[Consensus diagnosis in dementia syndrome]

A consensus development conference held to reach agreement on definition, diagnostic criteria and clinical and ancillary investigations concerning the diagnosis of the dementia syndrome was convened in Utrecht by the National Organization for Quality Assurance in Hospitals in the Netherlands on November 4, 1988. Dementia was defined as a clinical syndrome diagnosable by clinical methods only. Its manifestation is primarily behavioural. It is characterized by a decline of two or more cognitive capacities, including memory, without alteration of consciousness, and by a significant disturbance of the usual daily activities of the patient. It was agreed that at present the DSM-III-R diagnostic criteria for dementia are the most acceptable, with the exception of one viz. evidence or presumption of an etiologic organic factor, because this criterion is not compatible with the syndromal character of the dementia syndrome. Consensus was also reached about the following statements. The diagnosis of dementia syndrome is not valid in the presence of delirium. For clinical reasons it is considered important to distinguish between the conditions of cortical and subcortical dementia. Pseudodementia is an out-of-date concept. Epidemiological data on dementia are important for the diagnosis and prognosis in individual cases. In all patients with signs of the dementia syndrome, physical, neurological, psychiatric, and neuropsychological examinations should be performed, preferably according to a standardized protocol. The etiologic role of drugs in the dementia syndrome and delirium in the aged cannot be overemphasized. For the differential diagnosis of the disease states that produce the dementia syndrome, standardized laboratory tests should always be performed, but with individual modifications. EEG and CT (or NMR) are appropriate in certain cases.