Prognosis

In the minority of patients with a treatable cause, progression of the dementia can be arrested, and there may even be partial recovery, but most cases gradually deteriorate. The effect of acetylcholinesterase inhibitors, if any, is to delay decline, by putting back the time when the patient will no longer be able to be cared for at home. Acute confusional episodes due to other pathology, such as chest or urinary infections, strokes, faecal impaction, or inappropriate medication may be superimposed.

Drug treatment of behavioural and psychotic symptoms of dementia (BPSD) may be necessary, but it carries risks; atypical antipsychotics such as olanzepine and risperidone are contraindicated because of the risk of stroke. Specific types of dementia will now be described.

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