What Is the Connection Between Dementia and Hallucinations?

Dementia is chronic acquired progressive mental retardation syndrome. It is clinically characterized by the slow decline of intelligence, accompanied by varying degrees of personality. It is a group of clinical syndromes, not a separate disease.

Basic Information

English name

dementia

Common causes

CNS degeneration: Alzheimer's disease, fronto-temporal dementia, etc. Non-degenerative dementia: infection, traumatic brain injury, hydrocephalus, poisoning, hypoxia, etc.

Common symptoms

Slowly appearing intellectual decline is the main feature, accompanied by varying degrees of personality change.

Causes and classification of dementia

There are many causes of dementia, which are mainly divided into degenerative dementia and non-degenerative dementia.

Central nervous system degenerative disease

Alzheimer's disease, fronto-temporal dementia, Prion's disease (Creutzfeldt-Jakobdisease, CJD, among the main types), Lewy body dementia, Parkinson's disease, Huntington's disease.

2. Non-Degenerative Dementia

(1) Vascular dementia.

(2) Occupying lesions: tumors, chronic subdural hematomas, chronic brain abscesses.

(3) Infection: meningoencephalitis, neurosyphilis, AIDS dementia, Ruan protein disease.

(4) Traumatic dementia.

(5) Normal intracranial hydrocephalus.

(6) Endocrine and metabolic disorders Endocrine disorders, Cushing's syndrome, hyperinsulinemia, hypothyroidism, hypopituitarism, hypoglycemia. Liver failure, kidney failure, lung failure. chronic electrolyte disorders. Hematoporphyria. Vitamin deficiency: Vitamin B1, niacin, folic acid, vitamin B ₁₂ and other deficiency.

(7) Poisoning and hypoxia (alcohol, heavy metals, carbon monoxide, drugs, hypoxia, etc.).

(8) Paraneoplastic syndrome.

Clinical manifestations of dementia

How slowly the occurrence of dementia conceals. Memory loss is the main core symptom. Early onset of near-memory disorders and a marked decline in the ability to learn new things, even in severe cases cannot find a way home. As the disease progresses further, distant memory is also impaired. Slow and poor thinking, poorer understanding and judgment of general things, and increasingly impaired attention, time, place, and character disorientation can occur, and sometimes they can't write and can't identify people.

Another early symptom of dementia is decreased ability to learn new knowledge and master new skills. Its abstract thinking, generalization, comprehensive analysis and judgment ability progressively diminish. Impaired memory and judgment can cause dysfunction, and patients lose time, place, people, and even their ability to recognize. Therefore, it is often day and night without knowing the way home or roaming for no purpose.

In terms of emotions, patients may experience emotional instability at an early stage, and gradually become indifferent and dull in the course of disease progression. Sometimes emotions lose control and become superficial and changeable. Manifestation of anxiety, depression, or indifference, or outrage, easy to cry and laugh, unable to control oneself.

Some patients may experience personality changes first. Usually show reduced interest, poor initiative, social withdrawal, but can also be manifested as uninhibited behaviors, such as impulsiveness, naive behavior, etc. The patient's social function is impaired, and work that is familiar to him cannot be completed. Late life can not take care of themselves, motor function is gradually lost, and even clothing, bathing, eating and defecation require assistance from others. Even mania, hallucinations, etc. appear.

Dementia check

Blood and cerebrospinal fluid examination

Folic acid, vitamin B ₁₂ , thyroid function, four infections, blood routine, biochemical all; serum amyloid precursor, presenilin, ApoE gene, tumor markers, etc.

2. Determine Tau protein quantification and amyloid fragments.

3. Imaging examination

CT scan shows brain atrophy, enlarged ventricle, and cerebral infarction, which can provide basis for the nature and type of dementia. MRI examination shows bilateral temporal lobe, hippocampal atrophy provides a strong basis for AD. In recent years, it has been used in clinical functional MRI. Early diagnosis of AD has good specificity and sensitivity. SPECT and PET are based on the principles of glucose metabolism and cerebral blood flow distribution. The images shown by 18F-FDG can show the parietal lobe, temporal lobe, and frontal lobe, especially bilaterally. Reduced blood flow and metabolism in the temporal lobe hippocampus.

