Patient Care Neurology & Psychiatry - November 2007 - (Page 10)

Dementia workup and treatment: Do the drugs really work? Early diagnosis is the first best possible step in the long-term management of Alzheimer’s disease. It allows for early initiation of cholinesterase inhibitor treatment, which will likely stabilize and may possibly reduce the rate of symptomatic cognitive and functional decline. lzheimer’s disease (AD) is a progressive, degenerative disorder of the brain, affecting primarily cholinergic neurons and JOHN B. STANDRIDGE, MD, pathways, initially impairing neurotransmission but proProfessor, Department of Family gressing inexorably to neuronal death. According to the National Medicine, University of Tennessee Institute on Aging, AD is the most common cause of cognitive imCollege of Medicine Chattanooga, pairment in the population of people aged 65 and older.1 Scientists Chattanooga. estimate that 4.5 million people in the United States currently sufMALISSA G. TALBERT, MD, Geriatric fer with the disease.2 The prevalence doubles with every 5 years of Medicine Fellow, Department of Family age beyond 65. It is also estimated that approximately 360,000 Medicine, University of Tennessee new cases will occur each year in the United States. College of Medicine Chattanooga, It has been estimated that AD costs $90 to $100 billion yearly.3 Chattanooga. With population trends creating a larger percentage of elderly, AD is projected to nearly triple, if not quadruple, in prevalence, afflicting many millions in the United States and around the world in the next 50 years, unless Article at a glance new discoveries facilitate prevention and effecI The first step toward the best possible long-term tive treatment of the disease.3,4 In terms of cost management is early diagnosis of Alzheimer’s disease and psychological factors, the anticipated bur(AD) and early initiation of cholinesterase inhibitor (ChEI) den of this disease on caregivers and society at treatment. large is enormous.5,6 The development of new I The effectiveness of current therapies has generated insights into the processes of this devastating illa therapeutic goal of “aging in place.” Stabilization is a ness and the development of new medications worthy goal given that a more effective treatment– that may interrupt those processes offer hope antibodies against Abeta-derived diffusible ligands–is on the horizon. that the projected incidence and impact of AD I ChEI therapy with rivastigmine, donepezil, or galantamine may be modified in the near future. I CONTRIBUTORS A I I is recommended by experts as standard first-line therapy in patients with mild to moderate AD. The N-methyl-D-aspartate receptor-antagonist, memantine, may be used as monotherapy or in combination with a ChEI for patients with moderate AD. For patients with severe AD, memantine or donepezil may be used as monotherapy or in combination. When nonpharmacologic strategies are deemed insufficient, treatment with ChEIs, alone or in combination with memantine as appropriate for the stage of disease, may be considered as a first-line option. Dementia workup The first step in the workup of dementia is to maintain a high index of suspicion. Individuals with early and even moderate AD can be very social and pleasant. They can confabulate and hide limitations in other ways. At a restaurant an aging parent might tell a son or a daughter, “I will just have what you are having,” in order to hide his or her inability to choose from the menu. Once families become suspicious that their loved 10 PATIENT CARE NEUROLOGY & PSYCHIATRY www.patientcareonline.com http://www.patientcareonline.com

Table of Contents Feed for the Digital Edition of Patient Care Neurology & Psychiatry - November 2007

Patient Care Neurology & Psychiatry - November 2007 Contents Research Digest Medicine in the News The 15-Minute Visit Dementia workup and treatment: Do the drugs really work? Help for Your Patients Who Suffer from Specific Phobias Clinical Clips Case & Comment The Science of Healing Classified Advertising

Patient Care Neurology & Psychiatry - November 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.