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Seminars in Neurology Sep 2008Although dementia is a clinical diagnosis, neuroimaging often is crucial for proper assessment. Magnetic resonance imaging (MRI) and computed tomography (CT) may... (Review)
Review
Although dementia is a clinical diagnosis, neuroimaging often is crucial for proper assessment. Magnetic resonance imaging (MRI) and computed tomography (CT) may identify nondegenerative and potentially treatable causes of dementia. Recent neuroimaging advances, such as the Pittsburgh Compound-B (PIB) ligand for positron emission tomography imaging in Alzheimer's disease, will improve our ability to differentiate among the neurodegenerative dementias. High-resolution volumetric MRI has increased the capacity to identify the various forms of the frontotemporal lobar degeneration spectrum and some forms of parkinsonism or cerebellar neurodegenerative disorders, such as corticobasal degeneration, progressive supranuclear palsy, multiple system atrophy, and spinocerebellar ataxias. In many cases, the specific pattern of cortical and subcortical abnormalities on MRI has diagnostic utility. Finally, among the new MRI methods, diffusion-weighted MRI can help in the early diagnosis of Creutzfeldt-Jakob disease. Although only clinical assessment can lead to a diagnosis of dementia, neuroimaging is clearly an invaluable tool for the clinician in the differential diagnosis.
Topics: Dementia; Diagnostic Imaging; Humans
PubMed: 18843575
DOI: 10.1055/s-0028-1083695 -
The Journal of the American Osteopathic... Oct 2013The number of US older adults with dementia is expected to grow over the next several decades. For instance, the number of persons with Alzheimer disease is predicted to... (Review)
Review
The number of US older adults with dementia is expected to grow over the next several decades. For instance, the number of persons with Alzheimer disease is predicted to increase by 50% by 2030. Physicians commonly come into contact with patients who have dementia and, as such, need to understand its varied presentation. In the current review, the most common types of dementia, including Alzheimer disease, frontotemporal dementia, dementia due to vascular disease, and several others, are described. Characteristics and etiologic findings of cortical and subcortical dementias are differentiated, and cognitive profiles and symptoms of specific types of dementia are reviewed. An osteopathic approach to care, focusing on establishing a relationship with patients and their families, is also discussed.
Topics: Caregivers; Dementia; Family Practice; Humans; Osteopathic Medicine; Osteopathic Physicians; United States
PubMed: 24084803
DOI: 10.7556/jaoa.2013.046 -
BMC Geriatrics Dec 2008Nicotine may aid reaction time, learning and memory, but smoking increases cardiovascular risk. Cardiovascular risk factors have been linked to increased risk of... (Review)
Review
BACKGROUND
Nicotine may aid reaction time, learning and memory, but smoking increases cardiovascular risk. Cardiovascular risk factors have been linked to increased risk of dementia. A previous meta-analysis found that current smokers were at higher risk of subsequent dementia, Alzheimer's disease, vascular dementia and cognitive decline.
METHODS
In order to update and examine this further a systematic review and meta-analysis was carried out using different search and inclusion criteria, database selection and more recent publications. Both reviews were restricted to those aged 65 and over.
RESULTS
The review reported here found a significantly increased risk of Alzheimer's disease with current smoking and a likely but not significantly increased risk of vascular dementia, dementia unspecified and cognitive decline. Neither review found clear relationships with former smoking.
CONCLUSION
Current smoking increases risk of Alzheimer's disease and may increase risk of other dementias. This reinforces need for smoking cessation, particularly aged 65 and over. Nicotine alone needs further investigation.
Topics: Aged; Aging; Cognition Disorders; Dementia; Humans; Risk Factors; Smoking
PubMed: 19105840
DOI: 10.1186/1471-2318-8-36 -
Continuum (Minneapolis, Minn.) Apr 2013This review outlines a practical approach to the history, mental state, neurologic examination, and laboratory tests in the diagnosis of dementia. (Review)
Review
PURPOSE OF REVIEW
This review outlines a practical approach to the history, mental state, neurologic examination, and laboratory tests in the diagnosis of dementia.
