5 - The inpatient with dementia  pp. 85-99

The inpatient with dementia

By Michael I. Casher and Joshua D. Bess

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When specific diagnoses are mentioned, we are referring to diagnoses and criteria as listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) unless otherwise specified.

Why might a patient with dementia get admitted to the psychiatric inpatient unit?

Dementia is an umbrella term that refers to a group of disorders defined by deterioration in intellectual functioning. Alzheimer's dementia is the prototypical example, and accounts for some 40 to 60% of all cases of dementia. There are a number of other types of dementia, which present less frequently (Tables 5.1 and 5.2). A dementia diagnosis requires defects in memory and in at least one other domain of cognitive functioning, such as reasoning ability, visual–spatial processing, mathematical ability, language, or executive function. Aphasia (difficulty with receptive and/or expressive language), apraxia (loss of ability to perform previously learned tasks), and agnosia (misidentification of familiar people, objects, or places) are also often seen with dementia. In addition to cognitive deficits, dementia is also associated with personality, mood, and behavioral changes. With the incidence of dementia at 5 to 10% in the general population greater than 65 years old, it is not surprising that a general inpatient psychiatric unit will encounter these patients on a regular basis.