Fast Five Quiz: Dementia
How familiar are you with the presentation, workup, and management of dementia? Test your knowledge with this quick quiz.
According to data from 2022, the rate of dementia among patients with less formal education than a high school diploma or GED certificate was 7.9%. This rate decreases with higher levels of education, falling to 2.2% among patients with a college degree or greater.
Rates of diagnosed dementia among adults were comparable between men and women (3.8% and 4.2%, respectively). Additionally, Alzheimer's disease, not vascular dementia, is the most common type of dementia.
Dementia prevalence increases with age. Only 1.7% of people aged 65-74 years have been diagnosed with dementia, whereas 13.1% of those aged ≥ 85 years have received a dementia diagnosis.
Learn more about Alzheimer's disease epidemiology.
A probable diagnosis of dementia with Lewy bodies requires the presence of progressive dementia along with two or more core clinical features, or progressive dementia with a single core clinical feature plus one or more indicative biomarkers. According to the current consensus report from the Dementia with Lewy Bodies Consortium, progressive dementia with a classic parkinsonism feature, such as bradykinesia, and another core clinical feature, such as repeated episodic visual hallucinations, are sufficient for a diagnosis of probable dementia with Lewy bodies.
Although marked slow-wave posterior region activity on EEG and preserved medial temporal lobe structures on CT/MRI are characteristic of dementia with Lewy bodies, these imaging and electrophysiologic markers alone are insufficient for a probable dementia with Lewy bodies diagnosis. Likewise, heightened sensitivity to antipsychotic drugs and apathy, anxiety, and depression are often encountered in dementia with Lewy bodies. However, these are supportive, not core, clinical features and are insufficient for formal diagnosis in the absence of progressive dementia and accompanying core features.
Progressive dementia with tremor at rest would satisfy the criteria for probable dementia with Lewy bodies if another core clinical feature were also present. However, signs of severe autonomic dysfunction, such as orthostatic hypotension, are supportive rather than core clinical features. Therefore, this constellation of symptoms falls short of the full criteria for probable dementia with Lewy bodies.
Learn more about the presentation of dementia with Lewy bodies.
According to clinical practice guidelines from the Alzheimer's Association, although no single cognitive test is appropriate for every situation, the use of a validated tool to screen for cognitive impairment is a critical aspect of evaluating patients for possible Alzheimer's disease and related dementias.
The IQCODE, QDRS, and ECog scales are all validated tools that can support the assessment of cognitive decline in Alzheimer's disease. Each instrument has strengths in different clinical contexts, and no single tool is universally preferred. Clinicians should use their judgment to select the most appropriate assessment based on the patient's needs, setting, and available resources.
Learn more about Alzheimer's disease workup.
FDG PET measures cerebral glucose metabolism, which reflects neuronal and synaptic activity. Patterns of regional glucose hypometabolism can be linked to specific neurodegenerative conditions, such as Alzheimer's disease or frontotemporal lobar degeneration. These distinct metabolic patterns can help differentiate the clinical diagnosis when the presentation is unclear or atypical.
FDG PET does not detect tau protein. That is typically accomplished via tau PET imaging or cerebrospinal fluid biomarkers. Furthermore, frontotemporal dementia might involve tau pathology, but FDG PET provides only functional metabolic imaging and not protein-specific imaging. FDG PET also does not quantify tau or phosphorylated tau proteins in suspected Alzheimer's disease.
FDG PET is often most helpful in early or uncertain cases of cognitive decline, not in advanced dementia with broad functional deterioration, in which imaging offers limited additional value.
Learn more about imaging studies for frontotemporal dementia and frontotemporal lobar degeneration.
Brexpiprazole, an SDAM, is currently the only drug approved by the US Food and Drug Administration for control of agitation associated with Alzheimer's dementia. SSRIs and NDRIs are not approved for this purpose.
Donanemab and lecanemab are both monoclonal antibodies indicated for use in early Alzheimer's disease with mild dementia. They are intended for amyloid reduction and modest slowing of cognitive decline, not for control of agitation.
Learn more about medications for Alzheimer's disease.
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Butler suggests hospitals use different forms of screening, like verbal questions, to identify potential substance use issues that could affect the birth or baby. Verbal screening or questionnaires are also recommended by most major medical groups, including the American Medical Association and The American College of Obstetricians and Gynecologists. The National Library of Medicine also acknowledges that toxicology testing of pregnant patients has some limitations and possible negative consequences and said it should always be done with a woman's consent. The reporting of drug use during pregnancy to child welfare agencies "is strongly biased against racial and ethnic minorities, even following concerted efforts to prevent such bias. A positive toxicology test also shows evidence of use, but does not provide any information about the nature or extent of that use; similarly, a negative test does not rule out substance use, which is often sporadic," the National Library of Medicine states. Last fall, New Jersey Attorney General Mathew Platkin filed a civil rights lawsuit against the hospital group Virtua Health, accusing it of singling out pregnant mothers and drug testing them without their informed consent. Jennifer Khelil, executive vice president and chief clinical officer at Virtua Health, told "CBS Sunday Morning" that New Jersey law requires hospitals and health care providers to report positive drug screen results to the state's child protection agency, which then completes its own assessment and works directly with the families on next steps. "The devastating toll of the opioid epidemic requires thorough and equitable processes for identifying and supporting babies with neonatal opioid withdrawal syndrome and related conditions," Khelil said. Virtua Health implemented a universal urine drug testing policy — as an effort to "avoid subjectivity in testing," according to Khelil — for pregnant patients delivering at its hospitals back in 2018. In October 2024, a week after Platkin's suit was filed, the hospital group modified its universal urine testing protocol. A Virtua Health spokesperson told NJ Spotlight News at the time that it now screens pregnant patients admitted at its hospitals based on "patient indications." "I think it's wrong. When you're ruining precious moments of people's lives and uprooting things, you can't just shrug it off and say, well, sorry you fell in the cracks," Katie said. Nearly a year later, Katie is pregnant again — and the same fears are weighing on her. She spoke with her new doctor about refusing a drug screen this time, but says she was told that the hospital would report her to Alabama Department of Human Resources if she declined. "So I feel trapped. This all just happened a year ago. So it's very fresh. And I'm very wounded still from it, and terrified of it happening again," Katie said.
