Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- perda de memória
- desorientação
- disfasia nominal
- colocar itens no lugar errado/se perder
- apatia
- declínio das atividades da vida diária e atividades instrumentais da vida diária (AIVDs)
- alteração de personalidade
- exame físico inicial normal
Other diagnostic factors
- mudanças de humor e comportamento
- má qualidade do pensamento abstrato
- dispraxia construtiva
- prosopagnosia
- autoprosopagnosia
Risk factors
- idade avançada
- história familiar
- genética
- Síndrome de Down
- doença cerebrovascular
- fatores de estilo de vida e ambiente
- uso de determinados medicamentos
- Escolaridade inferior ao ensino secundário
- lesão cerebral traumática
- depressão
- perda auditiva
- doença periodontal
- comprometimento visual
- infecção por vírus do herpes simples 1 (HSV-1)
- hiperlipidemia
- sexo feminino
- nível elevado de homocisteína no plasma
- cirurgia sob anestesia geral
Diagnostic investigations
1st investigations to order
- testes cognitivos
- Hemograma completo
- perfil metabólico
- hormônio estimulante da tireoide (TSH) sérico
- vitamina B12 sérica
- exame de urina para detecção de drogas
- TC cranioencefálica (sem contraste)
- RNM cranioencefálica (sem contraste)
Investigations to consider
- Análise do líquido cefalorraquidiano (LCR)
- reagina plasmática rápida/teste Venereal Disease Research Laboratory (VDRL) séricos
- teste para sorologia de HIV
- testes neuropsicológicos formais
- teste genético
- PET com fluordeoxiglicose (FDG-PET)
- Teste de biomarcadores no LCR
Emerging tests
- tomografia por emissão de pósitrons (PET) do amiloide
- biomarcadores sanguíneos
Treatment algorithm
todos os pacientes
Contributors
Authors
Judith Neugroschl, MD
Associate Professor of Psychiatry
Alzheimer's Disease Research Center
Icahn School of Medicine at Mount Sinai
New York
NY
Disclosures
JN participates in research funded by National Institutes for Health (NIH) grants. The Alzheimer's Disease Research Center is a site for clinical research but JN is not the site Principal Investigator, has no role in purchasing nor choosing the studies, and gains no compensation if it succeeds. JN helps to edit the Focus on Healthy Aging Alzheimer's yearly report.
Acknowledgements
Dr Judith Neugroschl would like to gratefully acknowledge Dr Brandy R. Matthews, Dr Asif S. Bhutto, and Dr Julie K. Gammack, the previous contributors to this topic.
Disclosures
BRM, ASB, and JKG declare that they have no competing interests.
Peer reviewers
Roy J. Goldberg, MD, FACP, AGSF, CMD
Medical Director
Kings Harbor Multicare Center
New York
NY
Disclosures
RJG declares that he has no competing interests.
Philip Scheltens, MD, PhD
Professor of Neurology
Department of Neurology/Alzheimer Center
VU University Medical Center
Amsterdam
The Netherlands
Disclosures
PS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing commission. Lancet. 2024 Aug 10;404(10452):572-628. Abstract
American College of Radiology. ACR appropriateness criteria: dementia. 2024 [internet publication].Full text
McShane R, Westby MJ, Roberts E, et al. Memantine for dementia. Cochrane Database Syst Rev. 2019 Mar 20;(3):CD003154.Full text Abstract
Birks JS, Chong LY, Grimley Evans J. Rivastigmine for Alzheimer's disease. Cochrane Database Syst Rev. 2015 Sep 22;(9):CD001191.Full text Abstract
Birks JS, Harvey RJ. Donepezil for dementia due to Alzheimer's disease. Cochrane Database Syst Rev. 2018 Jun 18;(6):CD001190.Full text Abstract
Reus VI, Fochtmann LJ, Eyler AE, et al. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. Am J Psychiatry. 2016 May 1;173(5):543-6.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Delirium
- Depression
- Demência vascular
More DifferentialsGuidelines
- European intersocietal recommendations for the biomarker-based diagnosis of neurocognitive disorders
- ACR appropriateness criteria: dementia
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