The pathological and clinical features of the various types of dementia have been the subject of detailed discussion elsewhere in this book (see Chapter 14). A variety of conditions that occur in the elderly must be differentiated from true dementia. Delirium, for example, is associated with an alteration in the level of consciousness, disordered thinking and fluctuating cognitive impairment. Such a delirious state can occur for a variety of reasons, including inadequately treated diabetes, hyperparathyroidism or hepatic encephalopathy. Dementia must also be distinguished from psychosis, in which the patient shows impairment of thinking but not impairment of memory. The term ''pseudo-dementia'' is often used to describe a depressive episode in which the patient presents with abnormalities of mood, appetite and sleep disturbance with cognitive dysfunction which is directly caused by the depression. The cognitive deficits usually resolve with treatment of the underlying condition. Finally cerebrovascular disease (as exemplified by multi-infarct dementia, which is the second most common cause of dementia) or carotid occlusion may be associated with episodic memory loss. It is therefore important to diagnose correctly the cause of the memory and cognitive impairment so that appropriate treatment may be given. Should the results of clinical and neurological investigation clearly establish the existence of Alzheimer's disease, then the appropriate symptomatic therapy (e.g. a cholinesterase inhibitor) may be considered (see Chapter 14).
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