RECENT FINDINGS
Proposed new diagnostic criteria for Alzheimer disease recognize that nonamnestic presentations with symptoms that predominantly affect language, visuospatial abilities, or executive function may occur, particularly with onset before the age of 65. New criteria assign greater likelihood to diagnosis if progressive cognitive decline is documented through serial assessment, or if biomarkers are supportive. In patients aged 80 or older, more than one cause of dementia is often present, for example, Alzheimer disease plus vascular dementia. Clinical diagnostic criteria for non-Alzheimer dementias are evolving, particularly in areas such as frontotemporal dementia. Imaging and CSF biomarkers have been proposed in recent diagnostic criteria for Alzheimer disease. Although biomarkers can provide a higher level of certainty that Alzheimer pathology may or may not be present, biomarkers for non-Alzheimer dementias are lacking.
SUMMARY
The availability of biomarkers does not replace or diminish the need for a thorough clinical evaluation. A structured clinical approach helps to define the diagnosis and collects information essential for establishing a comprehensive care plan for patients with dementia and their families.
Topics: Age of Onset; Aged, 80 and over; Biomarkers; Dementia; Disease Progression; Humans; Mental Status Schedule; Neurologic Examination
PubMed: 23558485
DOI: 10.1212/01.CON.0000429176.37224.58 -
Journal of Alzheimer's Disease : JAD 2021Self-reported discrimination is a source of psychosocial stress that has been previously associated with poor cognitive function in older African Americans without...
BACKGROUND
Self-reported discrimination is a source of psychosocial stress that has been previously associated with poor cognitive function in older African Americans without dementia.
OBJECTIVE
Here, we examine the association of discrimination with dementia and cognitive impairment in racially diverse older Brazilians.
METHODS
We included 899 participants 65 years or older (34.3% Black) from the Pathology, Alzheimer's and Related Dementias Study (PARDoS), a community-based study of aging and dementia. A structured interview with informants of the deceased was conducted. The interview included the Clinical Dementia Rating (CDR) Scale for the diagnosis of dementia and cognitive impairment proximate to death and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a second measure of cognitive impairment. Informant-reported discrimination was assessed using modified items from the Major and Everyday Discrimination Scales.
RESULTS
Discrimination was reported by informants of 182 (20.2%) decedents and was more likely reported by informants of Blacks than Whites (25.3% versus 17.6%, p = 0.006). Using the CDR, a higher level of informant-reported discrimination was associated with higher odds of dementia (OR: 1.24, 95% CI 1.08 -1.42, p = 0.002) and cognitive impairment (OR: 1.21, 95% CI: 1.06 -1.39, p = 0.004). Similar results were observed using the IQCODE (estimate: 0.07, SE: 0.02, p = 0.003). The effects were independent of race, sex, education, socioeconomic status, major depression, neuroticism, or comorbidities.
CONCLUSION
Higher level of informant-reported discrimination was associated with higher odds of dementia and cognitive impairment in racially diverse older Brazilians.
Topics: Aged; Aged, 80 and over; Brazil; Cognitive Dysfunction; Dementia; Family; Female; Humans; Interviews as Topic; Male; Mental Status and Dementia Tests; Social Discrimination; Stress, Psychological
PubMed: 33935076
DOI: 10.3233/JAD-201436 -
Current Neurology and Neuroscience... Sep 2009Although most dementias are due to neurodegenerative or vascular disease, it is important to diagnose immunologically mediated dementias quickly because they can be both... (Review)
Review
Although most dementias are due to neurodegenerative or vascular disease, it is important to diagnose immunologically mediated dementias quickly because they can be both rapidly progressive and readily treatable. They usually affect function of limbic and cortical structures, but subcortical involvement can also occur. Because of the variety of symptoms and the rapid course, these dementias present a particular challenge to the clinician and may require evaluation and intervention in the inpatient setting. Diagnostic workup typically reveals evidence of an autoimmune process and, in some cases, cancer. In contrast to the neurodegenerative processes, many of the immunologically mediated dementias respond to immunomodulatory therapy.
