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Dementia

Characteristics of a referral population and factors associated with progression

From the Neurology Service (Dr. Thal), VA Medical Center, San Diego, and the Department of Neurosciences, University of California, San Diego, La Jolla, CA; the Department of Neurology (Dr. Grundman), St. Vincent's Hospital and Medical Center, New York. NY; and the Department of Community and Family Medicine (Dr. Klauber), University of California, San Diego, La Jolla, CA.

We evaluated in a standard fashion 375 patients presenting with complaints of memory loss. Etiology of memory loss included senile dementia of the Alzheimer type (SDAT)—70%, vascular dementia—5%, mixed dementia (SDAT + vascular)—9%, and other etiologies—16%. Incontinence, transient symptoms, and gait disturbances occurred more frequently in vascular dementia than in SDAT. A history of cardiovascular disease and stroke was more common in vascular dementia than SDAT. Disturbances of gait, bradykinesia, and pyramidal tract findings were commonly seen in vascular dementia. Advanced technology aided diagnosis in only 6% of patients and CT was the most useful of such tests. An earlier age of onset was noted in those with a positive family history of SDAT. Duration of symptoms at presentation for SDAT patients varied inversely with the rate of progression of dementia 15 to 55 months later, suggesting that individuals who progress more slowly require more time to elapse before the family or patient realizes the need for medical attention.

Address correspondence and reprint requests to Dr. Thal, Neurology Service (127), VA Medical Center. 3350 La Jolla Village Drive. San Diego, CA 92161.

Received August 14,1987. Accepted for publication in final form November 20,1987.

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