Vascular and mixed dementias

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1 Oxford Medicine Online You are looking at 1-10 of 35 items for: heart disease MED00840 oxford_textbooks_in_psychiatry Vascular and mixed dementias Robert Stewart DOI: /med/ Vascular disease is the most important environmental risk factor for dementia but this research area has been hampered by inadequate outcome definitions in particular, a diagnostic system that attempts to separate overlapping and probably interacting pathologies. There is now substantial evidence that the well-recognised risk factors for cardiovascular disease and stroke are also risk factors for dementia, including Alzheimer s disease. However, these risk factors frequently act over several decades, meaning that the chances of definitive randomised controlled trial evidence for risk-modifying interventions are slim. This should not obscure the wide opportunity for delaying or preventing dementia through risk factor control and uncontroversial healthy lifestyles. Care should also be taken that comorbid cerebrovascular disease is not considered as excluding a diagnosis of Alzheimer s disease, particularly now that this determines treatment eligibility. Epidemiology of dementia Laura Fratiglioni and Chengxuan Qiu DOI: /med/ This chapter deals with the occurrence, determinants and primary prevention of dementia. Dementia is one of the major causes of functional dependence, poor quality of life, institutionalisation and mortality among elderly people. The risk of dementia increases almost exponentially with advancing age. As the population ages, dementia poses a serious threat to public health and social welfare system of our society. Accumulating evidence suggests that cardiovascular risk factors significantly contribute to the development and expression of dementia. Thus, adequate management of vascular risk factors and related disorders can be one of the preventative strategies against cognitive ageing and dementia. In addition, psychosocial factors such as educational achievement, socially-integrated and mentally-stimulating lifestyles are critical for delaying the onset of dementia by increasing cognitive reserve. Taken together, maintaining vascular health and adopting a healthy cognitive lifestyle from a life-course perspective may be the most promising strategy to achieve late-life cognitive health. Page 1 of 5

2 Alzheimer s disease John-Paul Taylor and Alan Thomas DOI: /med/ Alzheimer s disease (AD) is a well recognised clinicopathological entity and the most common cause of dementia. This chapter critiques the several sets of newly proposed criteria for making the diagnosis of (AD) at different stages in the disease process, in the context of demand for earlier diagnosis and emerging biomarkers. The differential diagnosis and types of different cognitive symptoms are reviewed and the prevalence and pattern of the many non-cognitive symptoms associated with AD are considered. The management of non-cognitive symptoms is also updated, especially the circumstances in which antipsychotic drugs might be prescribed. And finally a summary of our current understanding of the aetiology (evidence for risk and protective factors for AD ) and the prognosis for AD is provided. Neuropathology Johannes Attems and Kurt A. Jellinger DOI: /med/ This chapter describes the main neuropathological features of the most common age associated neurodegenerative diseases including Alzheimer's disease, Parkinson's disease and dementia with Lewy bodies as well as other less frequent ones such as multiple system atrophy, Pick's disease, corticobasal degeneration, progressive supranuclear palsy, argyrophilic grain disease, neurofibrillary tangle dominant dementia, frontotemporal lobar degeneration with TDP-43 pathology and Huntington's disease. Likewise cerebral amyloid angiopathy, hippocampal sclerosis, vascular dementia and prion diseases are described. A main aim of this chapter is to assist the reader in interpreting neuropathological reports, hence criteria for the neuropathological classifications of the major diseases are provided. One section covers general considerations on neurodegeneration and basic pathophysiological mechanisms of tau, amyloid-#, #-synuclein, TDP-43 and prions are briefly described in the sections on the respective diseases. Finally, one section is dedicated to cerebral multimorbidity and we give a view on currently emerging neuropathological methods. Pharmacological treatment of dementia Roy W. Jones DOI: /med/ Page 2 of 5

