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Dementia Syndromes
George H. Dooneief, MD, MPH, is a board certified neurologist. He is on the medical staff of several Pennsylvania hospitals, and has written and lectured on a number of neurologic disorders. Here, he defines dementia ... noting its increasing prevalence as the population ages. For instance, the incidence of Alzheimer's disease, the commonest cause of dementia (65%) is estimated to increase more than threefold by 2040. Dr. Dooneief discusses several other causes of dementia, including diffuse Lewy body disease, Pick's disease, Parkinson's disease, Huntington's disease, Wilson's disease and Creutzfeldt-Jakob disease .He goes on to list treatable causes of cognitive dysfunction that may mimic dementia. Among the risk factors for Alzheimer's are, of course, age ... with women appearing to be at greater risk than men. Head trauma, stroke, and elevated homocysteine levels are also factors, as is low educational attainment. Onset of the disease is insidious, with gradual forgetfulness the major symptom, along with other cognitive deficits such as, speech and visuospatial disturbances, and personality changes .Progression is relentless. While a definitive diagnosis of Alzheimer's can be reached only by biopsy or autopsy, memory impairment is related to loss of cholinergic function in the brain. The author posits a number of genetic hypotheses, including amyloidogenesis in Alzheimer's disease. The problem of obtaining a precise history is exacerbated by the patient's condition itself. Neurologic testing is useful in making a differential diagnosis ... as are cognitive testing and neuroimaging. The lecture concludes with a discussion on acetylcholinesterase inhibitors in treatment, some future therapies such as amyloid antiaggregants &ndash and how to communicate the diagnosis to patient and family, which should include consideration of such legal factors as wills and advance directives in Alzheimer's disease. |
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