Topics: Biomarkers; Brain; Dementia; Diagnosis, Differential; Diagnostic Techniques, Neurological; ELAV Proteins; Humans; Immunotherapy; Paraneoplastic Syndromes, Nervous System
PubMed: 19664365
DOI: 10.1007/s11910-009-0053-2 -
Journal of Thrombosis and Haemostasis :... Aug 2011Hemostasis and thrombosis may be important contributors to cognitive decline and dementia. Certain blood markers may assist in diagnosis or management. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVES
Hemostasis and thrombosis may be important contributors to cognitive decline and dementia. Certain blood markers may assist in diagnosis or management.
OBJECTIVES
To collate evidence for the association of circulating hemostatic variables and dementia or cognitive impairment.
METHODS
A systematic review of studies describing blood markers of hemostatic function and cognition/dementia. Abstracts were reviewed by two independent assessors and studies selected based on pre-specified criteria. We described methodological quality and performed meta-analyzes where data allowed.
RESULTS
From 7103 titles, 485 abstracts and included 21 studies (n = 32,773) were assessed. In two longitudinal studies, the incident of vascular dementia risk was greater for higher D-dimer [hazard ratio (HR): 1.50, 95% confidence interval (CI): 1.15-1.96]. For case-control data, we calculated standardized mean differences (SMD) and 95% CI. Higher levels of: factor (F)VII (SMD: 0.93; 95% CI: 0.60-1.26), fibrinogen (SMD: 1.53; 95% CI: 1.17-1.87), prothrombin fragment 1 and 2 (SMD: 0.64; 95% CI: 0.32-0.96), plasminogen activator inhibitor (SMD: 0.68; 95% CI: 0.26-1.10), D-dimer (SMD: 2.00; 95% CI: 1.59-2.40) and von Willebrand factor (VWF) (SMD: 1.68; 95% CI: 1.30-2.06) showed modest but significant associations with vascular dementia. For patients with any dementia diagnosis, associations were with higher D-dimer (SMD: 0.36; 95% CI: 0.15-0.56) and VWF (SMD: 0.31; 95% CI: 0.11-0.51). For specific cognitive domains, significant (P < 0.001) positive correlations were fibrinogen and speed of processing (0.76; 95% CI: 0.67-0.84), verbal memory (0.69; 95% CI: 0.59-0.79) and non-verbal reasoning (0.57; 95% CI: 0.49-0.65).
CONCLUSIONS
The present results suggest a modest association between hemostasis and vascular dementia including increased levels of thrombin generation markers (D-dimer and prothrombin fragment 1 + 2) and endothelial dysfunction (VWF and plasminogen activator inhibitor). Associations are weaker for specific cognitive tests and when all dementias are combined.
Topics: Biomarkers; Cognition; Cognition Disorders; Dementia; Hemostasis; Humans; Neuropsychological Tests; Prognosis; Risk Assessment; Risk Factors
PubMed: 21676170
DOI: 10.1111/j.1538-7836.2011.04403.x -
AJNR. American Journal of Neuroradiology 2014There is increasing use of neuroimaging modalities, including PET, for diagnosing dementia. For example, FDG-PET demonstrates hypometabolic regions in the posterior... (Review)
Review
There is increasing use of neuroimaging modalities, including PET, for diagnosing dementia. For example, FDG-PET demonstrates hypometabolic regions in the posterior cingulate gyri, precuneus, and parietotemporal association cortices, while amyloid PET indicates amyloid deposition in Alzheimer disease and mild cognitive impairment due to Alzheimer disease. Furthermore, the use of combination PET with structural MR imaging can improve the diagnostic accuracy of dementia. In other neurodegenerative dementias, each disease exhibits a specific metabolic reduction pattern. In dementia with Lewy bodies, occipital glucose metabolism is decreased, while in frontotemporal dementia, frontal and anterior temporal metabolism is predominantly decreased. These FDG-PET findings and positive or negative amyloid deposits are important biomarkers for various neurodegenerative dementias.
