Patient Care Neurology & Psychiatry - November 2007 - (Page 14)

I Dementia donepezil (Aricept) compared with placebo.26 Disease modifying benefits have also been reported. Patients from 3 large clinical trials of AD who prematurely discontinued treatment with rivastigmine (Exelon) exhibited less continued deterioration in cognitive function compared with placebo-treated patients. The less severe worsening of cognition after withdrawal of treatment in patients previously treated with rivastigmine suggests an effect on disease progression.27 The benefits of disease modification even reveal themselves in imaging of the gross anatomy; as research reveals that donepezil treatment slows the progression of hippocampal atrophy, suggesting a neuroprotective effect of donepezil in AD.28 TABLE 2 Efficacy of ChEI at the molecular level is established foremost by the drugs’ ability to preserve a critical mass of the neurotransmitter acetylcholine and by extension to enhance the cholinergic neurons’ role in the functions of memory and learning. Additionally, medications currently in use for treatment of AD have been demonstrated to interfere with molecular mechanisms of cholinergic neuron destruction in addition to their role in enhancing neurotransmitter function. The protective effect of galantamine is concentration-dependent and suggests that galantamine can prevent apoptotic cell death by activation of nicotinic acetylcholine receptors and through a tripling of the expression of the The other dementias Vascular dementia Patients with vascular dementia commonly have mood and behavioral changes. Severe depression is more common in persons with vascular dementia than in those with Alzheimer’s disease. In some patients with lacunar state and Binswanger’s disease, such problems may be more prominent than intellectual deficits. Psychotic symptoms, particularly delusions, have been described in vascular dementia. The average age of onset is between the fourth and seventh decades of life, and 80% of patients have a history of hypertension. Patients also show progressive motor, cognitive, mood, and behavioral changes over a period of 5-10 y. Mood and behavioral changes are observed early and, in some patients, may be the presenting feature. Patients may be apathetic or abulic. Intellectual deficits are observed early in the disease, and patients are frequently described as disoriented, having memory deficits, inattentive, and vague. Patients with Binswanger’s dementia often have early-onset urinary incontinence and gait disturbances. The hallmark of Parkinson’s disease is involvement of the motor system, causing tremor, rigidity, and slowness of movement. But cognitive symptoms are frequently present at the time of diagnosis, contribute heavily to disability, and progress to dementia at an alarming rate. Dementia will develop in 40%-70% of patients with Parkinson’s disease during the course of their illness. Recurrent visual hallucinations. Fluctuating cognitive impairment and Parkinsonism features. REM sleep behavior disorder. Frequency of adverse reactions to antipsychotic medications is high. Frontal lobe dementia is a term signifying neuropsychological features localizing to the frontal lobes (executive function). Patients have memory problems, personality changes, and deterioration of social skills. Onset is usually between the fifth and sixth decades of life. Upon physical examination, the patient has frontal release signs such as snout and grasp reflex. Onset is between the fourth and sixth decades of life. Associated with neurologic signs such as myoclonus, seizures, and ataxia. Rapid progression typical. Binswanger’s dementia Parkinson’s disease with dementia Lewy body dementia Frontotemporal dementia (Pick’s disease is an example) CreutzfeldtJakob disease Key: REM, rapid eye movement. 14 PATIENT CARE NEUROLOGY & PSYCHIATRY www.patientcareonline.com http://www.patientcareonline.com

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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

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