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Seminars in Neurology Apr 2019Rapidly progressive dementia (RPD) or cognitive decline is a common presenting complaint in neurology. While primary dementia is often a concern, other forms of... (Review)
Review
Rapidly progressive dementia (RPD) or cognitive decline is a common presenting complaint in neurology. While primary dementia is often a concern, other forms of reversible dementia must be thoroughly considered. This article focuses on the growing field of autoimmune encephalitis (AE) as it pertains to the differential diagnostic considerations in a work-up for RPD. Understanding clues in the history and examination is the first step in identifying patients with a potential autoimmune cause for RPD. While testing for infectious and toxic-metabolic etiologies is commonly preformed, it is necessary to consider early ancillary testing for AE in appropriate cases of RPD. Autoantibody testing in the spinal fluid and serum, brain imaging, and electroencephalography all form the first line of investigations for AE. Treatment options and strategies depend on the AE subtype and a number of individual patient considerations.
Topics: Autoimmune Diseases of the Nervous System; Dementia; Disease Progression; Encephalitis; Humans
PubMed: 30925620
DOI: 10.1055/s-0039-1678583 -
Acta Neurologica Belgica Dec 2019It is well established that the clinical picture of dementias is not clinically homogeneous. For example, non-amnestic presentations of Alzheimer's disease have been... (Review)
Review
It is well established that the clinical picture of dementias is not clinically homogeneous. For example, non-amnestic presentations of Alzheimer's disease have been referred to as a typical variant. Careful examination of clinical characteristics contributes to understanding the neurobiology of Alzheimer's disease and other dementias and may in turn enhance knowledge of the potential risk factors involved. This study aimed at describing uncommon or bizarre symptoms/syndromes observed in patients suffering from dementia. Medline and Google scholar searches were conducted for relevant articles, chapters, and books published before 2019. Search terms used included dementia, déjà vu, zoophilia, pathological lying, and somatic symptom disorder. Publications found through this indexed search were reviewed for further relevant references. Uncommon/bizarre features of dementia were described as case reports and there were no systematic investigations.
Topics: Dementia; Humans
PubMed: 31552557
DOI: 10.1007/s13760-019-01208-1 -
Continuum (Minneapolis, Minn.) Apr 2016This article describes the methods of diagnosis and management of autoimmune encephalopathies and dementias. The expedited distinction of autoimmune encephalopathies and... (Review)
Review
PURPOSE OF REVIEW
This article describes the methods of diagnosis and management of autoimmune encephalopathies and dementias. The expedited distinction of autoimmune encephalopathies and dementias from neurodegenerative disorders is important because treatment is most effective at the early stage of illness.
RECENT FINDINGS
The spectrum of antibody biomarkers of treatable autoimmune encephalopathies continues to broaden and now includes antibodies targeting glutamate receptors (N-methyl-D-aspartate [NMDA] and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid [AMPA]), γ-aminobutyric acid A and B (GABA-A and GABA-B) receptors, glycine receptors, potassium channel complexes (Kv1, which includes leucine-rich, glioma inactivated 1 [LgI1], contactin-associated proteinlike 2 [CASPR2], and unknown specificity, and Kv4.2, which includes dipeptidyl-peptidase 6 [DPPX]), and glutamic acid decarboxylase 65 (GAD65). Early treatment of certain autoimmune encephalopathies with rituximab or cyclophosphamide improves outcome when corticosteroids, IV immunoglobulin (IVIg), and plasma exchange have proven ineffective.
SUMMARY
Despite the progress made in diagnostics, in many instances, patients with immunotherapy-responsive encephalopathies and dementias are seronegative for encephalitis-specific antibodies. Other clues to an autoimmune cause include a subacute symptom onset, rapid progression, personal history of autoimmunity or cancer, an inflammatory CSF, non-neural antibodies detected in serum, and a response to immunotherapy.
Topics: Autoantibodies; Autoimmune Diseases of the Nervous System; Dementia; Humans
PubMed: 27042907
DOI: 10.1212/CON.0000000000000299 -
Neurology Dec 2017Goal 1 of the National Plan to Address Alzheimer's Disease is to prevent and effectively treat Alzheimer disease and Alzheimer disease-related dementias by 2025. To help... (Review)
Review
Goal 1 of the National Plan to Address Alzheimer's Disease is to prevent and effectively treat Alzheimer disease and Alzheimer disease-related dementias by 2025. To help inform the research agenda toward achieving this goal, the NIH hosts periodic summits that set and refine relevant research priorities for the subsequent 5 to 10 years. This proceedings article summarizes the 2016 Alzheimer's Disease-Related Dementias Summit, including discussion of scientific progress, challenges, and opportunities in major areas of dementia research, including mixed-etiology dementias, Lewy body dementia, frontotemporal degeneration, vascular contributions to cognitive impairment and dementia, dementia disparities, and dementia nomenclature.
