The assessment of PIB imaging may prove to be most useful in D/D of dementia, especially in differentiating AD & FTD
Very recent work suggests that no PIB binding is found in patients with FTD
Note increased uptake and retention of [18F]FDDNP (arrowheads) in temporal lobes of pt with AD, compared with those in control subject. The pt with AD still demonstrates typical findings of decreased temporal (arrows) and parietal (not shown) FDG uptake. A second compound FDDNP, labels multiple neuritic elements including neuritic plaques & NFT
Increased education has been associated with reduced risk for AD or later onset of dementia.
An attractive hypothesis has been that better-educated individuals have a cognitive reserve, so biological disease progression must progress further before the reserve is overcome and clinical symptoms begin to develop.
MRI has a number of advantages in evaluating brain structures and is more appropriate for nonemergent evaluation.
MRI also avoids the risks of ionizing radiation, and therefore, serial studies involving repeated measures over time are possible.
Hence, MRI is one of the most widely used imaging techniques in the assessment of the degenerative dementias. The inclusion of MRI in the clinical workup can significantly improve the reliability of the differential diagnosis of dementia.
Most of these illnesses will have other historical symptoms or physical signs that will suggest their possibility and need for a lumbar puncture to allow CSF testing, a procedure which is no longer routinely indicated in the patient with dementia
Such interventions have included music, videotapes of family members, audiotapes of the voices of caregivers, walking and light exercise, and sensory stimulation and relaxation.
Little consideration has been given to nonpharmacologic interventions for patients living in the community, but attention has been given to interventions that may benefit the caregivers of these patients.
Caregivers must make decisions regarding driving, advance directives, financial management, removal of firearms, home safety, and programs such as Safe Return, a nationwide network created by the Alzheimer's Association. 83
Studies show that caregivers of patients with Alzheimer's disease rate their own health as relatively poor.
Furthermore, they endure a greater number of illnesses, have more somatic symptoms, have more depression and anxiety, use more health care, and engage in fewer preventive-health activities than people who are not caregivers
randomized, placebo-controlled trials of estrogen-replacement therapy in such women showed no benefit. 47 , 48 The Women's Health Initiative study of estrogen plus medroxyprogesterone acetate showed an increased risk of dementia among postmenopausal women who lacked cognitive deficits at the time of randomization and were assigned to the active-treatment group. 49 Thus, hormone-replacement therapy is not recommended for treatment or prevention of Alzheimer's disease.
Ultimately, proteomic studies in plasma and CSF in large prospective longitudinal clinical studies, such as the Alzheimer's Disease Neuroimaging Initiative, may yield more sensitive and specific biological markers for AD.
Cortical extracellular amyloid plaques and intraneuronal NFTs are the basic features of AD, and stereotypic spread of the NFTs, as originally described by Braak and Braak (1991) , provided a basis for staged neuropathologic criteria for AD that remain useful today.
Considerable evidence indicates, however, that plaques and tangles can be found in substantial numbers in many elderly patients with normal cognitive functioning and that overlap exists in plaque and tangle pathology between the very elderly (over age 90) with normal cognition and those who are demented ( Bennett et al, 2006 ), such that
diagnosis on the basis of neuropathologic changes alone in the earlier stages may be difficult