Dementia In The Elderly

Medication Review


Dementia takes on many forms and types, yet, we are still unaware of what causes these diseases.  Alzheimer’s Disease (AD) is the most common form of dementia, affecting up to 80% of patients who are diagnosed.  This number has been growing exponentially over the last few years and will continue to do so.  Current numbers:9

  1. Alzheimer’s is the 6th leading cause of death in the United States.
  2. Between 2000 and 2015 deaths from heart disease have decreased 11%, which deaths from Alzheimer’s have increased 123%.
  3. It is estimated in 2018 that Alzheimer’s and other dementias will cost the nation $277 BILLION by 2050, and early diagnosis could save up to $7.9 TRILLION in medical and care costs.

Presentation and detection of dementia is complicated in day to day practice. Most patients do not present with a complaint of memory loss.  Rather, it is a relative or caregiver who brings up issues with memory problems.  One study’s results sowed that the diagnosis of dementia was missed in 21% of demented patients on a hospital ward, and 20% of NON-demented patients were diagnosed with dementia.1 There are also other forms of dementia, and proper diagnosis is very important.

Four Types of Common Dementia

Many people attribute “forgetfulness” and “memory problems” to normal aging.  This allows the disease to go undiagnosed for longer periods of time.  A thorough history is essential.  Most family members/caregivers have a hard time pin pointing when memory loss actually started since it is so insidious in onset.  By the time it I brought to the attention of the PCP, the disease may have been present for a few years.  The diagnosis must be differentiated from delirium and depression as well.  (Table 1).

Let’s look at some of the known risk factors for dementia.  (CDC, 2015)10

  1. Age – this is the strongest risk factor
  2. Genetics
  3. Vascular (Hypertension, Hypercholesterolemia, Diabetes) – These have been shown to be linked to cognitive decline, but not shown to decrease dementia if treated
  4. Lack of social, mental and physical activity
  5. Head trauma, obesity, alcohol abuse, depression