES

  • Appropriate care and support, according to the level of impairment.
  • Ambulatory care is preferred to hospitalisation, if feasible.
  • Family counselling and support.

MEDICINE TREATMENT

Management is mainly symptomatic.

To control restless patients:

  • Haloperidol, oral, 0.75–1.5 mg 8 hourly with a higher dose at night, if required.

Note:

  • There is uncertainty of benefit versus harm of long-term use of antipsychotics in dementia, but antipsychotics may be of benefit in severe behavioural and psychological symptoms.
  • Inform the family of a possible elevated risk of mortality with prolonged use of antipsychotics.
  • If there is no improvement, stop the antipsychotic.
  • Initiate treatment at a low dose and titrate to the lowest effective dose for the shortest possible time. Reassess the person at least every 6 weeks, to check whether they still need medication.

LoEIII [19]

For pellagra :

  • Nicotinamide, oral, 100 mg 8 hourly.

Wernicke’s syndrome: E51.2 + (F02.8*)

  • Thiamine, IV, 500 mg 12 hourly for 3 days, followed by 500 mg daily for 3–5 days.
    • Follow with oral thiamine 100 mg 8 hourly.

Prophylaxis in patients at risk (alcoholism, malnutrition):

  • Thiamine, IM/oral, 100 mg 8 hourly for 14 days.

LoEIII [20]

Treat other commonly associated nutritional deficiencies:

If confirmed Vitamin B[12] deficiency, manage as Anaemia, megaloblastic.