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Differential Diagnosis

The recognition of dementia is a two-step process.  Clinicians must first determine whether dementia exists or not.  In order to do so, other possible disorders such as those described below must first be ruled out.  Once this has occurred, specific causes of dementia can be identified [1].

Delirium

  • acute confusional state that develops over a short period of time

  • disturbance of consciousness with reduced attention span

  • change in cognition present i.e. memory deficit, disorientation, language disturbance

  • there is usually evidence of a medical cause e.g. drugs, infections, metabolic disorder and electrolytes/fluid imbalance [2]

Depression

  • very common in the elderly population

  • symptoms of weight loss or depressed mood lasting at least two weeks and a change from previous level

  • plus any 4 of  the following:  weight loss, insomnia/hypersomnia, fatigue, feelings of worthlessness/guilt, psychomotor agitation, decreased concentration, recurrent thoughts of death or suicidal ideation

  • may have patchy cognitive losses on testing [2]

Mild Cognitive Impairment (MCI)

  • impairment in memory only

  • all other cognitive functions are spared

  • preserved basic day to day functioning

  • no other obvious medical or psychiatric explanation for the memory problems

  • 10-15% of patients with MCI will progress to dementia per year, particularly the amnesic type MCI [3]

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1. Mendez MF, Cummings JL. Dementia: a clinical approach. 3rd ed. Philadelphia (PA): Elsevir Inc; 2003.

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM IV) 4th edition. Washington: The Association; 1994.

3. Morris JC, Storandt M, Miller JP, McKeen DW, Price JL, Rubin EH et al. Mild cognitive impairment represents early-stage Alzheimer's Disease. Archives of Neurology 2001; 58(3): 397-405.

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