Alzheimer's disease accounts for th...

Alzheimer's disease accounts for the majority of dementia cases, if it were not that a substantial number of individuals may be affected by other dementias, including vascular dementia (10 to 20 percent of cases), dementia with Lewy bodies (10 to 15 percent) and frontotemporal dementia (5 to 15 percent) Kawas currents a clinical review of the early diagnosis and treatment of dementia.

The diagnostic criteria for dementia require the patient to have cognitive impairment sharp enough to cause social or occupational disability in at least sum of two units domains, including memory, language, calculations, orientation, and discernment The author recommends using a formal testing instrument, similar as the Mini-Mental State Examination (MMSE) for detection and follow-up of cognitive decline. Patients with disabling cognitive impairment in at least couple domains generally score less than 24 upon the MMSE. Patients with sole mild cognitive impairment usually score 24 or higher if it were not that typically do poorly on the memory element of the examination, which experiments for recall of three named targets The MMSE score should be adjusted for age and education of the same height A table of cutoff values for normal scores is available at http://www.nemc.org/ psych/mmse.asp.

In addition to the MMSE the make acceptableed work-up for a patient reporting early signs of cognitive decline includes a thorough history and physical examination. Special attention should be given to screening for medications that may be impairing cognition, of that kind as prescription and over-the-counter sleeping pills, antianxiety medications, and nipping and allergy preparations. Non-contrast-enhanced comput tomography or magnetic resonance imaging of the brain is commended as is a limited battery of laboratory exhibitions (i.e., electrolyte levels; renal, hepatic, and thyroid function tests; vitamin B12 level) The author notes that B12 deficiency or thyroid dysfunction is rarely the single cause of dementia but commonly coexist and warrant treatment to improve function. All patients with cognitive decline should be asked about possible depression, which can mimic dementia and be a coexistent complication.

An insidious assault of cognitive problems and steady progression of impairment prompts Alzheimer's disease. However, there is no laboratory or neuropsychiatric example that can definitively diagnose the disease. The appearance of certain atypical features (see the accompanying table) insinuates the possibility of an alternative diagnosis for the cognitive impairment.

The author infers with a summary of the limited pharmacotherapeutic options available for the treatment of Alzheimer's disease and the psychosocial support measures that should be explored with the patient and caregivers.

Kawas CH Early Alzheimer's disease. N Engl J M September 11 2003;349:1056-63

COPYRIGHT 2004 American Academy of Family Physicians

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