4. Electrophysiological examination

EEG, P300 analysis.

5. Neuropsychological test

Commonly used tools are the Wechsler Adult Intelligence Scale (WAIS-CR), the Wechsler Memory Scale (WMS-CR), the Mini Mental State Scale (MMSE), the Daily Life Function Scale (ADL), Alzheimer's Dementia Scale (ADAS), Alzheimer's Dementia Cognitive Scale (ADAS-cog), Blessed Behavior Scale and Cognitive Ability Screening Scale (CASI), etc. The above scales can be used in combination or can be applied separately. It is based on clinical needs and patient compliance. Neuropsychological tests are mainly used to distinguish dementia from non-dementia in terms of cognitive function, but the diagnosis of dementia cannot be made based on a test result alone.

Dementia diagnosis

Objective evidence sheets clearly indicate short-term or episodic memory impairment. For patients with suspected dementia, screening for blood routine, serum calcium, phosphorus, blood glucose, renal, liver, and thyroid function, blood vitamin B12 and folic acid, and syphilis serum screening are required. Nervous system imaging can also be done according to clinical needs to determine the cause. Physical examination is also very important. Patients with dementia caused by most intracranial diseases often have signs of neurological localization. The diagnosis is mainly based on the following scales:

Diagnostic scale for dementia

(1) MMSE: a total of 30 items, including orientation, long-term and short-term memory, attention, calculation and operation.

(2) Hastgawadementiascale (HDS).

(3) The Blessed Dementia Scale is also called the Common Sense Memory Attention Scale.

(4) Extended Dementia Scale (ESD).

(5) Clinical Memory Scale (CMS).

(6) Wechsler Memory Scale (WMS).

2. Dementia Rating Scale

(1) The Daily Life Scale (ADL) includes the Physical Self-care Scale (PSMS) and the Instrumental Daily Life Ability Scale (IADL).

(2) The clinical dementia scale (CDR) includes memory, orientation, problem solving, social affairs, family life, hobbies, and personal care.

(3) The GDS is divided into 7 levels.

Differential diagnosis of dementia

First of all, we should pay attention to distinguish it from pseudo-dementia caused by depression, toxicity in old age, reactive psychosis and so on. It should also be distinguished from delirium. Second, try to find the cause of dementia.

Dementia Treatment

The cause of dementia treatment should be clear and targeted to the cause. If it is caused by neurodegenerative disease, there is no specific medicine for treatment, and the main purpose is to improve cognition and symptomatic treatment. Although some nootropic drugs (such as cholinesterase inhibitors) can improve patients' ability to accept new things in the short term, and delay the further exacerbation of dementia, its long-term efficacy remains to be seen. Antipsychotics can be used to combat psychotic symptoms, aggressive behavior, or aggressive behavior. Antidepressants can be used in patients with dementia and depression to help improve dementia syndrome. However, it must be noted that the anticholinergic side effects of tricyclic drugs can increase cognitive impairment. Selective serotonin reuptake inhibitors can be considered, such as fluoxetine, paroxetine, citalopram, sertraline, and duloxetine can be used in patients with neuropathic pain. Although benzodiazepines can control the behavioral problems of dementia, they should be used with extreme caution because they can cause falls and drug dependence.

In addition to medication, life care rehabilitation is very important to strengthen nutritional support and prevent pneumonia. Gene therapy technology has been studied a lot, but it is still immature and is in the preclinical experimental stage.

Dementia prognosis

Dementia progresses progressively, patients lose their ability to live independently within a few years, and die from lung infections and malnutrition. If they can be found in time and treated early, the prognosis of some patients with degenerative dementia is relatively good.