According to the World Health Organisation, dementia is a set of symptoms caused by a brain disease, usually chronic or progressive, clinically characterised by multiple impairments of higher cortical functions such as memory, thinking, orientation, comprehension, counting, learning ability, language competence and criticism.
In addition to the aforementioned disease processes, dementia also accompanies a number of other conditions, these are:
- tumours and other brain tumours
- metabolic disorders such as thyroid disease, Cushing's disease, Addison's disease, liver or kidney failure
- b vitamin deficiencies, complex nutritional deficiencies or deficiencies due to parasitic diseases
- bacterial, parasitic, fungal or viral (including HIV) neuroinfections
- side effects of medications, most commonly psychotropic, anticonvulsant, general anaesthetic, antiarrhythmic drugs
- mental disorders, mainly schizophrenia and depression
- autoimmune diseases, e.g. systemic lupus, vasculitis, multiple sclerosis
- chronic exposure to toxins - alcohol, heavy metals, solvents, pesticides
- hydrocephalus, chronic obstructive pulmonary disease, nocturnal apnoea syndrome
Diagnosis of dementia and determination of cause
Crucial to the diagnosis of dementia is the finding of cognitive decline and associated symptoms such as behavioural disorders or psychosis. Neuroimaging examinations - magnetic resonance imaging or computed tomography - are also used in every case of dementia. The main purpose of performing these examinations is to exclude potentially reversible lesions such as brain tumours, haematomas or normotensive hydrocephalus.
photo ojoimages
In addition to neuroimaging examinations in the detection of potentially reversible dementing changes, there are blood morphology examinations, biochemical examinations of liver and kidney function, TSH, vitamin B12 concentration tests and serological examinations for central nervous system infections.
Dementia differentiation
At the initial stage, it should be determined whether it is indeed dementia due to organic brain damage or a potentially reversible cognitive deficit. Depression, anxiety disorders, substance abuse or psychosis should be excluded. The next step is to differentiate between degenerative and vascular dementia. Primary degenerative dementia has characteristic clinical aspects, e.g. age of onset, rate of progression of symptoms, accompanying neurological symptoms, behavioural disturbances.
In most cases, the clinical diagnosis is probable or only possible, while a definite diagnosis is usually only possible on the basis of neuropathological examination.
