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By Marianne De Nobel i'm a physician in the elderly care at an Hospice and in a nursing home, with people with dementia and /or chronic diseases also i'm working in the primary care
Charlotte L Allan, Sophie Behrman, Klaus P Ebmeier, Vyara Valkanova
Mild cognitive impairment (MCI) is a term used to describe cognitive impairment in one or more cognitive domains that is greater than any expected age-related changes, but not of the magnitude to warrant a diagnosis of dementia. This review considers how early cognitive decline is diagnosed, focusing on the use of neuropsychological tests and neuroimaging, as well as the differential diagnosis. Potential treatments, including secondary prevention, post-diagnostic support and self-help are discussed. Finally, medico-legal matters such as driving, lasting power of attorney and employment are outlined...
February 2017: Maturitas
Jill Manthorpe, Kritika Samsi
Person-centered dementia care is widely accepted as a value-based commitment to supporting people with dementia and is a guiding principle in care services. Policy ambitions to put people at the center of their own care are being developed internationally. These may be seen as part of the evolution of person-centered care which has its origins in critical perspectives on practice and social responses to people with dementia. In England, one further development of person-centered care has been personalization - a government policy to extend individuals' choice and control over their social care and, latterly, ways to meet their health care needs...
2016: Clinical Interventions in Aging
Marco Canevelli, Flaminia Lucchini, Carlo Garofalo, Giuseppina Talarico, Alessandro Trebbastoni, Fabrizia D'Antonio, Letizia Imbriano, Patrizia Velotti, Carlo de Lena, Marina Gasparini, Giuseppe Bruno
OBJECTIVE: Inappropriate sexual behaviors (ISBs) represent challenging and stressful manifestations of dementia and are highly burdening for patients, families, and healthcare providers. Nevertheless, ISBs have so far attracted limited clinical and scientific interest compared with other neuropsychiatric symptoms occurring in dementing illnesses. The authors aimed to systematically investigate the prevalence and characteristics of ISBs in a population of patients with dementia attending a memory clinic...
December 2, 2016: American Journal of Geriatric Psychiatry
José Antonio Gil-Montoya, Inés Sánchez-Lara, Cristobal Carnero-Pardo, Francisco Fornieles-Rubio, Juan Montes, Rocío Barrios, Miguel Angel Gonzalez-Moles, Manuel Bravo
The control of bacterial dental plaque through daily oral hygiene is essential to prevent oral diseases such as caries or periodontal disease, especially in at-risk populations, including the elderly with mild cognitive impairment and dementia. The aim of this study was to determine the association between different levels of cognitive impairment and dementia in an elderly population and their capacity to maintain adequate oral hygiene. A case-control study (elderly with versus without mild cognitive impairment or dementia) was performed in Granada, Spain...
December 26, 2016: Journal of the American Geriatrics Society
Yingshi Zhang, Jiayi Cai, Li An, Fuhai Hui, Tianshu Ren, Hongda Ma, Qingchun Zhao
Demographic aging is a worldwide phenomenon, cognitive and behavioral impairment is becoming global burden of nerve damage. However, the effect of pharmacological treatment is not satisfying. Therefore, we analyzed the efficacy of music therapy in elderly dementia patients, and if so, whether music therapy can be used as first-line non-pharmacological treatment. A comprehensive literature search was performed on PubMed, EMbase and the Cochrane Library from inception to September 2016. A total of 34 studies (42 analyses, 1757 subjects) were included; all of them had an acceptable quality based on the PEDro and CASP scale scores...
December 23, 2016: Ageing Research Reviews
Greg L Plosker
Memantine is an uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist that is a well-established treatment option for moderate to severe dementia of the Alzheimer's type, either alone or in combination with cholinesterase inhibitors. The immediate-release (IR) formulations of memantine (tablets and oral solution) have been available in numerous countries, including the USA, for more than a decade and are administered orally twice daily at a maximum recommended total daily dosage of 20 mg/day. The memantine extended-release (ER) (Namenda XR(®)) 28 mg once-daily capsule formulation was approved in the USA in 2010 and became available more recently...