Topics: Alzheimer Disease; Dementia; Goals; Humans; Research; United States
PubMed: 29117955
DOI: 10.1212/WNL.0000000000004717 -
Clinics in Geriatric Medicine Aug 2014Because neurodegenerative dementias are progressive and ultimately fatal, a palliative approach focusing on comfort, quality of life, and family support can have... (Review)
Review
Because neurodegenerative dementias are progressive and ultimately fatal, a palliative approach focusing on comfort, quality of life, and family support can have benefits for patients, families, and the health system. Elements of a palliative approach include discussion of prognosis and goals of care, completion of advance directives, and a thoughtful approach to common complications of advanced dementia. Physicians caring for patients with dementia should formulate a plan for end-of-life care in partnership with patients, families, and caregivers, and be prepared to manage common symptoms at the end of life in dementia, including pain and delirium.
Topics: Aged; Dementia; Humans; Palliative Care; Quality of Health Care
PubMed: 25037291
DOI: 10.1016/j.cger.2014.04.004 -
Neurological Sciences : Official... Apr 2018Dementia represents one of the most diffuse disorders of our Era. Alzheimer's disease is the principle cause of dementia worldwide. Metabolic, infectious, autoimmune,... (Review)
Review
Dementia represents one of the most diffuse disorders of our Era. Alzheimer's disease is the principle cause of dementia worldwide. Metabolic, infectious, autoimmune, inflammatory, and genetic dementias represent a not negligible number of disorders, with increasing numbers in younger subjects. Due to the heterogeneity of patients and disorders, the diagnosis of dementia is challenging. In the present article, we propose a practical diagnostic approach following the two-step investigation procedure. The first step includes basic blood tests and brain neuroimaging, performed on all patients. After this first-line investigation, it is then possible to rule out metabolic causes of dementia and to identify three main subgroups in dementia: predominant gray matter atrophy, white matter disease, basal ganglia pathologies. The predominant gray matter atrophy subgroup includes neurodegenerative causes of dementia and some lysosomal storage disorders. The white matter subgroup indicates a comprehensive list of vascular dementia causes, mitochondrial diseases, and leukodystrophies. Whereas, the basal ganglia alterations are due to metal accumulation pathologies, such as iron, copper, or calcium. Each category has specific clinical hallmarks, accurately reported in the article, and requires specific second-line investigation. Thus, we indicate the distinct second diagnostic step of each disease. The proposed diagnostic flow-chart follows the clinical reasoning and helps clinicians through the differential diagnosis of dementia.
Topics: Alzheimer Disease; Atrophy; Brain; Cognition Disorders; Dementia, Vascular; Diagnosis, Differential; Humans
PubMed: 29198043
DOI: 10.1007/s10072-017-3206-0 -
Progress in Neurobiology 2016Neurodegenerative diseases with abnormal protein aggregates such as Alzheimer's disease, tauopathies, synucleinopathies, and prionopathies, together with vascular... (Review)
Review
Neurodegenerative diseases with abnormal protein aggregates such as Alzheimer's disease, tauopathies, synucleinopathies, and prionopathies, together with vascular encephalopathies, are cause of cognitive impairment and dementia. Identification of reliable biomarkers in biological fluids, particularly in the cerebrospinal fluid (CSF), is of extreme importance in optimizing the precise early clinical diagnosis of distinct entities and predicting the outcome in particular settings. In addition, the study of CSF biomarkers is useful to identify and monitor the underlying pathological processes developing in the central nervous system of affected individuals. Evidence suggests that levels of key CSF molecules correlate, in some circumstances, with prediction, disease progression, and severity of cognitive decline. Correlation of CSF markers and underlying pathological molecular substrates in brain is an exciting field for further study. However, while some dementias such as Creutzfeldt-Jakob disease have accurate CSF biomarkers, other disease types such as dementia with Lewy bodies, vascular dementia, and frontotemporal dementia lack reliable biomarkers for their specific clinical diagnosis.
Topics: Animals; Biomarkers; Dementia; Humans; Neurodegenerative Diseases
PubMed: 27016008
DOI: 10.1016/j.pneurobio.2016.03.003 -
Journal of Medical Internet Research Apr 2022The dementia epidemic is progressing fast. As the world's older population keeps skyrocketing, the traditional incompetent, time-consuming, and laborious interventions... (Review)
Review
BACKGROUND
The dementia epidemic is progressing fast. As the world's older population keeps skyrocketing, the traditional incompetent, time-consuming, and laborious interventions are becoming increasingly insufficient to address dementia patients' health care needs. This is particularly true amid COVID-19. Instead, efficient, cost-effective, and technology-based strategies, such as sixth-generation communication solutions (6G) and artificial intelligence (AI)-empowered health solutions, might be the key to successfully managing the dementia epidemic until a cure becomes available. However, while 6G and AI technologies hold great promise, no research has examined how 6G and AI applications can effectively and efficiently address dementia patients' health care needs and improve their quality of life.
