What a general practitioner should know about dementia

Disorder of higher functions of the core is characteristic of dementia, which often affects old people. It is mainly caused by Alzheimer’s disease (AD), vascular dementia (VaD), fronto-temporal dementia and dementia with Lewy’s Bodies. The aetiology of AD is still unknown. The most important risk factors are APOE 4 gene, age, sex, short education period, professions that do not require intellectual activity and dementia among family members. The main pathomorphological changes are the presence of senile plaques and neurofibrillary tangles, whereas pathophysiological changes are disorders in the cholinergic system. AD manifests itself in insidious onset, slow course of the disease, memory, spatial orientation and behavioural disorders, aphasia, apraxia, agnosia, dyssomnia, difficulties in getting dressed and practising personal hygiene, and later on hallucinations, delusions, incontinent sphincters, lack of mobility, and finally infections and decubitus ulcers. Vascular dementia is generally caused by cerebral ischaemia. The main risk factors include age, sex, hypertension, level of education, smoking, diabetes, and hypercholesterolaemia. VaD differs from AD with a sudden onset, an irregular course of disease, criticism and mood depression. It is more frequent in men. Dementia with Lewy Bodies takes a course with intensified extrapyramidal disorders, whereas fronto-temporal dementia takes a course with behavioural disorders. In dementia diagnosis interview as well as laboratory, neuropsychological, CT and MRI investigations play an important role. In AD treatment cholinesterase inhibitors are most often used, whereas in VaD antiarteriosclerotic drugs and drugs improving cerebral circulation are usually used.