Basic Principles Neurological Perspective

The neurologic chapters in this handbook stress three general principles of neurology as applied to dementia. These principles are not unique to neurology, but are routinely used by neuroscientists and clinical neurologists. These chapters and approaches emphasize the biomedical model of disease causation and treatment and demonstrate that their application can result in more accurate diagnosis and more appropriate and effective treatments. Principle 1 Biomedical Research Can Lead to a Better...

Assessment of Psychosis in Alzheimers Disease

Using one of the neuropsychiatric batteries to help determine target symptoms should occur after reversible medical conditions (e.g., occult infection, metabolic imbalance) and iatrogenic or medication-induced symptom production are ruled out. Several assessment batteries are available to identify and reliably quantify target symptoms for treatment. The most common rating scales available to measure neuro-psychiatric symptoms of AD include the Neuropsychiatric Inventory (NPI Cummings et al.,...

Assessing Behavioral And Psychiatric Symptoms

While behavioral disturbances are not part of the diagnostic symptomatology, they are very common in AD, particularly as the disease progresses. Early in the disease, depression is noted, which may be minimally disturbing to patients and family. Later symptoms such as agitation, psychosis, and wandering can be disturbing and threaten patient safety. While clinicians often deal with these symptoms, there is less information on how to assess, prepare patient and family members, and treat in the...

Summary of Lewy Body Dementia

Although pathologically distinct from Alzheimer's disease, LBD usually occurs in combination with the neurofibrillary tangles and plagues of AD, suggesting an etiological connection between these two forms of dementia that has not yet been discovered. Epidemiological characteristics such as the low rate of pure LBD cases, the higher rate of LBD in males than females, and the more rapid course of LBD compared to pure AD, may provide clues into the risk and etiological factors of LBD. The most...

Neurobiological Mechanisms of Psychosis in Dementia

Based on neuroimaging studies, an association between delusions in dementia and dysfunction in the paralimbic area of the frontal cortex has been found (Sultzer, 1996). Using neuropathological and neuochemical investigations in patients with primary dementia, those with psychosis have been found to have significantly more plaques and tangles in the medial temporal-prosubicular area and the middle frontal cortex (Zubenko et al., 1991) and four to five times higher levels of abnormal paired...

Depression in PD

Depression is the most common neuropsychiatric disturbance in IPD. A comprehensive review of the literature by Cummings (1992) found rates of depression to average 40 with the range being 4 to 70 depending on the specific population assessed and the rating scales used. Of these, approximately half met criteria for major depression and the other half had chronic dysthymia. Another recent literature review between 1922 and 1998 by Slaughter, Slaughter, Nichols, and Martens (2001) found an overall...

Psychiatric Assessment and Treatment of Nonpsychotic Behavioral Disturbances in Dementia

Michael Ryan, M. Saleem Ismail, and Pierre N. Tariot In addition to core cognitive and functional deficits, neuropsychiatry symptoms, emotional disorders, and behavioral alterations are ubiquitous among patients with dementia syndromes. Clinicians should be concerned with the behavioral signs and symptoms of Alzheimer's disease (AD) and other dementias because they are prevalent, distressing to the patient, and upsetting to caregivers. Often they contribute...

Clinical Presentation and Diagnosis of DLB

DLB has been recognized as a clinical entity that overlaps in clinical, pathological, and genetic features with AD and PD. Much of the literature describing the characteristic clinical profile of the DLB patient has come from evaluating patients presenting to memory disorders clinics, old age psychiatry clinics, or via retrospective chart review of autopsied confirmed cases. However, many patients with DLB present to movement disorders specialists, neurologists, and community physicians for...

Aphasia Agnosonosia

In late dementia, communication of depressive mood states may be difficult secondary to aphasia. Here, making a diagnosis of depression may depend more on caregiver reporting (see later discussion) as well as careful observation. Behavioral disturbances including aggression, vocal disruption, as well as food refusal can all represent depressive equivalents and should prompt the search for other depressive symptoms. Additionally, some patients with dementia experience agnosonosia (denial of...

The Caregiver Role In Managing Ad

The efficient diagnosis and successful management of AD depends on identifying a caregiver. Typically, family members and friends take on some part of the role and self-identify at the time of the initial presentation by providing a history of the cognitive problem. At this early stage, it is important to establish permission to speak openly with the caregiver to acknowledge and reinforce the notion that the caregiver is the advocate for the patient. Caregivers may be spouses of affected...

Diffuse Lewy Body Dementia DLBD

Prevalence rates for depression in DLBD are less studied. Depression may be more common in DLBD than in AD (Ballard et al., 2002). Rates of depressive symptoms have been reported to be up to 50 of DLBD patients (Klatka, Louis, & Schiffer, 1996) with the proportion of major depression estimated at 14 to 33 (Ballard et al., 1995 McKeith, Perry, Fairbairn, Jabeen, & Perry, 1992). A study comparing clinical and neuropathological cohorts using Diagnostic and Statistical Manual of Mental...

Behavioral Management Techniques

Literature that compares drug treatment to behavior management therapy BMT indicates that, in some instances, BMT can be as effective in managing symptoms as pharmaceutical interventions. Teri et al. 2000 compared pharmacological and nonpharmacological treatments in managing agitation and depressive symptoms for AD patients. In this study, no significant differences were found among treatment with haloperidol, trazodone, BMT, or placebo, and results indicated that behavioral changes were seen...