3 This chapter summarises the available clinical evidence for specific pharmacological treatments for dementia with a particular emphasis on practical considerations and realistic expectations of currently available anti-dementia drugs. It covers the treatment of both cognitive and non-cognitive symptoms. The search for specific treatments for dementia has inevitably concentrated on Alzheimer s disease (AD), partly because it is the commonest cause of dementia and partly because scientific progress has provided more potential therapeutic targets for AD than other dementias. AD is treated with AChEIs (donepezil, galantamine or rivastigmine) and the goals of treatment should be explained at the commencement of treatment. For DLB use AChEI, especially for hallucinations and other behavioural disturbance and consider memantine or increasing dose if BPSD symptoms persist. For VaD look for sources of emboli (e.g. carotid disease) and consider anticoagulation for atrial fibrillation and low dose aspirin. Ensure other relevant conditions (e.g. hypertension and diabetes) are being managed appropriately. Molecular genetics and biology of dementia Denise Harold and Julie Williams DOI: /med/ Considerable progress has been made in our understanding of the genetics and molecular biology of dementia. In this chapter we focus predominantly on the most common form of dementia, Alzheimer s disease (AD), but also discuss vascular dementia and frontotemporal dementia. Genetic mutations have been identified that cause Mendelian subtypes of each disorder, and in recent years genome-wide association studies have greatly aided the identification of risk genes for more common forms of disease. For example, 9 susceptibility genes have been identified in AD in the past 3 years as a result of genomewide association studies, the first robust risk loci to be identified since APOE in This progress in genetic research is having a dramatic effect on our understanding of disease pathogenesis, by refining previous ideas and defining new primary disease mechanisms. Dementia with Lewy bodies and Parkinson s disease dementia Arvid Rongve and Dag Aarsland DOI: /med/ Dementia with Lewy bodies and Parkinson s disease dementia belong to the #- synucleinopathies, a family of diseases pathologically characterized by aggregation of #- synuclein in Lewy bodies in the brain. In this chapter we present the epidemiological data for both conditions including new data on MCI. Clinical diagnostic criteria are reviewed and the different neuropathology staging systems for DLB and PDD and the most important genetic findings are considered. Biomarkers in DLB and PDD with particular focus on imaging techniques like CIT-SPECT and MRI are described. Important clinical symptoms Page 3 of 5

4 in both conditions are presented in detail and the most important clinical differential diagnoses are discussed. Pharmacological and non- pharmacological treatment of different symptoms in both conditions are discussed with particular emphasis on the choline esterase inhibitors and antipsychotic medications.new data on memantine are presented. Physical assessment of older patients Duncan Forsyth DOI: /med/ Mental health problems may co-exist with or be the presenting feature of other medical illness in older age. All clinicians also need to consider the potential psychological impact of ill-health and its treatments on patients and their carers. This chapter gives a geriatrician s guide to comprehensive geriatric assessment, identifying physiological changes that occur with ageing and the potential mental health presentations of common medical conditions. The geriatric giants of falls, immobility, incontinence, delirium and drug toxicity are put in the context of maintaining higher-order cortical functioning to enable the individual to remain upright, mobile, continent and clear in their thinking. These are considered with admissions avoidance or safe discharge planning in mind. Biological aspects of human ageing Doug Gray, Carole Proctor, and Tom Kirkwood DOI: /med/ At the molecular and cellular levels human ageing is characterized by the accumulation of unrepaired random damage, and an accompanying loss of function. A major source of damage is oxidative stress caused by the generation of reactive oxygen species as a byproduct of respiration. DNA and proteins are both susceptible to damage but whereas DNA damage repair systems exist, faulty proteins are generally removed by protein degradation systems. During ageing these systems become less efficient and the subsequent accumulation of damaged protein promotes protein aggregation, a process which is especially problematic in the ageing brain. Other aspects of ageing include genetic and epigenetic changes, mitochondrial dysfunction, telomere shortening, and cellular senescence, all subject to stochasticity. The complexity of the biology of ageing has led to an increase in the use of systems biology approaches whereby the use of mathematical modelling and bioinformatic tools complement the more traditional experimental approaches. Page 4 of 5

5 Epidemiology of old age psychiatry: an overview of concepts and main studies Thais Minett, Blossom Stephan, and Carol Brayne DOI: /med/ Epidemiology is the foundation of public health and rational planning of services. In the field of old age psychiatry, the information provided by epidemiological research has been highly influential. As the world older population is growing proportionally faster than the other age segments, there is a continuous need for further epidemiological research in old age psychiatry. Neuropsychiatric conditions, such as depression and dementia, cognitive impairment, behavioural and functional decline, place a considerable onus on the health, social and economic systems. This chapter presents some of the world demographic data and basic epidemiological concepts, discusses some methodological issues in the epidemiology of mental disorders in old age, and presents a summary of many of the most important studies in this field. Page 5 of 5