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.
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 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.
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.
"Pseudodementia" needs a third look. Always a "soft" diagnosis, it has never had objective, explicit diagnostic criteria or a spot in an official nomenclature.
More than 100 neurologic diseases, injuries, and intoxications are known to prominently or exclusively involve the white matter of the brain.