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The Journal of Clinical Psychiatry Sep 2020 Along with cognitive decline, 90% of patients with dementia experience behavioral and psychological symptoms, such as psychosis, aggression, agitation, and... (Review)
Review
Along with cognitive decline, 90% of patients with dementia experience behavioral and psychological symptoms, such as psychosis, aggression, agitation, and depression. Dementia-related psychosis (DRP), which includes delusions and hallucinations, contributes to institutionalization, cognitive decline, and caregiver burden. Delusions and hallucinations tend to increase with the duration and severity of the disease, but there are also individual fluctuations. While a variety of symptoms can occur in all types of dementia, visual hallucinations are particularly common in the Lewy body dementias (dementia with Lewy bodies and Parkinson disease dementia). Mechanisms behind DRP are multifactorial, including different neurobiological factors as well as environmental, social, and psychological factors. This report examines the frequency, symptoms, and pathophysiology of DRP and communication about psychotic symptoms with patients with dementia (if possible) and their care partners.
Topics: Aged; Caregivers; Dementia; Humans; Psychotic Disorders
PubMed: 32936544
DOI: 10.4088/JCP.AD19038BR1C -
The American Journal of Medicine Oct 2018Dementia is any decline in cognition that is significant enough to interfere with independent, daily functioning. Dementia is best characterized as a syndrome rather... (Review)
Review
Dementia is any decline in cognition that is significant enough to interfere with independent, daily functioning. Dementia is best characterized as a syndrome rather than as one particular disease. The causes of dementia are myriad and include primary neurologic, neuropsychiatric, and medical conditions. It is common for multiple diseases to contribute to any one patient's dementia syndrome. Neurodegenerative dementias, like Alzheimer disease and dementia with Lewy bodies, are most common in the elderly, while traumatic brain injury and brain tumors are common causes in younger adults. While the recent decade has seen significant advancements in molecular neuroimaging, in understanding clinico-pathologic correlation, and in the development of novel biomarkers, clinicians still await disease-modifying therapies for neurodegenerative dementias. Until then, clinicians from varied disciplines and medical specialties are well poised to alleviate suffering, aggressively treat contributing conditions, employ medications to improve cognitive, neuropsychiatric, and motor symptoms, promote evidence-based brain-healthy behaviors, and improve overall quality of life for patients and families.
Topics: Activities of Daily Living; Cognition; Dementia; Humans; Neuroimaging; Patient Care; Quality of Life
PubMed: 29425707
DOI: 10.1016/j.amjmed.2018.01.022 -
Journal of the International... Oct 2017Although dementia has been described in ancient texts over many centuries (e.g., "Be kind to your father, even if his mind fail him." - Old Testament: Sirach 3:12), our... (Review)
Review
Although dementia has been described in ancient texts over many centuries (e.g., "Be kind to your father, even if his mind fail him." - Old Testament: Sirach 3:12), our knowledge of its underlying causes is little more than a century old. Alzheimer published his now famous case study only 110 years ago, and our modern understanding of the disease that bears his name, and its neuropsychological consequences, really only began to accelerate in the 1980s. Since then we have witnessed an explosion of basic and translational research into the causes, characterizations, and possible treatments for Alzheimer's disease (AD) and other dementias. We review this lineage of work beginning with Alzheimer's own writings and drawings, then jump to the modern era beginning in the 1970s and early 1980s and provide a sampling of neuropsychological and other contextual work from each ensuing decade. During the 1980s our field began its foundational studies of profiling the neuropsychological deficits associated with AD and its differentiation from other dementias (e.g., cortical vs. subcortical dementias). The 1990s continued these efforts and began to identify the specific cognitive mechanisms affected by various neuropathologic substrates. The 2000s ushered in a focus on the study of prodromal stages of neurodegenerative disease before the full-blown dementia syndrome (i.e., mild cognitive impairment). The current decade has seen the rise of imaging and other biomarkers to characterize preclinical disease before the development of significant cognitive decline. Finally, we suggest future directions and predictions for dementia-related research and potential therapeutic interventions. (JINS, 2017, 23, 818-831).
Topics: Alzheimer Disease; Cognitive Dysfunction; History, 20th Century; History, 21st Century; Humans; Neuropsychological Tests
PubMed: 29198280
DOI: 10.1017/S135561771700100X -
Practical Neurology May 2020Ageing, genetic, medical and lifestyle factors contribute to the risk of Alzheimer's disease and other dementias. Around a third of dementia cases are attributable to... (Review)
Review
Ageing, genetic, medical and lifestyle factors contribute to the risk of Alzheimer's disease and other dementias. Around a third of dementia cases are attributable to modifiable risk factors such as physical inactivity, smoking and hypertension. With the rising prevalence and lack of neuroprotective drugs, there is renewed focus on dementia prevention strategies across the lifespan. Neurologists encounter many people with risk factors for dementia and are frequently asked whether lifestyle changes may help. Exercise has emerged as a key intervention for influencing cognition positively, including reducing the risk of age-related cognitive decline and dementia. This article focuses on the current evidence for physical inactivity as a modifiable dementia risk factor and aims to support neurologists when discussing risk reduction.
