Image of symptoms of dementia – body-check not forget!
Dementias are produced with life expectancy as an expression of disease correlated with age more and more. But not always, Alzheimer’s disease or other diseases mainly cortical get behind. internal diseases can also cause symptoms of dementia. Its appearance and development is mainly based on internal medical conditions. Since the default states are no longer reversible, early intervention is important. Therefore, the general practitioner should know that the measures for an “audit body” diagnosis is important.
The onset of dementia is often characterized by problems with attention and memory, lack of motivation and lethargy or excitement and hyperactivity. The cause of these symptoms also internal disorders play a minor role.  This is a cortical dementia (prototype: Alzheimer’s disease), the characteristic of “triple A syndrome” (aphasia, apraxia, agnosia) or negligence occurs in the etiology of internal medicine, but most only constructional apraxia (character or different spatial However, the synthesis disorder) is possible. For example, in hepatic encephalopathy . At least subtle neurological abnormalities rarely fails.
Mini Mental State Examination provides a first indication
Is likely to be light organic psycho syndromes, are particularly neglected by the people who are with the patient in constant contact because symptoms often develop insidiously. In such cases, the opinions of others and psychometric tests are tools . An example of a neuropsychological test profile shown in Figure 1.
The Mini Mental State Examination (MMSE) is widespread internationally and shows reasonably reliable dementias, but sometimes fails as a screening tool or at an early stage because it is too insensitive. An evaluation of dementia should be possible or not, but in general, especially because it is thanks to its maneuverability and short easy to practice. 
The above other diagnoses are the external and internal history, a complete physical examination, including neurological outcomes and cognitive status. For the laboratory diagnosis causal association and perhaps the electroencephalogram (EEG) are usually more important than brain imaging in all, although this can provide objective information, especially if simultaneous (micro) angiopathy – a damage left – as in diabetes mellitus, always a study of internal diseases need to experience a demonstration of organs. the development of specific drugs (eg. As anticholinergics), it should not be overlooked.
Search basic diseases
For selection, especially differential blood count with hematopoietic (blood count, renal function, liver function tests, blood glucose, HbA1c, basal TSH, narcotic, vitamin B12, folic acid) are appropriate.
Because the brain’s response to an internal systemic toxic dementias monomorphic derivable certain characteristics. Therefore, the results of neuropsychological tests are often impressive effect and can define the severity or the profile, but the differential diagnosis is not always productive. Significantly, the course. Often, early psychological anomalies I found a slower disorders such unit or loss of memory, attention, changing personality and often random neurological symptoms, such as polyneuropathy. The assessment should be based on more specific laboratory data and synopsis electrophysiological and neuropsychiatric studies.
As base of dementia is a series of conditions set for the examination. Of particular importance, they are:
endocrine diseases (diabetes mellitus)
diseases of the thyroid,
Electrolyte disturbances (hypo- and Hypernatremia)
kidney disease (CKD)
liver disease (hepatic encephalopathy)
The lack of oxygen, hematological diseases (anemia)
respiratory and cardiovascular disease (chronic respiratory failure, heart failure, the sleep apnea syndrome)
bowel disorders malnutrition (vitamin B12, malnutrition)
paraneoplastic syndromes (incl. Brain metastases).
Of course, combinations are possible. Its detection requires careful history of past illnesses, exposures and medical treatment. But research is useful, since only the treatment of primary disease of internal medicine can lead to a sustainable improvement in cognitive performance and also superimposed, if only hirndegenerative or modified disease.
Case Study 1
burning tingling represented a patient aged 74, hands and feet and tongue. The hallway was deteriorated.
History of reflux disease and gastritis gastroscopy were regular, though. In neurological outcome, he fell into a kind of glove hypoesthesia of both hands and a cross watchdogs of the section as Th1 feeling and sense the reduced position in the legs; Romberg test acrobats March was uncertain, it is possible. tibial September (somatosensory evoked potentials) was delayed on both sides. In neuropsychological tests revealed the results shown (Fig.1).
MRI may signal propagation shows the rear pillars (Fig. 2). cerebrospinal fluid was normal, but striking was macrocytic anemia in hochpathologischem Schilling test, but the levels of vitamin B12 in normal serum. Intramuscular cyanocobalamin I heard a slight improvement of symptoms. In practice, however, often with reduced amounts cases, which may well meet a substitution. Not always this biochemical abnormality but a guarantee for a successful therapy. However pathological values must always be balanced.
Case Study 2
A 56 years old patient came by memory problems, loss of attention and deteriorating treatment transition neurological hospital. In addition, States that have as seizures, can be interpreted epileptic kind existed. These are the exact requirements, such as tetanus, where Karpopedalspasmen, in one case, a loss of consciousness were even asking. Chvostek sign was positive, the Achilles tendon reflexes were absent and there were signs of polyneuropathy past or discrete. The patient underwent surgery reported 30 years ago for unknown reasons, thyroid, so it took a preparation of the thyroid. Laboratory diagnosis revealed a significantly reduced level of calcium with parathyroid hormone almost disappeared. In the brain CT scan to multiple symmetric cortical calcifications (3 fig.) Represented, including basal ganglia. This was a secondary hypoparathyroidism and replaced with calcium, calcitriol diagnosis die side and a mineralocorticoid. The patient was relieved that the tetanus sistierten convulsions and after three months the initial striking neuropsychological profile was normal for the discharged age.
Internist and laboratory screening are useful
To clarify dementia in doubt an internal investigation and an advanced laboratory examination are so useful. Especially in a delirium or unconsciousness should think of an underlying illness internist.