Dementias Classification

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Based on cause

Alzheimer's Cerebrovascular

Multi-infarct dementia Subcortical vascular disease (Binswanger's disease) Neurodegenerative Pick's disease Huntington's chorea Parkinson's disease Infectious

Creutzfeld-Jakob disease HIV infection Viral encephalitis Progressive multifocal leucoencephalopathy Normal pressure hydrocephalus

Nutritional

Wernicke Korsakoff

(thiamine deficiency) B12 deficiency Folate deficiency Metabolic

Hepatic disease Thyroid disease Parathyroid disease Cushing's syndrome Chronic inflammatory

Collagen vascular disease and vasculitis Multiple sclerosis Trauma

Head injury

'Punch drunk' syndrome Tumour e.g. Subfrontal meningioma

Alzheimer's disease accounts for 60% of all dementias; cerebrovascular disease 20%.

It is important to investigate all patients with dementia as many causes are treatable; in practice 10-15% can be reversed.

Based on site

Subdividing dementia depending upon the site of predominant clinical involvement is of questionable diagnostic value. However, many clinicians use this classification:

Anterior

(Frontal premotor cortex)

Behavioural changes/loss of inhibition, antisocial behaviour, facile and irresponsible

e.g. Normal pressure hydrocephalus Huntington's chorea Metabolic disease

Anterior

(Frontal premotor cortex)

Behavioural changes/loss of inhibition, antisocial behaviour, facile and irresponsible

e.g. Normal pressure hydrocephalus Huntington's chorea Metabolic disease or

Posterior

(Parietal and temporal lobes)

Disturbance of cognitive function

(memory and language) without marked changes in behaviour

ALZHEIMER'S DISEASE

Subcortical

Apathetic

Forgetful and slow, poor ability to use knowledge Associated with other neurological signs and movement disorders

e.g. PARKINSON'S DISEASE

AIDS DEMENTIA COMPLEX

Subcortical

Apathetic

Forgetful and slow, poor ability to use knowledge Associated with other neurological signs and movement disorders

e.g. PARKINSON'S DISEASE

AIDS DEMENTIA COMPLEX

Cortical

Higher cortical abnormalities

- dysphasia

- agnosia

- apraxia

e.g. ALZHEIMER'S DISEASE

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