**8. Brief information about how to diagnose dementia**

Because of the introduction of thiamine supplementation programs in some countries, as well as general dietary habits, there is no direct correlation between the prevalence of WE and per capita consumption of standard drinks, but all patients under suspicion of having WE should be treated immediately with parenteral thiamine [130]. Thiamine given orally does not work because it reaches poor concentration in plasma; therefore, a dosage of 200 mg IV three times a day (1 g may be required in the first 24 hours) for 5–7 days followed by oral thiamine in doses of 100 mg eight hourly for 1–2 weeks is strongly recommended. At this point, it is very important to highlight that other electrolyte deficiencies such as magnesium and niacin should also be corrected. Apart from parenteral thiamine, to eat food with a high content of vitamins such as peas, lentils, brown rice, pork, organ meats, milk, eggs, nuts, fruits, and vegetables is suggested. Alcohol interferes with thiamine uptake [172]. This treatment should

be continued until no further improvement in signs and symptoms is evident [173].

with memantine, although these findings require replication [174, 175].

tinction is now being brought into question [140].

continue progressing up to Korsakoff syndrome or ARD.

manifestations of ARD [185].

gen levels [181].

208 Cognitive Disorders

Some patients with ARD and WKS have shown cognitive improvement following treatment

As we also mentioned before, ARD and WKS have some similarities. However, some neuropsychological studies have largely attempted to differentiate these syndromes by limiting individuals with more global cognitive impairment from WKS investigations and by excluding individuals with past symptoms of WKS from ARD studies, but the validity of this dis-

Ethanol concentration in blood raises blood levels of high-density lipoprotein cholesterol (HDL-C) in a dose-dependent fashion, and some studies suggest that this effect accounts for at least half of the protection against CAD [176]. Ethanol also increases insulin sensitivity [177], prevents platelet aggregation [178], increases fibrinolysis [179], opposes thrombin activity [180], and reduces inflammatory markers such as plasma C-reactive protein and fibrino-

*While "dementia" in current neurological settings is typically used to describe a progressive disease of the brain, it perhaps more accurately encompasses a deterioration of intellectual or cognitive function that may or may not be progressive in nature* [182]. Effect of ethanol on patients presenting ARD can be reversed if the diagnosis is made early enough (48–72 hours of the onset of symptoms) and adequately treated with parenteral thiamine [172]. Abovementioned foods are essential to replace the deficient vitamins/minerals, and faster recovery is usually seen in females than males as it was mentioned before as well. Support of family and friends is paramount in achieving abstinence [183]. The Wernicke's encephalopathy and WKS also may be reversed if diagnoses made at early stage (48–72 hours of the onset of symptoms) and adequately treated with parenteral thiamine [143]. In WE, if the administration of right doses of thiamine IV is not reached, then the mortality rate will be elevated up to 20% level [184] or patient will

In a prospective 12-week study done by Cheon et al. on patients with probable ARD, they found that memantine (a low-affinity NMDA receptor antagonist) improved global cognition, quality of life, and behavioral symptoms on their patients [174]. Another investigation reported that rivastigmine at the dose of 3–12 mg per day for 2 months improved clinical First of all, it is very important to highlight the importance of clinical assessment on any type of dementia followed by imagenology and other investigations. The best assessment can be done by the well-skilled health-care professional knowing the clinical features of all dementia, duration, frequency, and rate of progression. This professional must guarantee an adequate comfortableness of the patients, while the process of diagnosis is finished. Therefore, the patient's fears regarding type of dementia and condition should be well managed including a full review of the patient's health care, family history and treatment history, proper evaluation for depression, toxic substance abuse and nutrition, and other conditions that can cause memory dysfunction such as infections, chronic anemia, vitamin deficiency, diabetes mellitus type 2, chronic kidney or liver disease, thyroid gland disease, cardiopulmonary disorders, and other risk factors for dementia including hearing loss. Currently, there is no single test that confirms Alzheimer's disease, although to achieve 90% accuracy is certain. Nevertheless, to identify the true underlying cause of the problem can be very difficult.

Findings from physical examination are crucial, and some laboratory tests such as CFS levels of total tau protein results are of relevant importance for identifying type of dementia and way of management. One of the most recent investigations has documented the results from evaluation of cerebrospinal fluid phosphorylated tau231 as a biomarker in the differential diagnosis of Alzheimer's disease and vascular dementia by assessing whether the use of sensitive and specific biomarkers such as phosphorylated tau proteins could contribute to an earlier and more accurate diagnosis of AD and VD, as well as to their differentiation, and the authors found that FS (p-tau231 and MMSE) has a strong potential to provide an early distinction between AD and VD [189, 190].

Obviously, according to the statement mentioned before, not every health professional is familiar with the complexities of dementia diagnosis. Therefore, to select the medical doctor with the necessary skill and experience to diagnose all different types of dementia is mandatory.

