Snapshot A 62-year-old man presents to his primary care physician due to trouble with walking and difficulty with concentrating. The patient describes his walking as if he is "stuck to the ground." On gait testing, the patient has magnetic gait and on montreal cognitive assessment (MoCA) testing, he has a deficit in executive functioning. Laboratory tests are ordered and return normal. Lumbar puncture shows a normal opening pressure and magnetic resonance imaging (MRI) of the head is shown. (Normal pressure hydrocephalus) Introduction Clinical definition dementia describes a gradual and progressive decline in memory and other cognitive abilities (e.g., language and visuospatial function) Etiology dementia can be divided into primary dementia login to view 1 more bullet secondary dementia login to view 1 more bullet Management given the large array of causes of dementia it is important to focus on identifying and treating reversible causes of dementia laboratory tests such as vitamin B12 levels thyroid function tests serum syphillis tests in endemic areas MRI is ideally used tests are ordered in order to support one's clinical suspicion Examples of dementia given in section below Vascular Dementia Clinical definition a heterogenous syndrome leading to dementia secondary to cerebrovascular disease that range from login to view 1 more bullet Epidemilogy incidence second most common cause of dementia after Alzheimer's disease risk factors elderly multiple vascular risk factors (e.g., atherosclerosis, lipohyalinosis, and cerebral amyloid angiopathy) Pathogenesis cerebrovascular lesions impair brain function leading to vascular dementia Presentation clinial presentation is diverse and depends on where the damage is cortical features login to view 6 more bullets subcortical features login to view 4 more bullets Imaging MRI may show white matter lesions (leukoaraiosis) login to view 1 more bullet cortical and/or sub-cortical infarcts Diagnosis certain criteria highlights clinical findings suggestive of vascular dementia, such as stepwise deterioration of cognitive function login to view 1 more bullet hypertension stroke history focal neurologic symptoms fluctuating symptoms Treatment treat and prevent vascular risk factors e.g., managing hypertension and diabetes pharmacologic therapy acetylcholinesterase inhibitors (e.g., donepezil) N-methyl-D-aspartate (NMDA) receptor antagonists (e.g., memantine) Normal Pressure Hydrocephalus Clinical definition pathologically enlarged ventricles in the setting of a normal opening pressure noted on lumbar puncture a potentially reversible cause of dementia Pathogenesis believed to be due to impaired cerebral spinal fluid (CSF) absorption which can be due to login to view 5 more bullets this results in fibrotic changes of the arachnoid granulations Presentation the classic triad is dementia gait disturbances urinary incontinence Diagnosis MRI or CT of the head, which shows ventriculomegaly that is not login to view 1 more bullet Lumbar puncture should show normal (or mildly elevated) CSF opening pressures Treatment ventricular shunting Dementia Secondary to Infection HIV-associated neurocognitive disorder clinical definition cognitive impairement secondary to HIV infection and login to view 1 more bullet epidemiology risk factors login to view 1 more bullet presentation in HIV-associated dementia login to view 6 more bullets treatment antiretroviral therapy (ART) Neurosyphilis Dementia Secondary to Metabolic Causes Thiamine deficiency (Wernicke-Korsakoff encephalopathy) Vitamin B12 deficiency Hypothyroidism Alcohol-related dementia