Many physicians, including psychiatrists, may shy away from seeing elderly patients with symptoms of dementia because they imagine that there are a large number of alternative diagnoses and that differential diagnosis is complicated. In fact, however, the number of possible diagnoses in most situations is relatively small and the diagnosis of dementia in older patients is certainly feasible in primary care psychiatry.
An unfavorable prognosis may be in store for patients who report severely disrupted sleep patterns accompanied by rapid eye movement (REM).
The numbers of patients with Alzheimer disease (AD), as well as those with severe cognitive impairment caused by traumatic brain injury and stroke, are continuing to increase. This article includes some nonconventional treatment approaches for which the evidence is limited.
While dementia is marked by such cognitive deficits as disorientation, memory loss and changes in intellectual functioning, these are not the symptoms that cause the most distress to caregivers.
The obvious sometimes bears repeating: Sick people have trouble thinking. They may be suffering from a delirium, a dementia or a more subtle disturbance of cognition caused by fever, drugs, infection, inflammation, trauma, hypoxemia, metabolic derangement, hypotension, tumor, intracranial pathology, pain and so forth.
The psychiatric community has a need for diagnostic and predictive tests. Some recent techniques have just become available for clinical care.
The Risk of Cerebrovascular Problems in Patients With Dementia Treated With Atypical Antipsychotics
mental notes
A review of nonconvention treatments for dementia and mild cognitive impairment, including dietary modification, Ginkgo Biloba, Huperzine-A, Phosphatidylserine, CDP-choline, Idebenone, and exercise.
Patients with Alzheimer disease (AD) often have Lewy body pathology (LBP). Although the exact significance of LBP is unknown, LBP appears to be more common in persons with familial AD related to gene mutations of presenilin 1 (PSEN1), presenilin 2 (PSEN2), and amyloid precursor protein. To examine the genetics of LBP, the team from Puget Sound HCS, led by James B. Leverenz, MD, associate professor at the University of Washington in Seattle, reviewed 25 familial AD cases that included 9 known PSEN1 mutations and 14 familial AD cases that included a single PSEN2 mutation. The brain stem, limbic cortex, and neocortex were examined for LBP.
Spinal cord injury, Oxidative stress, Acrolein, Hydralazine
Physicians who use electroconvulsivetherapy (ECT) need tobe vigilant for unstable medicalconditions before and during the courseof treatment. This brief review is intendedto highlight some basic principlesand specific concerns that maybe encountered in the use of ECT inpatients who have comorbid medicalillness.
During and after menopause, many women report impairments in cognitive functioning. Should hormones be prescribed in an effort to mitigate cognitive symptoms of menopause?
The cost-effectiveness of treatment for Alzheimer disease has been questioned. But until the next generation of therapeutics arrives, cholinesterase inhibitors and memantine will probably remain essential components of therapy for cognition and function.
Dementia is characterized as a progressive and chronic decline in cognitive function, not limited to memory impairment, which significantly interferes with baseline daily functioning and frequently involves behavioral disturbances. It is known that behavioral problems in dementia negatively affect patients and caregivers. These disturbances lead to institutionalization, increased costs and caregiver burden, and a poorer prognosis.
Obesity has long been recognized as increasing the risk of associated conditions, including hypertension, diabetes, and cardiovascular disease. Now another disorder has been added to this chilling list: Alzheimer disease (AD).
Alzheimer disease, cognitive impairment, neurologic imaging
Neuroscience 2005: Encouragement for Alzheimer Diagnosis and Treatment
Patients with Alzheimer's disease may suffer the same age- and disease-related changes to sleep as their age-matched peers. However, as the dementia progresses, even more severe disturbances develop, with impairments in both nighttime sleep continuity and daytime alertness. This article focuses on long-term, holistic approaches to treatment, including environmental and behavioral interventions to augment sleep medications.
Affecting 70% of patients with Alzheimer's disease and common in patients suffering from other dementing illnesses, apathy is associated with functional impairment and caregiver distress at all levels of disease severity. Assessment and treatment for this under-recognized syndrome are discussed.
Advances in technology are providing assistive and supportive interventions for people with dementia across all aspects of their lives. These interventions are mainly addressed at meeting the safety, security and social needs of people with dementia. The psychological needs of people with dementia for conversation and other forms of positive social interactions are also being tackled through developments such as the CIRCA project.
Patients with HIV infection are at risk of developing psychiatric symptoms and disorders similar to those seen in the general population. What unique biological, psychological and environmental factors are involved in treating this population?
Elderly patients are a heterogeneous population with myriad issues facing them. The group of articles in this Special Report should stimulate thinking, discussion and future research in a variety of areas.
stroke, tissue plasminogen activator, tPA, stent, transcranial Doppler, MRI
The Alzheimer's Disease Neuroimaging Initiative (ADNI) was set to begin recruiting this month for its clinical trial (www.alzheimers.org/clintrials/fullrec.asp?PrimaryKey=208) that will study how brain imaging technology can help measure the progression of mild cognitve impairment (MCI) and early Alzheimer disease (AD).
