The management of dementia 

The term dementia is used in two different ways. First there are the dementias. These are diseases that cause progressive and diffuse cerebral damage, of which Alzheimer's disease is the most common. Second, dementia can be used to refer to a clinical syndrome. Thus dementia is ‘an acquired global impairment of intellect, memory, and personality, but without impairment of consciousness’. For clinicians this is the preferred usage, and the one adopted in this chapter. It demands that the cause of the dementia is explored, and makes no comment on the likely prognosis. This chapter will focus on the management of dementia regardless of the cause; however given the burden of dementia in older age, the discussion will be invariably, but not exclusively, slanted towards the management of dementia in this age group. Aspects of management specific to individual diseases which produce dementia will be avoided. In addition, a discourse on the management of cognitive and memory problems is excluded as these are described elsewhere (see Chapters 2.5.4 and 6.2.7). Patients who suffer the dementia before 18 years of age will, by and large, not be included; their needs are often best met by services provided for people with intellectual disability.