
		• Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. • Screening for dementia: recommendations and rationale. • Dementia. Nutrition management for older adults. Washington (DC): Nutrition Screening Initiative (NSI).


		• Alzheimer Disease • Delirium, Dementia, and Amnesia • EEG in Dementia and Encephalopathy • Pick Disease • Vascular Dementia • View All Dementia Articles


		• Alzheimer in Down Syndrome Patient • Advanced Alzheimer CT • AIDS Dementia Complex CT • EEG in Dementia • View All Dementia Multimedia Files


		• Alcoholism • Alzheimer Disease


		• Geriatric depression scale (Koenig)

DEMENTIA RESOURCE CENTER

Dementia encompasses a group of neurodegenerative diseases that causes an acquired cognitive and behavioral impairment of sufficient severity to interfere significantly with social and occupational functioning. Alzheimer disease (AD) is the most common of the diseases that cause dementia. At present, the disorder afflicts approximately 5 million people in the United States and more than 30 million people worldwide. A larger number of individuals have lesser levels of cognitive impairment, which frequently evolves into full-blown dementia. Prevalence of dementia is expected to nearly triple by 2050, since the disorder preferentially affects the elderly, who constitute the fastest-growing age bracket in many countries, especially in industrialized nations.

Alzheimer Disease

Neurology

Alzheimer disease (AD) most commonly presents with insidiously progressive memory loss, to which other spheres of cognitive impairment are added over the course of several years. Functions commonly affected after the development of memory loss include language disorders (eg, anomia, progressive aphasia) and impaired visuospatial skills and executive functions. Substantially rarer presentations include right parietal lobe syndrome, progressive aphasia, spastic paraparesis, and impaired visuospatial skills, subsumed under the so-called visual variant of AD.

Delirium, Dementia, and Amnesia

Emergency Medicine

Delirium, dementia, amnesia, and certain other alterations in cognition are subsumed under more general terms such as mental status change (MSC), acute confusional state (ACS), or organic brain syndrome (OBS). OBS can be divided into 2 major subgroups: acute (delirium or acute confusional states) and chronic (dementia). A third entity, encephalopathy (subacute OBS), denotes a gray zone between delirium and dementia.

EEG in Dementia and Encephalopathy

Neurology

EEG is used in patients who suffer from cognitive dysfunction, either a general decline of overall brain function or a localized or lateralized deficit. This article addresses primarily the clinical use of EEG in evaluation of dementias and encephalopathies. In addition, aspects of digital EEG and other newer developments are discussed.

Pick Disease

Neurology

Pick disease (named after Arnold Pick) is a progressive dementia defined by clinical and pathologic criteria. Unlike Alzheimer disease and other dementias that present with cognitive deficits localized to the posterior (parietal) cortex, Pick disease typically affects the frontal and/or temporal lobes.

Efficacy of donepezil treatment in Alzheimer patients with and without subcortical vascular lesions.

A pilot case control study on the efficacy of donepezil treatment was investigated in patients with Alzheimer's disease who were stratified according to radiological criteria into patients without and with subcortical vascular lesions (AD+SVD group). Changes in cognition were assessed as the primary outcome measurement after 6 and 18 months of treatment by the Mini-Mental Status Examination and the Consortium to Establish a Registry for Alzheimer's Disease test battery. Results measured at 6 and 18 months showed no significant difference between the groups. These data support previous observations that donepezil therapy is effective in AD patients with and without subcortical vascular lesions.

The efficacy of donepezil in the treatment of neuropsychiatric symptoms in Alzheimer disease.

Patients with mild-to-moderate AD with marked neuropsychiatric symptoms at baseline were treated openly with donepezil 5 mg daily for 6 weeks followed by 10 mg daily for 6 weeks. Patients were then randomized (60:40) to either placebo or 10 mg donepezil daily. All patients were assessed at 6 weeks and, provided there was no marked cognitive deterioration, their blinded treatment was continued for 6 more weeks. NPI and carer distress were assessed at 6 weekly intervals throughout the study. A total of 134 patients participated. Results showed that donepezil has significant efficacy in the treatment of neuropsychiatric symptoms in patients with mild-to-moderate AD.

Rivastigmine in Alzheimer disease: efficacy over two years.

The clinical course of AD patients treated with rivastigmine was compared with a prediction of their course derived by a baseline-dependent historical model of disease progression developed from data in untreated AD patients. Rivastigmine efficacy data came from four 6-month, placebo-controlled, randomized, controlled trials and two open-label extension studies. Cognitive performance was assessed by various clinician- and caregiver-rated measures. After 2 years on rivastigmine, there was less cognitive deterioration than in historical-control subjects. These effects of rivastigmine on cognitive performance were considered clinically meaningful relative to expected global decline. Treatment-emergent adverse events were the common side effects of ChEIs and were similar in frequency to those seen in patients assigned to shorter-term rivastigmine therapy. Rivastigmine had a beneficial effect on cognitive performance for up to 2 years in patients with AD, versus no treatment or placebo treatment in historical-control subjects. In addition, rivastigmine remained safe over this 2-year treatment period.

Modrego PJ, Ferrandez J. Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study. Arch Neurol. Aug 2004;61(8):1290-1293.

Dougall N, Nobili F, Ebmeier KP. Predicting the accuracy of a diagnosis of Alzheimer's disease with 99mTc HMPAO single photon emission computed tomography. Psychiatry Res. Jul 30 2004;131(2):157-168.

Aarsland D, Mosimann UP, McKeith IG. Role of cholinesterase inhibitors in Parkinson's disease and dementia with Lewy bodies. J Geriatr Psychiatry Neurol.September 2004; 17(3):164-171.

Boeve BF, Silber MH, Ferman TJ. REM sleep behavior disorder in Parkinson's disease and dementia with Lewy bodies. J Geriatr Psychiatry Neurol. September 2004;17(3):146-157.

Spalletta G, Baldinetti F, Buccione I, Fadda L, Perri R, Scalmana S, Serra L, Caltagirone C. Cognition and behaviour are independent and heterogeneous dimensions in Alzheimer's disease. J Neurol. 2004 Jun;251(6):688-695.

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