Dementia Symptoms and Executive Functioning:
Dementia symptoms related to impairment of executive functioning, involve the ability to think abstractly, plan, initiate and carry out complex behavior. On mental status examination, individuals with these dementia symptoms display problems coping with new tasks. Activities such as subtracting serial sevens may be impaired in these individuals with dementia.
In addition to the diagnostic features of the dementia symptoms already mentioned, these individuals display other identifying features that often prove problematic, poor insight and judgment are common in dementia, and often cause individuals to engage in dangerous activities or make unrealistic and relatively grandiose plans for the future. Visual-spatial functioning may be impaired in these individuals, as well as their ability to construct a plan and carry it out. Rather than trying to intentionally harm themselves, more commonly they unintentionally harm themselves due to carelessness, undue familiarity with strangers, and disregard for the accepted rules of conduct. Emotional lability is a dementia symptom frequently seen in pseudobulbar palsy after cerebral injury, which can be particularly frustrating for caregivers, as well as the occasional psychotic features such as delusions and hallucinations. Changes in their environment and daily routine can be extremely frustrating for individuals with these dementia symptoms, sometimes with their frustration being manifested in violent behavior.
The mental status examination, in conjunction with a complete medical history, and collateral discussions with family members or other informants, is essential to the evaluation and differential diagnoses of individuals with dementia symptoms. The findings on the mental status examination may vary depending upon the etiology of the dementia. In general, symptoms seen on the mental status examination, regardless of the etiology, are related to the location and extent of the brain injury, individual adaptation to the dysfunction, premorbid coping skills and psychopathology, as well as the concurrent medical illnesses.
When you are evaluating dementia symptoms, the most significant abnormality is usually related to disturbance of memory, (especially primary and secondary memory). Confabulation (filling in the gaps of memory, when not remembering specific information) may be present as the individual attempts to minimize their memory loss. Disorientation and altered levels of consciousness may also occur, but are generally not seen in the early stages of dementia that is not complicated by delirium. Affect (facial expression) may also be impacted as in the masked faces of Parkinson’s patients, or in individuals with the more expansive affect and labile mood of pseudobulbar palsy following cerebral injury. The affect of individuals with hepatic encephalopathy is often described as blunted and apathetic. A lack of inhibition can sometimes be seen in individuals with conditions such as tertiary syphilis, and occasionally the effects of some medications can even precipitate mania.
Some information from DSM-IV-TR Mental Disorders: Diagnosis, Etiology & Treatment by Michael B. First and Allan Tasman
Additional information and webpage By Paul Susic Ph.D. Licensed Psychologist