Some authors discovered that the Parkinson's disease-cognitive rating scale (PDCRS) was better than MoCA in detecting MCI, while other test was more specific for executive dysfunction. They failed to demonstrate the association between plasma α-synuclein levels and cognitive impairment in their PD patients. However, genotype *e3/e4* and being a carrier of e4 allele of the *ApoE* gene correlated with the presence of executive dysfunction in PD patients. Therefore, these findings can bring new perspectives to the understanding of the genetic influence on cognitive impairment and confirm a possible link between *ApoE* and cognitive impairment in

Updated Information on Some Cognitive Disorders http://dx.doi.org/10.5772/intechopen.81826 211

We would like to thank Dr. NE Cishe, Director of the Research Office Walter Sisulu University; Penelope Dawson, Department of Research, Walter Sisulu University in South Africa; and Lorna Maria, Thabo Humberto Jorge, and Fatima Susana Adolfina for their unconditional

The authors declare that this chapter was written in the absence of any commercial or finan-

Head of Department of Neurology, Faculty of Health Sciences, Nelson Mandela Central

[1] Nelson PT, Schmitt FA, Jicha GA, et al. Association between male gender and cortical Lewy body pathology in large autopsy series. Journal of Neurology. 2010;**257**(11):1875-1881 [2] Augustine EF, Pérez A, Dhall R, et al. Sex differences in clinical features of early, treated

[3] ADI. World Alzheimer Report 2015: The Global Impact of Dementia An Analysis of Prevalence, Incidence, Cost and Trends. London, UK: Alzheimer's Disease International;

cial relationships that could be construed as a potential conflict of interest.

Humberto Foyaca Sibat\* and Lourdes de Fatima Ibanez Valdes

Parkinson's disease. PLoS One. 2015;**10**(7):e0133002

Academic Hospital, Mthatha, South Africa

\*Address all correspondence to: humbertofoyacasibat@gmail.com

PD [198].

support.

**Acknowledgements**

**Conflict of interest**

**Author details**

**References**

2015

Below, we describe the most commonly used tests to diagnose dementia.

The MMSE is the most widely used cognitive screening test worldwide, and it is a very brief investigation of the patient's cognitive status used in diagnosing dementia types and serves to evaluate appearance and behavior, attitude, perception, orientation, judgment, cognition, abstraction, and insight. It can be administered quickly and repetitively. Patient is requested to identify the time, date, and place (including street, city, and state) where the test is taking place, be able to count backward, identify objects previously known by them, be able to repeat common phrases, perform basic skills involving math, language, and comprehension, and demonstrate basic motor skills. This examination provides information to distinguish organic from "functional" illnesses and also provides objective data regarding the patient's improving or deteriorating sensorium. It helps substantiate clinical decisions on competence, potential for danger, and hospitalization [191].

*Some researchers have questioned the utility of brief cognitive tests such as the MMSE and the Montreal Cognitive Assessment in serial administration and suggested that brief cognitive tests may not accurately track changes in global cognition and other investigator also confirmed that there is limited utility in brief cognitive tests for tracking cognitive decline. Instead, they should be used for identifying participants who remain cognitively stable on follow-up. These results accentuate the importance of acknowledging the limitations of brief cognitive tests when assessing cognitive change* [192]. Eleven versions of the MMSE were identified, and the Bertolucci et al. [193] version is the most cited in the medical literature [194].

The Mini-Cog is a brief, cognitive screening test that is frequently used to evaluate cognition in older adults in various settings; the mini-cog takes only a few minutes to administer and is used as an initial screening for different types of cognitive disorders. The patient is required to identify three objects in the office, then draw the face of a clock in its entirety from memory, and finally, recall the three items identified earlier.

There are currently few studies assessing the diagnostic test accuracy of the Mini-Cog in community settings. The limited number of studies and the methodological limitations that are present in the study done by Fage et al. *made it difficult to provide recommendations for or against the use of the Mini-Cog as a cognitive screening test in community settings. Additional well-designed studies comparing the Mini-Cog to other brief cognitive screening tests are required in order to determine the accuracy and utility of the Mini-Cog in community-based settings* [195]. The clock drawing test and the MMSE have been used in dementia screening over the past 30 years, and they were the tests of choice in almost all relevant investigations on cognitive disorders already done.

Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument that was designed to address some of the limitations of the MMSE [196].

Based on the MoCA scores, the patients were further categorized as normal cognition (PD-NC) if their MoCA scores were 26–30 or mild cognitive impairment (PD-MCI) if their scores were 18–25 according to a Malaysian study [197].

Some authors discovered that the Parkinson's disease-cognitive rating scale (PDCRS) was better than MoCA in detecting MCI, while other test was more specific for executive dysfunction.

They failed to demonstrate the association between plasma α-synuclein levels and cognitive impairment in their PD patients. However, genotype *e3/e4* and being a carrier of e4 allele of the *ApoE* gene correlated with the presence of executive dysfunction in PD patients. Therefore, these findings can bring new perspectives to the understanding of the genetic influence on cognitive impairment and confirm a possible link between *ApoE* and cognitive impairment in PD [198].
