Main Types Of Dementia Research Articles

Differences in Multimodal Electroencephalogram and Clinical Correlations Between Early-Onset Alzheimer's Disease and Frontotemporal Dementia.

BackgroundAlzheimer’s disease (AD) and frontotemporal dementia (FTD) are the two main types of dementia. We investigated the electroencephalogram (EEG) difference and clinical correlation in early-onset Alzheimer’s disease (EOAD), and FTD using multimodal EEG analyses. EOAD had more severe EEG abnormalities than late-onset AD (LOAD). Group comparisons between EOAD and LOAD were also performed.MethodsThirty patients diagnosed with EOAD, nine patients with LOAD, and 14 patients with FTD (≤65 y) were recruited (2008.1–2020.2), along with 24 healthy controls (≤65 y, n = 18; >65 y, n = 6). Clinical data were reviewed. Visual EEG, EEG microstate, and spectral analyses were performed.ResultsCompared to controls, markedly increased mean microstate duration, reduced mean occurrence, and reduced global field power (GFP) peaks per second were observed in EOAD and FTD. We found increased durations of class B in EOAD and class A in FTD. EOAD had reduced occurrences in classes A, B, and C, while only class C occurrence was reduced in FTD. The visual EEG results did not differ between AD and FTD. Microstate B showed correlations with activities of daily living score (r = 0.780, p = 0.008) and cerebrospinal fluid (CSF) Aβ42 (r = −0.833, p = 0.010) in EOAD. Microstate D occurrence was correlated with the CSF Aβ42 level in FTD (r = 0.786, p = 0.021). Spectral analysis revealed a general slowing EEG, which may contribute to microstate dynamic loss. Power in delta was significantly higher in EOAD than in FTD all over the head. In addition, EOAD had a marked increased duration and decreased occurrence than late-onset AD (LOAD), with no group differences in visual EEG results.ConclusionThe current study found that EOAD and FTD had different EEG changes, and microstate had an association with clinical severity and CSF biomarkers. EEG microstate is more sensitive than visual EEG and may be useful for the differentiation between AD and FTD. The observations support that EEG can be a potential biomarker for the diagnosis and assessment of early-onset dementias.

Pharmacotherapy of dementia

This review aims to evaluate the existing evidence for pharmacotherapy for management of dementia. Data search strategies included electronic databases of relevant publications or cross-references. The searches were limited to acetyl cholinesterase inhibitors (AChEIs), memantine, antipsychotics, antidepressants, mood stabilizers, and benzodiazepines. Data in the form of meta-analysis and systemic reviews for treatment in five main types of dementia (Alzheimer's, frontotemporal, Parkinson's, Lewy body disease, and vascular type) were extracted. If a meta-analysis or systemic review was not available, then the searches included evaluation of data in the form of double-blind, randomized controlled trials or open-label studies. Various studies suggest that compared to placebo, AChEIs and memantine are associated with better outcome in all domains of Alzheimer's disease. In addition, combination therapy of AChEIs and memantine is superior to monotherapy with AChEIs in terms of behavioral disturbances, activities of daily living, and global assessment. In patients with dementia associated with Parkinson's disease or Lewy body dementia, use of donepezil, rivastigmine, and memantine is associated with significant efficacy on the global outcome measures when compared with placebo. Compared to placebo, AChEIs, but not memantine, have also been shown to have better cognitive outcomes in patients with dementia associated with Parkinson's disease or Lewy body dementia. Data are limited for the role of pharmacotherapy in management of frontotemporal dementia. In patients of vascular dementia, all AChEIs and memantine show some beneficial effects on cognition. Antidepressants and antipsychotics have been shown to be beneficial in management of behavioral symptoms and agitation. However, it is important to remember that there is black box warning for use of antipsychotics among patients with dementia. One of the major limitations of the research is variability in assessment instruments used for rating various symptoms encountered in patients of dementia. However, it can be concluded that in recent times, quality of studies has improved and many studies have included adequate sample sizes.

Memory clinic experience under a social security health system in Costa Rica.