May 2015: Drugs
Nan Greenwood, Raymond Smith
Dementia is usually diagnosed in later life but can occur in younger people. The experiences of those with older-onset dementia are relatively well understood but little is known about the experiences of those with young-onset dementia (aged less than 65 years). This meta-ethnography therefore synthesised qualitative literature investigating the experiences of people with young-onset dementia (YOD). Six electronic databases were searched and 1155 studies were identified, of which eight fitted the inclusion criteria...
October 2016: Maturitas
Ramon Landin-Romero, Rachel Tan, John R Hodges, Fiona Kumfor
Progressive and relatively circumscribed loss of semantic knowledge, referred to as semantic dementia (SD) which falls under the broader umbrella of frontotemporal dementia, was officially identified as a clinical syndrome less than 50 years ago. Here, we review recent neuroimaging, pathological, and genetic research in SD. From a neuroimaging perspective, SD is characterised by hallmark asymmetrical atrophy of the anterior temporal pole and anterior fusiform gyrus, which is usually left lateralised. Functional magnetic resonance imaging (fMRI) studies have revealed widespread changes in connectivity, implicating the anterior temporal regions in semantic deficits in SD...
December 5, 2016: Alzheimer's Research & Therapy
Gary W Small
Current diagnostic and treatment strategies for cognitive decline can help patients maintain cognitive ability and higher levels of function longer. Despite advances in detection and early treatment strategies, many patients do not receive proper assessments and available therapies. A systematic assessment strategy will increase the likelihood of an accurate diagnosis, which can facilitate pharmacologic and non-pharmacologic treatment plans that can have a meaningful impact on prognosis. Available data support the integration of healthy lifestyle strategies in the treatment plan to help to stabilize symptoms and potentially delay future cognitive decline...
December 2016: American Journal of Geriatric Psychiatry
Andrew H Ford
Delirium is a common, disabling medical condition that is associated with numerous adverse outcomes. A number of inter-related factors, including pre-existing cognitive impairment, usually contribute to the development of delirium in a particular susceptible individual. Non-pharmacological approaches to prevention typically target multiple risk factors in a systematic manner (multicomponent interventions). There is generally good evidence that multicomponent interventions reduce the incidence of delirium in hospital populations but there are limited data in people with dementia and those living in the community...
October 2016: Maturitas
Alessandro Morandi, Daniel Davis, Giuseppe Bellelli, Rakesh C Arora, Gideon A Caplan, Barbara Kamholz, Ann Kolanowski, Donna Marie Fick, Stefan Kreisel, Alasdair MacLullich, David Meagher, Karen Neufeld, Pratik P Pandharipande, Sarah Richardson, Arjen J C Slooter, John P Taylor, Christine Thomas, Zoë Tieges, Andrew Teodorczuk, Philippe Voyer, James L Rudolph
Delirium occurring in patients with dementia is referred to as delirium superimposed on dementia (DSD). People who are older with dementia and who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision are considered the standard reference for the diagnosis of delirium and include criteria of impairments in cognitive processes such as attention, additional cognitive disturbances, or altered level of arousal...
January 2017: Journal of the American Medical Directors Association
Rose Ries, Amirali Sayadipour
We review the literature on management of psychosis and agitation in medical-surgical patients who have or are at risk for prolonged QT interval, a risk factor for torsade de pointes (TdP), and we describe our protocols for treating these patients. We searched PubMed and PsycInfo for relevant studies and found few papers describing options for treating psychosis and agitation in these patients. Prolonged QTc interval has been more often associated with low-potency phenothiazines such as thioridazine; however, it may occur with high potency typical antipsychotics such as fluphenazine and haloperidol as well as with atypical antipsychotics such as quetiapine, risperidone, olanzapine, iloperidone, and particularly ziprasidone...
September 2014: Journal of Psychiatric Practice
Peter Paul De Deyn, Annemieke F J Drenth, Berry P Kremer, Richard C Oude Voshaar, Debby Van Dam
INTRODUCTION: Psychosis is a common and difficult to treat symptom in Alzheimer's disease (AD). It is a cause of diminished quality of life and caregiver distress. Atypical antipsychotics are frequently used for the treatment of dementia-related psychosis, despite FDA warnings because of increased mortality associated with the use of these medications in dementia patients. Aripiprazole is a newer atypical antipsychotic drug with partial agonist activity at dopamine receptors and antagonist activity at 5-HT(2A) receptors, with a low side-effect profile...