Topics: Adult; Aged; Aging; Alzheimer Disease; Dementia; Exercise; Healthy Lifestyle; Humans; Male; Risk Reduction Behavior
PubMed: 31964800
DOI: 10.1136/practneurol-2019-002335 -
Seminars in Neurology Apr 2019Treatment of dementias represents an important but relatively neglected part of neurological care of the elderly population. Individual therapeutic interventions may... (Review)
Review
Treatment of dementias represents an important but relatively neglected part of neurological care of the elderly population. Individual therapeutic interventions may make only small changes to the quality of life of individuals afflicted with dementia, but when used in combination these interventions synergize and can make a significant difference. Additionally, given the societal scale of the problem of dementia care, the overall impact, in economic and sociological terms, of such therapies is of consequence. Presently there are no disease-modifying treatments for any of the neurodegenerative dementias. Instead, the clinician has several therapeutic tools to mitigate cognitive and behavioral consequences of dementias. There are also strategies to minimize harm to patients with dementia. In this article, we aim to review these tools and place them in the greater context of dementia care.
Topics: Behavioral Symptoms; Cognitive Dysfunction; Cognitive Remediation; Dementia; Harm Reduction; Humans
PubMed: 30925610
DOI: 10.1055/s-0039-1683408 -
Journal of Cerebral Blood Flow and... Jan 2016The prevalence of dementia is increasing in our aging population at an alarming rate. Because of the heterogeneity of clinical presentation and complexity of disease... (Review)
Review
The prevalence of dementia is increasing in our aging population at an alarming rate. Because of the heterogeneity of clinical presentation and complexity of disease neuropathology, dementia classifications remain controversial. Recently, the National Plan to address Alzheimer’s Disease prioritized Alzheimer’s disease-related dementias to include: Alzheimer’s disease, dementia with Lewy bodies, frontotemporal dementia, vascular dementia, and mixed dementias. While each of these dementing conditions has their unique pathologic signature, one common etiology shared among all these conditions is cerebrovascular dysfunction at some point during the disease process. The goal of this comprehensive review is to summarize the current findings in the field and address the important contributions of cerebrovascular, physiologic, and cellular alterations to cognitive impairment in these human dementias. Specifically, evidence will be presented in support of small-vessel disease as an underlying neuropathologic hallmark of various dementias, while controversial findings will also be highlighted. Finally, the molecular mechanisms shared among all dementia types including hypoxia, oxidative stress, mitochondrial bioenergetics, neuroinflammation, neurodegeneration, and blood–brain barrier permeability responsible for disease etiology and progression will be discussed.
Topics: Blood-Brain Barrier; Cerebrovascular Disorders; Dementia; Humans; Lewy Bodies; Neurodegenerative Diseases; Neurogenic Inflammation; Prevalence; Risk Factors
PubMed: 26174330
DOI: 10.1038/jcbfm.2015.164 -
Handbook of Clinical Neurology 2016This chapter will focus on the descriptive, analytic, and intervention-oriented epidemiology of dementia and its most frequent etiologic type due to Alzheimer's disease.... (Review)
Review
This chapter will focus on the descriptive, analytic, and intervention-oriented epidemiology of dementia and its most frequent etiologic type due to Alzheimer's disease. The chapter opens with a brief presentation of the concept of dementia, followed by the presentation of dementia of the Alzheimer type (DAT), including natural history, clinical manifestation, neuropathology, medical prognosis, and management. Further, the chapter presents the prevalence and incidence of dementia, with special consideration of secular trends in prevalence and incidence of DAT, and prognosis of the socioeconomic impact of dementia. Thereafter the main risk factors for DAT are covered. The chapter also addresses the results of ongoing therapeutic and preventive intervention trials for DAT. Finally, the future challenges of the epidemiology of dementia with a focus on the impact of the new diagnostic criteria for neurocognitive disorders, as well as the development of biomarkers for DAT and other types of dementia, will be briefly discussed.
