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This is a clinician-written, evidence-based summary aligned to the USMLE Step 2 CK Content Outline. It is intended for medical students preparing for USMLE Step 2 CK. Management reflects current ACC/AHA, USPSTF, and APA guidelines. Always cross-reference with UpToDate, institutional protocols, and clinical judgment.
The Bottom Line
- Dementia interferes with independence; MCI does not
- Alzheimer disease begins with episodic memory loss
- Initial workup includes cognitive screen, medication review, CBC, CMP, TSH, B12, and imaging in most new cases
- Cholinesterase inhibitors provide modest symptomatic benefit
- Safety assessment is mandatory
Overview
Dementia is acquired cognitive decline severe enough to impair function. Alzheimer disease is most common, but vascular dementia, Lewy body dementia, frontotemporal dementia, NPH, depression, drugs, hypothyroidism, B12 deficiency, and subdural hematoma are key mimics.
Epidemiology
Risk rises with age. Risk factors include family history, APOE epsilon 4, Down syndrome, vascular disease, TBI, hearing loss, depression, smoking, and social isolation.
Clinical Features
Symptoms
Progressive short-term memory impairment
Difficulty managing finances, medications, cooking, or navigation
Word-finding, visuospatial, or executive dysfunction
Visual hallucinations/fluctuations suggest Lewy body dementia
Rapid progression or focal deficits suggest secondary cause
Signs
Impaired delayed recall and orientation
Normal motor exam early in Alzheimer disease
Stepwise decline with focal signs suggests vascular dementia
Parkinsonism plus hallucinations suggests Lewy body dementia
Disinhibition/language change suggests frontotemporal dementia
Investigations
First-line
Cognitive screeningMoCA or MMSE plus functional assessment
LabsCBC, CMP, TSH, vitamin B12
Medication/depression reviewAnticholinergics, sedatives, alcohol, depression
Second-line
MRI brainAssess stroke, tumor, NPH, subdural, atrophy pattern
Neuropsychological testingAtypical or high-functioning cases
HIV/RPR/other labsRisk-based testing
Specialist
Amyloid/tau biomarkersSpecialist use when diagnosis uncertain or therapy eligibility considered
CSFRapid progression or inflammatory/infectious concern
1
General care
- Disclose diagnosis and involve caregivers
- Advance directives and power of attorney
- Treat hearing/vision, sleep, depression, pain
- Optimize vascular risks
2
Medications
- Donepezil/rivastigmine/galantamine for mild-moderate Alzheimer disease
- Memantine for moderate-severe disease
- Monitor bradycardia and syncope with cholinesterase inhibitors
- Avoid anticholinergics
3
Behavior
- Identify pain, infection, constipation, sleep triggers
- Nonpharmacologic management first
- Antipsychotics only for severe danger/distress
- Avoid typical antipsychotics in Lewy body dementia
4
Safety
- Assess driving, cooking, wandering, firearms, finances
- Caregiver support and respite
- Fall prevention
- Community resources
Complications
- Falls and delirium: Common in dementia
- Wandering/injury: Requires safety planning
- Caregiver burnout: Major determinant of placement
- Aspiration: Later-stage complication
USMLE Step 2 CK Exam Tips
- 1Dementia impairs independence; MCI does not
- 2Alzheimer starts with memory; FTD starts with behavior/language
- 3Lewy body = hallucinations + fluctuations + parkinsonism
- 4Vascular dementia = stepwise decline
- 5NPH = gait first + urinary + cognitive decline
- 6Check TSH and B12
- 7Cholinesterase inhibitors can cause bradycardia
practicetest your knowledge on alzheimer disease & dementiaApply what you've learnt with USMLE Step 2 CK-style questions from the iatroX Q-Bank — neurology and beyond.
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