The Singapore Family Physician

Back to issue Vol 39 No. 2 - Dementia

Overview of Dementia and Diagnosis of Dementia

Nagaendran Kandiah
The Singapore Family Physician Vol 39 No 2 - Dementia
8 - 14
1 June 2013
Dementia is a syndrome characterised by cognitive, behavioural and neurological deficits. Both neurodegenerative and non-neurodegenerative conditions can result in dementia. Nuerodegenerative diseases include diseases such as Alzheimer’s disease, Frontotemporal Dementia and Dementia with Lewy body, while non-neurodegenerative conditions include conditions such as vascular dementia and normal pressure hydrocephalus. The prevalence of dementia is on a rising trend with the rapidly ageing population in Singapore. Early diagnosis of dementia is important to allow timely pharmacological and non-pharmacological interventions. A thorough history, cognitive evaluation along with suitable investigational studies is necessary for early diagnosis. The ability to diagnose dementia at the earliest stages has been greatly improved with the use of biomarkers such as medial temporal atrophy on MR imaging and cerebrospinal fluid beta amyloid levels. A 4-step approach to dementia evaluation, incorporating local data, where possible can be used: The first step requires the exclusion of delirium as the cause of the forgetfulness or confusion; the second step involves establishing the diagnosis of dementia; the third step assesses for the behavioural, functional and social problems associated with dementia; and the final step, with the use of a focused history, physical examination, investigations and selected use of neuroimaging, attempts to establish the aetiological diagnosis of the dementia. The management of dementia requires a multidisciplinary approach. While acetyl cholinesterase inhibitors and NMDA antagonist can slow cognitive deterioration, research for newer disease modifying drugs which target the underlying pathology is ongoing. Research into non-pharmacological interventions such as cognitive training is also on-going.