Topics: Alzheimer Disease; Biomarkers; Dementia; Humans; Incidence; Prevalence; Risk Factors
PubMed: 27637956
DOI: 10.1016/B978-0-12-802973-2.00008-2 -
Revista de Neurologia Jun 2018Dementia is a clinical syndrome resulting from a number of causations and which is usually accompanied by progressive and diffuse brain dysfunction. The different... (Review)
Review
INTRODUCTION
Dementia is a clinical syndrome resulting from a number of causations and which is usually accompanied by progressive and diffuse brain dysfunction. The different subtypes are characterised by a clinical picture with common symptoms that differ in terms of their aetiology, age, clinical presentation, clinical course and associated disorders.
AIM
To present an update on the information available about the descriptive epidemiology of dementia and its main subtypes.
DEVELOPMENT
The main data on prevalence, incidence and mortality were extracted from a literature review. Alzheimer's disease is the most frequent subtype and accounts for 60-80% of all the cases, followed by vascular dementia and other neurodegenerative dementias, such as dementia due to Lewy bodies, the dementia-Parkinson complex and frontotemporal dementia. Other subtypes of dementias present frequencies below 1%, and the epidemiological indicators available are not very robust.
CONCLUSIONS
The prevalence and incidence of dementia increase exponentially from the age of 65 onwards. As a consequence of the progressive ageing of the population and the increase in life expectancy, the number of cases of dementia will rise in the coming decades. Recent studies point to a slight drop in the accumulated risk of dementia adjusted by age groups and sex over the last few decades in some countries. It is possible that by means of primary prevention strategies implemented upon the known risk factors for dementia the burden of dementia on public health will diminish in the future.
Topics: Aged; Aged, 80 and over; Alzheimer Disease; Dementia; Developed Countries; Developing Countries; Female; Global Health; Humans; Incidence; Life Expectancy; Male; Meta-Analysis as Topic; Population Dynamics; Prevalence; Risk Factors
PubMed: 29790571
DOI: No ID Found -
Brain : a Journal of Neurology Mar 2021The association between hearing impairment and dementia has emerged as a major public health challenge, with significant opportunities for earlier diagnosis, treatment... (Review)
Review
The association between hearing impairment and dementia has emerged as a major public health challenge, with significant opportunities for earlier diagnosis, treatment and prevention. However, the nature of this association has not been defined. We hear with our brains, particularly within the complex soundscapes of everyday life: neurodegenerative pathologies target the auditory brain, and are therefore predicted to damage hearing function early and profoundly. Here we present evidence for this proposition, based on structural and functional features of auditory brain organization that confer vulnerability to neurodegeneration, the extensive, reciprocal interplay between 'peripheral' and 'central' hearing dysfunction, and recently characterized auditory signatures of canonical neurodegenerative dementias (Alzheimer's disease, Lewy body disease and frontotemporal dementia). Moving beyond any simple dichotomy of ear and brain, we argue for a reappraisal of the role of auditory cognitive dysfunction and the critical coupling of brain to peripheral organs of hearing in the dementias. We call for a clinical assessment of real-world hearing in these diseases that moves beyond pure tone perception to the development of novel auditory 'cognitive stress tests' and proximity markers for the early diagnosis of dementia and management strategies that harness retained auditory plasticity.
Topics: Aged; Aged, 80 and over; Alzheimer Disease; Auditory Perception; Brain; Cognitive Dysfunction; Comorbidity; Dementia; Frontotemporal Dementia; Hearing; Hearing Loss; Humans; Lewy Body Disease; Middle Aged
PubMed: 33351095
DOI: 10.1093/brain/awaa429 -
Seminars in Neurology Apr 2019Dementia is a global health issue, the burden of which will worsen with an increasingly aging population. Alzheimer's disease (AD) is the most common dementia, with 50... (Review)
Review
Dementia is a global health issue, the burden of which will worsen with an increasingly aging population. Alzheimer's disease (AD) is the most common dementia, with 50 to 60% of all dementias attributable to AD alone, while the rest are mostly due to frontotemporal lobar dementia, dementia with Lewy bodies, Parkinson's disease dementia, and vascular dementia. Diagnosis of dementias is made clinically with the aid of other testing modalities including neuroimaging. While the role of imaging has traditionally been to exclude reversible causes of dementia, positron emission tomography (PET) with 18-fluorine fluorodeoxyglucose and magnetic resonance imaging now are increasingly used more for definitive diagnosis of dementia in the prodromal stages and to aid with formulating the differential diagnoses. Introduction of molecular imaging modalities such as amyloid PET and tau PET have improved diagnostic certainty in the clinical trial setting and promise to find their way into the clinic in the near future. In this review, we will focus on the multimodality imaging of dementias especially AD and its differential diagnoses.
Topics: Dementia; Humans; Magnetic Resonance Imaging; Neuroimaging; Positron-Emission Tomography
PubMed: 30925612
DOI: 10.1055/s-0039-1678580