Diagnostic Criteria

The defining criteria for dementia vary (9,10,16,17). Our working definition is as follows: Dementia is a progressive, but not necessarily irreversible, decline in cognitive or behavioral functioning that interferes with daily living activities that are appropriate for one's age and background and is not simply due to a delirium, confusional state, or related alteration in sensorium. Both DSM-IV and NINCDS-ADRDA diagnostic criteria for dementia require a decline in memory and other cognitive processes such as language, visual-spatial abilities, or executive functions. DSM-IV criteria explicitly states that such cognitive deficits must "cause significant impairment in social or occupational functioning (e.g., going to school, working, shopping, dressing, bathing, handling finances, and other activities of daily living) and must represent a decline from a previous level of functioning" (9). This criterion is not explicitly included in the NINCDS-ADRDA formula (Table 1). In both

Fig. 1. Proposed algorithm for dementia diagnosis and workup. *Suspected and worrisome history without obvious abnormalities on office mental state testing. **Some physicians will work up patients who show no functional decline without doing neuro-psychological testing. (Reprinted with permission from Neurology 1995; 45:212.)

Fig. 1. Proposed algorithm for dementia diagnosis and workup. *Suspected and worrisome history without obvious abnormalities on office mental state testing. **Some physicians will work up patients who show no functional decline without doing neuro-psychological testing. (Reprinted with permission from Neurology 1995; 45:212.)

schemes, dementia cannot be appropriately diagnosed in the context of an altered sensorium such as delirium or confusional state. It is also important to point out that the diagnosis of dementia is a clinical one. It reflects impairments in neuropsychological and functional status. As such, the diagnosis of dementia cannot be made by a pathologist, neuroradiologist, or blood test.

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