March 2013: Expert Opinion on Pharmacotherapy
H Karl Greenblatt, David J Greenblatt
Antipsychotic medications are widely used in the management of behavioral and psychological symptoms of dementia. While nonpharmacological interventions should be the first-line treatment for behavioral symptoms of dementia, these are often unfeasible and/or ineffective. Conventional and atypical antipsychotic agents appear to have modest to moderate clinical efficacy in the treatment of these symptoms, though it is unclear which individual agents are most effective. No conclusive evidence exists that any available alternative medications are safer and more effective than antipsychotics...
September 2016: Journal of Clinical Pharmacology
A Gurevich, V Guller, Y N Berner, S Tal
Atypical antipsychotics seem to be preferable than conventional agents in treating psychological symptoms of dementia (BPSD), because they have substantially lower risks of extrapyramidal neurological effects with lower reported rates of parkinsonism and tardive dyskinesia. However, in the course of time, with the increase in their use, more and more side effects have been reported. The benefits and risks of antipsychotic treatment should be carefully evaluated according to the co-morbidity and the severity of the psychological and behavioral symptoms and their impact on the individual elderly patient...
2012: Journal of Nutrition, Health & Aging
Salvatore Gentile
RATIONALE: Antipsychotic drugs are widely used as a first-line pharmacological approach to treat dementia-related psychiatric symptoms. However, in this population of patients, such drugs have been associated with severe safety concerns. Hence, the aim of this review is to asses systematically the efficacy of second-generation antipsychotics (SGAs) in treating dementia-related neuropsychiatric symptoms in order to establish if the potential clinical benefits of such treatment outweigh the hypothesised risks related to pharmacological intervention...
October 2010: Psychopharmacology
Faustino Gonzalez
Extrapyramidal symptoms are well-documented complications of therapy with haloperidol, even when small doses are used. Dysphagia, though uncommon, can be quite debilitating and can mimic a paraneoplastic syndrome. It is important to always review the medications the patient is taking and consider them as etiological culprits in any new symptom complex. This report highlights a case of drug-induced dysphagia in a patient receiving haloperidol for obsessive nocturnal thoughts and auditory disturbances.
October 2008: American Journal of Hospice & Palliative Care
Gianluca Trifiró, Janet Sultana, Edoardo Spina
With an increase in the global prevalence of dementia, there is also an increase in behavioural and psychological symptoms of dementia (BPSD) for which antipsychotic drugs are often used. Despite several safety warnings on antipsychotic use in dementia, there is little evidence to support the efficacy of antipsychotics in individual BPSD symptoms or to evaluate the drug safety profile by individual antipsychotic drug. There is emerging but scarce evidence that suggests an inter-drug variability between antipsychotic safety outcomes in BPSD...
July 2014: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
Pietro Gareri, Pasquale De Fazio, Valeria Graziella Laura Manfredi, Giovambattista De Sarro
In recent years, the use of antipsychotics has been widely debated for reasons concerning their safety in elderly patients affected with dementia. To update the use of antipsychotics in elderly demented people, a MEDLINE search was conducted using the following terms: elderly, conventional and atypical antipsychotics, adverse events, dementia, and behavioral and psychotic symptoms in dementia (BPSD). Owing to the large amounts of studies on antipsychotics, we mostly restricted the field of research to the last 10 years...
February 2014: Journal of Clinical Psychopharmacology
Gila Bronner, Judith Aharon-Peretz, Sharon Hassin-Baer
Sexual dysfunction (SD) is common among patients with Parkinson's disease (PD), Alzheimer's disease (AD), and other dementias. Sexual functioning and well-being of patients with PD and their partners are affected by many factors, including motor disabilities, non-motor symptoms (e.g., autonomic dysfunction, sleep disturbances, mood disorders, cognitive abnormalities, pain, and sensory disorders), medication effects, and relationship issues. The common sexual problems are decreased desire, erectile dysfunction, difficulties in reaching orgasm, and sexual dissatisfaction...
2015: Handbook of Clinical Neurology
2016-09-06 16:09:05
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