Topics: Aged; Dementia; Fluorodeoxyglucose F18; Humans; Neuroimaging; Positron-Emission Tomography; Radiopharmaceuticals
PubMed: 23945233
DOI: 10.3174/ajnr.A3695 -
Journal of Pain and Symptom Management May 2022Pain is a significant concern among older adults with Alzheimer's disease and related dementias (ADRD).
CONTEXT
Pain is a significant concern among older adults with Alzheimer's disease and related dementias (ADRD).
OBJECTIVES
Examine the association between cognitive impairment across the ADRD spectrum and pain assessment and treatment in community-dwelling older Americans.
METHODS
This cross-sectional, population-based study included 16,836 community-dwelling participants ≥ 50 years in the 2018 Health and Retirement Study. ADRD, assessed by validated cognitive measures, was categorized into "dementia," "cognitive impairment, no dementia (CIND)" and "intact cognition." Pain assessment included pain presence (often being troubled with pain), pain severity (degree of pain most of the time [mild/moderate/severe]), and pain interference (pain making it difficult to do usual activities). Pain treatment included recent use of over-the-counter pain medications and opioids (past 3 months), and regular intake of prescriptions for pain.
RESULTS
Dementia were associated with lower likelihood of reporting pain presence (Odds Ratio [OR]= 0.61, P = 0.01), pain interference (OR = 0.46, P < 0.001), reporting lower pain severity (e.g., moderate vs. no: Relative Risk Ratio = 0.38, P < 0.001), and lower likelihood of receiving pain treatment, that is, recent use of over-the-counter pain medications (OR = 0.60, P = 0.02) and opioids (OR = 0.33, P < 0.001), and regular intake of prescriptions for pain (OR = 0.461, P = 0.002). CIND was associated with reporting lower pain severity (e.g., moderate vs. no: Relative Risk Ratio = 0.75, P = 0.021), lower likelihood of reporting pain interference (OR = 0.79, P = 0.045) and recent over-the-counter pain medication use (OR = 0.74, P = 0.026).
CONCLUSION
CIND and dementia increased the risk of under-report and under-treatment of pain. Systematic efforts are needed to improve pain recognition and treatment among older adults with cognitive impairment, regardless of dementia diagnosis.
Topics: Aged; Alzheimer Disease; Analgesics, Opioid; Cognitive Dysfunction; Cross-Sectional Studies; Dementia; Humans; Independent Living; Pain; United States
PubMed: 35081442
DOI: 10.1016/j.jpainsymman.2022.01.012 -
Neurology Aug 2014The National Alzheimer's Project Act, signed into law in 2011, mandates a National Plan to Address Alzheimer's Disease that is updated annually. In the Plan, the term... (Review)
Review
The National Alzheimer's Project Act, signed into law in 2011, mandates a National Plan to Address Alzheimer's Disease that is updated annually. In the Plan, the term Alzheimer disease includes not only Alzheimer disease (AD) proper, but also several specified related dementias, namely, frontotemporal, Lewy body, vascular, and mixed dementia. In response to a specific action item in the 2012 National Plan, the National Institute of Neurological Disorders and Stroke, in collaboration with the National Institute on Aging, convened panels of experts and conducted a 2-day public conference to develop research priorities and timelines for addressing Alzheimer disease-related dementias (ADRD) in 5 topic areas: multiple etiology dementias, health disparities, Lewy body dementias including dementia with Lewy bodies and Parkinson disease dementia, frontotemporal dementia and related tauopathies, and vascular contributions to ADRD. By design, the product was up to 8 prioritized research recommendations in each topic area including estimated timelines from when work on a recommendation is started to completion or to full implementation of an ongoing activity, and recognition of shared research themes across recommendations. These included increased education and training of both researchers and health care professionals, addressing health disparities, fundamental neurobiology research, advanced diagnostics, collaborative biosample repositories, and a focus on developing effective interventions to prevent or treat ADRD by the year 2025 as targeted by the National Plan.
Topics: Alzheimer Disease; Dementia; Humans; Research; United States
PubMed: 25080517
DOI: 10.1212/WNL.0000000000000733