Mixed dementia and hyperactive delirium: a diagnostic challenge.

BMJ Case Reports
Louise DunphyZac Etheridge

Abstract

It is well recognised that acute confusion or delirium complicates up to 10% of acute medical admissions. Disorientation in time and place with an impaired short-term memory and conscious level are the hallmarks of an acute confusion. In delirium, disorders of perception may produce restlessness and agitation. A similar state during the final days of life is termed 'terminal delirium'. Less than 10% of affected individuals will have a primary neurological disorder, for example, dementia, a neurodegenerative disease with varying aetiologies. Currently there are at least 50 million people globally suffering from dementia rendering it a global healthcare problem. Mixed dementia (MD) can be defined as a cognitive decline sufficient to impair independent functioning in daily life resulting from the coexistence of Alzheimer's disease (AD) and cerebrovascular pathology. MD occurs in patients with a neurodegenerative disorder, such as AD, Lewy body or Pick's disease and additionally cerebrovascular disease. The mechanistic synergisms between the coexisting pathologies affecting dementia risk, progression and the ultimate clinical manifestations remain elusive. Although AD can be diagnosed with a considerable degree of accuracy, the dis...Continue Reading

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