Dementia and mild cognitive impairment (MCI) are an increasingly prevalent clinical entity in our field, showing an increasing incidence with age.ObjectiveThe purpose of this study was to identify the main types of dementia and MCI treated in a memory disorders unit in Costa Rica.MethodsA consecutive and standardized register of patients diagnosed with dementia and MCI at the memory disorders unit of the National Geriatrics and Gerontology Hospital (NGGH) was analyzed.ResultsDementia was diagnosed in 63.5% of the 3572 cases, whereas 10.6% met criteria for MCI. The most frequent type of dementia was Alzheimer's disease (47.1%), followed by vascular pathology (28.9%), mixed forms (17.2%) and other types (6.8%). In MCI, 69.5% were of amnestic multiple domain type and 14.3% were non-amnestic multiple domain, while 41.3% were of vascular and 35.8% of neurodegenerative etiology. Mean age was 79.6±6.7 years and 64.7% were women in dementia cases whereas mean age was 76.4±6.9 years and 62.1% were women in MCI. Mean years of schooling was 4.95±4.09 years and 6.87±4.71, while mean time between onset of symptoms and clinical diagnosis was 3.2±2.6 years and 2.67±2.69 years, in dementia and MCI, respectively.ConclusionThe determination of the main types of dementia and MCI in Costa Rica and their main features has allowed the registration of comprehensive, hitherto unavailable information that will be useful for the management and strategic planning of public health care.

‘Beyond forgetfulness’: How psychoanalytic ideas can help us to understand the experience of patients with dementia

We must cast ourselves forwards to a time when words must fail (Samuel Beckett, Happy days, 1961). This paper approaches dementia and its care from a psychoanalytic perspective. It recognizes both the psychoanalytic literature on dementia and a biological understanding of neuro‐degenerative processes. Using neuro‐psychoanalysis to synthesize the two views, meeting points are found that may take the theoretical understanding of dementia processes a small step further, introducing the death instinct as one example. The mind and the brain are distinct entities which are also intimately related. A mind/brain model was proposed by Freud in his ‘project’ (1895). It pre‐dated his psychoanalytic work but was abandoned. None the less it runs as a rich vein throughout his work. Although other causes exist there are two main types of dementia. Alzheimer's and vascular dementia have distinct differences and similarities in their respective clinical presentations. This paper explores the complex deterioration of brain and mind in both diseases and explains these in psychoanalytic terms. Developmental models of the mind are helpful, however dementia patients are adults, and are losing their minds in a non‐linear fashion. Dementia is not infant/child development in reverse order. Three broad stages of dementia are proposed and psychoanalytic models of patient experience are suggested, as well as potentially offering ameliorating interventions. The first stage of dementia is dominated by anxiety and depression; also repression and denial and behavioural problems that may be akin to hysterical states. These seem to be amenable to analysis and psychoanalytically informed therapy. In the intermediate stages reality principle versus pleasure principle issues are patent, as are shame and humiliation (particularly around sexuality). Art and music therapies informed by psychoanalysis can be helpful as they depend less on words. In the final stages of extreme dependency, projective identification may be the most common method of communication. Understanding this phenomenon can assist sufferers and help carers to cope with unbearable states of mind. Some psychoanalytic ideas are already in use in some enlightened dementia services; there is room for more.

Progress in Cardiovascular Diseases: Cognitive Function in Essential Hypertension

Essential hypertension has rather recently become recognized as a major factor in the development of the 2 main types of dementia, that is, no longer merely vascular dementia but Alzheimer disease as well. The relationship between high blood pressure (BP) and the dementias is quite a complicated one, given a wide variability in temporal courses. The interval between the respective manifestations of hypertension and cognitive deterioration may vary from a few years to several decades. Moreover, temporal relationships may be obscured because of the observation that BP tends to fall in the face of imminent Alzheimer disease. Although the cause-and-effect sequence of this relationship has not been established, it may suggest that a low BP in this phase of life could be equally harmful as hypertension in the preceding period. Individual monitoring of BP and drug titration in the hypertensive elderly may well become mandatory in the highest age group. The question whether some antihypertensive drug categories might act more effectively in preventing cognitive deterioration than others, irrespective of their antihypertensive potential, remains. A modest meta-analysis on our part seems to suggest that suppression of the renin-angiotensin-aldosterone system (RAAS) would fail to offer such protection, in contrast to certain dihydropyridine (DHP) calcium-channel blockers. Unfortunately, recently published comparative prospective megatrials (Anti-hypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial and Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm) failed to carry any record on the mental status of the study populations, thereby missing a golden opportunity to resolve the above issue. Consequently, there remains an urgent need for further blinded long-term comparative hypertension trials, including follow-up evaluation of cognitive functions in relation to the course of BP.