Table of Contents
Overview – Dementia
Dementia is a clinical syndrome characterised by progressive cognitive decline that interferes with independence and daily functioning. It involves impairments in memory, attention, executive function, language, and social cognition, and is most commonly caused by neurodegenerative disorders like Alzheimer’s disease. Given its increasing global prevalence and significant impact on quality of life, early diagnosis and comprehensive management of dementia are essential in both hospital and community settings.
Definition
Dementia, now referred to in DSM-5 as “major neurocognitive disorder,” involves significant cognitive decline in one or more domains, with a clear interference in everyday activities and social or occupational independence.
DSM-5 Diagnostic Criteria
- A) Significant cognitive decline in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, social cognition), based on:
- 1: Concern expressed by the individual, an informant, or clinician
- 2: Objective evidence (neuropsychological testing or other quantified clinical assessment)
- B) Deficits interfere with independence in everyday activities (e.g. managing medications, finances)
- If interference is absent but decline is evident, this is termed mild neurocognitive disorder
- C) Deficits do not occur exclusively in the context of delirium
- D) Deficits are not better explained by another mental disorder (e.g. major depressive disorder, schizophrenia)
- E) For neurodegenerative dementias (e.g. Alzheimer’s), symptoms should have insidious onset and progressive course
Management
1. Investigate and Address Underlying Causes
- Screen for reversible causes:
- Blood tests: VDRL, HIV
- Imaging: CT head or SPECT scan
- Manage concurrent medical issues
2. Cognitive and Environmental Support
- Provide orientation aids: visible clocks, calendars, and familiar objects
- Encourage structured routine and caregiver involvement
- Inform transport authorities when driving becomes unsafe
3. Psychosocial Interventions
- Patient and family education
- Supportive services: day programs, respite care, support groups, home-based care
- Advance care planning: power of attorney, living wills, long-term care options
4. Pharmacological Therapy
- Cholinesterase inhibitors for mild to severe disease:
- Donepezil (Aricept®), rivastigmine, galantamine
- NMDA receptor antagonist for moderate to severe disease:
- Memantine
- Symptom-specific treatment for behavioural and emotional disturbances:
- Low-dose antipsychotics (e.g. risperidone, quetiapine)
- Antidepressants or trazodone as needed
- Follow “start low, go slow” principle
- Reassess pharmacotherapy every 3 months
Summary – Dementia
Dementia is a progressive decline in cognitive functioning that significantly interferes with daily life and independence. Management involves a combination of pharmacological therapy, caregiver support, environmental optimisation, and long-term planning. For a broader context, see our Psychiatry & Mental Health Overview page.