Dementia: Definitions and Clinical Course

Dementia is a brain disorder in which multiple cognitive functions progressively deteriorate. The deterioration is sufficiently severe to interfere with social or occupational functions. Memory, orientation, abstraction, ability to learn, visuospatial perception and constructional praxis are all impaired. Although memory is thought to be impaired early, this is not the case in all types of dementia. In some cases, behavioral changes such as disinhibition, poor judgment and social misconduct appear before memory fails; when memory fails in these cases, the impairment may only be mild. The progression of disease is chronic, over a period of months to years.

In a broader sense, the dementias are a group of diseases, or more appropriately, a symptom of organic brain disease. In contrast to delirious patients, dementia patients are fully awake and alert until late in the disease. The speed of deterioration depends mainly on the etiology. The degree of deterioration may be lower initially and the capability to compensate for deficits may be higher in patients with a baseline large intellectual reserve.

Classification of Dementias

Cortical
Frontotemporal

Subcortical

Subcortical dementias are characterized by psychomotor slowing. Examples of these are Huntington disease, progressive supranuclear palsy (PSP) and normal pressure hydrocephalus (NPH).

Patients with cortical dementias have

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