Mohammed T. Abou-Saleh

186 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYTable 36.1Dementia (DSM-IV) (adapted)A1A2BMemory impairment (impaired ability to learn new information or to recall previously learned information)andOne (or more) of the following cognitive disturbances:(a) Aphasia(b) Apraxia(c) Agnosia(d) Disturbance in executive functioningThe cognitive deficit in A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline froma previous level of functioningAmerican Psychiatric Association 2 .Table 36.2Dementia (DSM-III-R) (adapted)ABCDEDemonstrable evidence of impairment in short and long-term memoryandAt least one of the following:(i) Impairment in abstract thinking(ii) Impaired judgement(iii) Other disturbances of higher cortical function, such as:aphasia, apraxia, agnosia, constructional difficulty(iv) Personality changeThe disturbance in A+B significantly interferes with work or usual social activities or relationships with othersNot occurring exclusively during the course of deliriumEither (1) there is evidence from the history, physical examination, or laboratory tests of a specific organic factor (or factors) judged to be etiologicallyrelated to the disturbance, or (2) in the absence of such evidence, an etiologic organic factor can be presumed if the disturbance cannot beaccounted for by any non-organic mental disorderAmerican Psychiatric Association 1 .Table 36.3ICD-10 Criteria for dementia. Definition of dementia in the ICD-10 (adapted)G1 There is evidence of each of the following:(1) A decline in memory (at least) sufficient to interfere with everyday activities, though not so severe as to be incompatible with independent living(2) A decline in other cognitive abilities characterized by deterioration in judgement and thinking, such as planning and organizing, and in the generalprocessing of information (at least) sufficient to cause impaired performance in daily living, but not to a degree that makes the individualdependent on othersG2 Awareness of the environment (i.e. absence of clouding of consciousness)G3 There is a decline in emotional control or motivation, or a change in social behaviour manifest as at least one of emotional lability, irritability, apathyor coarsening of social behaviourG4 The symptoms in criterion G1 should have been present for at least 6 monthsWorld Health Organization 3 .Table 36.4NINCDS–ADRDA Criteria for Alzheimer’s disease1. Probable Alzheimer’s disease:DementiaDeficits in two or more areas of cognitionProgressive worsening of memory and other cognitive functionsNo disturbance of consciousnessOnset between ages 40 and 90Absence of systemic disorders or other diseases that in and of themselves could account for the progressive deficits in memory and cognition2. Possible Alzheimer’s disease:DementiaVariations in the onset, in the presentation, or in the clinical courseMay be made in the presence of a second systemic or brain disorder sufficient to produce dementia, which is not considered to be the cause of thedementiaShould be used in research studies when a single, gradually progressive severe cognitive deficit is identified in the absence of other identifiable causeMcKhann et al. 29 .Vascular DementiaVascular dementia is a dementia caused by different forms ofcerebrovascular disorder (CVD) 9,10 , most often stroke andischaemic white matter lesions (WMLs). The Hachinski IschemicScore 11 was the most widely used instrument for the diagnosis ofvascular dementia, or rather multi-infarct dementia (MID), fromthe 1970s to the early 1990s. It consists of a symptom checklistthat incorporates some of the symptoms that are believed to beessential in MID, such as abrupt onset, stepwise deterioration,fluctuating course, a history of stroke, and focal neurologicalsymptoms and signs. The assumption was that MID was caused