OBJECTIVE
This study aims to investigate ways in which 6G and AI technologies could elevate dementia care to address this study gap.
METHODS
A literature review was conducted in databases such as PubMed, Scopus, and PsycINFO. The search focused on three themes: dementia, 6G, and AI technologies. The initial search was conducted on April 25, 2021, complemented by relevant articles identified via a follow-up search on November 11, 2021, and Google Scholar alerts.
RESULTS
The findings of the study were analyzed in terms of the interplay between people with dementia's unique health challenges and the promising capabilities of health technologies, with in-depth and comprehensive analyses of advanced technology-based solutions that could address key dementia care needs, ranging from impairments in memory (eg, Egocentric Live 4D Perception), speech (eg, Project Relate), motor (eg, Avatar Robot Café), cognitive (eg, Affectiva), to social interactions (eg, social robots).
CONCLUSIONS
To live is to grow old. Yet dementia is neither a proper way to live nor a natural aging process. By identifying advanced health solutions powered by 6G and AI opportunities, our study sheds light on the imperative of leveraging the potential of advanced technologies to elevate dementia patients' will to live, enrich their daily activities, and help them engage in societies across shapes and forms.
Topics: Artificial Intelligence; COVID-19; Dementia; Humans; Quality of Life; Technology
PubMed: 35475733
DOI: 10.2196/30503 -
European Journal of Nuclear Medicine... Jul 2016The multifaceted nature of the pathology of dementia spectrum disorders has complicated their management and the development of effective treatments. This is despite the... (Review)
Review
The multifaceted nature of the pathology of dementia spectrum disorders has complicated their management and the development of effective treatments. This is despite the fact that they are far from uncommon, with Alzheimer's disease (AD) alone affecting 35 million people worldwide. The cholinergic system has been found to be crucially involved in cognitive function, with cholinergic dysfunction playing a pivotal role in the pathophysiology of dementia. The use of molecular imaging such as SPECT and PET for tagging targets within the cholinergic system has shown promise for elucidating key aspects of underlying pathology in dementia spectrum disorders, including AD or parkinsonian dementias. SPECT and PET studies using selective radioligands for cholinergic markers, such as [(11)C]MP4A and [(11)C]PMP PET for acetylcholinesterase (AChE), [(123)I]5IA SPECT for the α4β2 nicotinic acetylcholine receptor and [(123)I]IBVM SPECT for the vesicular acetylcholine transporter, have been developed in an attempt to clarify those aspects of the diseases that remain unclear. This has led to a variety of findings, such as cortical AChE being significantly reduced in Parkinson's disease (PD), PD with dementia (PDD) and AD, as well as correlating with certain aspects of cognitive function such as attention and working memory. Thalamic AChE is significantly reduced in progressive supranuclear palsy (PSP) and multiple system atrophy, whilst it is not affected in PD. Some of these findings have brought about suggestions for the improvement of clinical practice, such as the use of a thalamic/cortical AChE ratio to differentiate between PD and PSP, two diseases that could overlap in terms of initial clinical presentation. Here, we review the findings from molecular imaging studies that have investigated the role of the cholinergic system in dementia spectrum disorders.
Topics: Choline; Dementia; Diagnostic Imaging; Humans; Synapses
PubMed: 26984612
DOI: 10.1007/s00259-016-3349-x -
Health Services Research Aug 2019To estimate dementia's incremental cost to the traditional Medicare program.
OBJECTIVE
To estimate dementia's incremental cost to the traditional Medicare program.
DATA SOURCES
Health and Retirement Study (HRS) survey-linked Medicare part A and B claims from 1991 to 2012.
STUDY DESIGN
We compared Medicare expenditures for 60 months following a claims-based dementia diagnosis to those for a randomly selected, matched comparison group.
DATA COLLECTION/EXTRACTION METHODS
We used a cost estimator that accounts for differential survival between individuals with and without dementia and decomposes incremental costs into survival and cost intensity components.
PRINCIPAL FINDINGS
Dementia's five-year incremental cost to the traditional Medicare program is approximately $15 700 per patient, nearly half of which is incurred in the first year after diagnosis. Shorter survival with dementia mitigates the incremental cost by about $2650. Increased costs for individuals with dementia were driven by more intensive use of Medicare part A covered services. The incremental cost of dementia was about $7850 higher for females than for males because of sex-specific differential mortality associated with dementia.
CONCLUSIONS
Dementia's cost to the traditional Medicare program is significant. Interventions that target early identification of dementia and preventable inpatient and post-acute care services could produce substantial savings.
Topics: Age Factors; Aged; Aged, 80 and over; Alzheimer Disease; Comorbidity; Dementia; Female; Health Expenditures; Humans; Male; Medicare; Retrospective Studies; Sex Factors; Socioeconomic Factors; Time Factors; United States
PubMed: 30868557
DOI: 10.1111/1475-6773.13134